Theory and technology of Medical Immunology are widely used in scientific research.Our teaching and research group uses experimental teaching of Medical Immunology as a platform to carry out practice of scientific research project-based experi-mental system among"5+3"integration students.By completing a mini-project research including experimental design-experimental operation-research article writing,students cultivated scientific research thinking and exercised scientific research practice ability,and generally reported that the course is very difficult,but after completing it,it is very rewarding.

Objective To analyze the effects of national centralized volume-based procurement(CVBP)on hospitaliza-tion expenses of patients undergoing artificial joint replacement under the Diagnosis-Related Group(DRG)payment model in a public hospital,and to provide evidence for advancing reforms in high-value medical consumables and healthcare payment sys-tems.Methods Data from patients undergoing artificial joint replacement in a tertiary public hospital in 2022 were collected.Statistical analysis was used to assess the surplus and deficit of DRG year-end settlements for these cases.By comparing cost com-positions across different medical insurance types,differences in total inpatient medical expenses,out-of-pocket payments,per-sonal medical insurance account expenditures,and pooled fund reimbursements were evaluated before and after CVBP implemen-tation.Results Following CVBP implementation,the sample hospital demonstrated significant improvements in reducing medical costs,alleviating patient financial burdens,and optimizing medical insurance fund utilization.Under the DRG payment model,operational performance remained stable.Post-CVBP,total hospitalization expenses,patient out-of-pocket payments,and pooled fund reimbursements all decreased significantly(P＜0.001).Conclusion The practice of centralized procurement of artificial joints can be extended to other high-value medical consumables,continuously promoting the reform of the medical and health sys-tem,and ultimately achieving mutually beneficial and sustainable development among healthcare providers,insurers,and patients.

[Objective] To explore the strategy of blood management in patients with massive transfusion in the frigid plateau region. [Methods] The treatment process of a patient with liver rupture in the frigid plateau region was analyzed, and the blood management strategy of the frigid plateau region was discussed in combination with the difficulties of blood transfusion and literature review. [Results] The preoperative complete blood count (CBC) test results of the patient were as follows: RBC 3.14×10¹²/L, Hb 10⁶ g/L, HCT 30.40%, PLT 115.00×10⁹/L; coagulation function: PT 18.9 s, FiB 1.31 g/L, DD > 6 μg/mL, FDP 25.86 μg/mL; ultrasound examination and imaging manifestations suggested liver contusion and laceration / intraparenchymal hematoma, splenic contusion and laceration, and massive blood accumulation in the abdominal cavity; it was estimated that the patient's blood loss was ≥ 2 000 mL, and massive blood transfusion was required during the operation; red blood cell components were timely transfused during the operation, and the blood component transfusion was guided according to the patient's CBC and coagulation function test results, providing strong support and guarantee for the successful treatment of the patient. The patient recovered well after the operation, and the CBC test results were as follows: RBC 4.32×10¹²/L, Hb 144 g/L, HCT 39.50%, PLT 329.00×10⁹/L; coagulation function: APTT 29.3 s, PT 12.1 s, FiB 2.728 g/L, DD>6 μg/mL, FDP 25.86 μg/mL. The patient was discharged after 20 days, and regular follow-up reexamination showed no abnormal results. [Conclusion] Individualized blood management strategy should comprehensively consider the patient’s clinical symptoms, the degree of hemoglobin decline, dynamic coagulation test results and existing treatment conditions. Efficient and reasonable patient blood management strategies can effectively improve the clinical outcomes of massive transfusion patients in the frigid plateau region.

Objective To explore the influencing factors of hypothermia after extraperitoneal laparoscopic radical prostatectomy in prostate cancer patients over 80 years old,so as to improve the effectiveness of treatment.Methods The clinical data of 26 cases of prostate cancer patients over 80 years old who underwent extraperitoneal laparoscopic radical prostatectomy in Shanghai 411 hospital from January 2021 to December 2023 were analyzed retrospectively.The incidence of postoperative hypothermia was investigated.Univariate and multivariate Logistic regression analyses were used to analyze the related factors of postoperative hypothermia in elderly patients.Results The incidence of hypothermia was 61.54%(16/26).Univariate analysis indicated that body mass index(BMI),intraoperative thermal insulation,intraoperative infusion volume,operation time,and anesthesia time were related to the occurrence of postoperative hypothermia in elderly patients(all P<0.05).Multivariate Logistic regression analysis indicated that BMI≤24,intraoperative infusion volume>2 000 ml,anesthesia time>3 h and operation time>2.5 h were high risk factors for postoperative hypothermia in patients over 80 years old.Conclusion The independent influencing factors of hypothermia after extraperitoneal laparoscopic prostatectomy for selected prostate cancer patients over 80 years old are BMI,intraoperative infusion volume,duration of anesthesia,and operation time.These factors should be paid more attention during perioperative period in order to improve clinical safety.

Objective To explore the effect of tongue pressure resistance feedback training in the rehabilitation of dysphagia in patients with ischemic stroke(IS).Methods A total of 100 pa-tients with dysphagia after IS were randomly divided into control group(receiving conventional reha-bilitation therapy and oral motor training)and experimental group(receiving tongue pressure resist-ance feedback training on the basis of conventional rehabilitation therapy),with 50 patients in each group.The treatment duration was 4 weeks for both groups.During the study,3 patients dropped out due to personal reasons,and ultimately 49 patients in the control group and 48 patients in the experi-mental group completed the study.Before and after treatment,tongue muscle function was measured in both groups;videofluoroscopic swallowing studies(VFSS)were used to measure temporal and kinemat-ic parameters of swallowing;the Rosenbek Penetration-Aspiration Scale(PAS)was used to assess aspi-ration risk;the Stroke and Aphasia Quality of Life Scale(SWAL-QOL)was used to evaluate quality of life;and occurrence of complications in both groups were compared.Results After 4 weeks of treat-ment,peak tongue pressure,mean tongue pressure,and tongue pressure duration increased inboth groups,with these indicators being higher in the experimental group than in the control group;oral transit time,soft palate elevation time,and hyoid bone displacement time shortened,while upper esoph-ageal sphincter(UES)opening time and laryngeal closure time prolonged,hyoid and thyroid cartilage movement(upward and anterior displacement)and UES opening degree increased,and pharyngeal contractile ratio(PCR)decreased in both groups,with these indicators being superior in the experi-mental group compared to the control group;PAS scores decreased and SWAL-QOL scores increased in both groups,with PAS scores being lower and SWAL-QOL scores being higher in the experimental group compared to the control group;the differences between the two groups in the aforementioned indicators were statistically significant(P＜0.05).The complication rate was 4.17％(2/48)in the experimental group and 10.20％(5/49)in the control group,with no statistically significant difference(P＞0.05).Conclusion Tongue pressure resistance feedback training can improve tongue function and swallowing function,effectively reduce the risk of aspiration after swallowing,and enhance the quality of life of patients with dysphagia after IS during their rehabilitation treatment.

Lens injury is an important etiological factor in the reduction of visual function following ocular trauma.Currently, there are no clear standards for the classification of lens injury, and comprehensive diagnostic tools are lacking.This deficiency leads to numerous controversies and challenges in critical areas, such as diagnosis and preoperative evalution, timing of surgery, surgical strategy, and assessment of postoperative prognosis.Tomographic imaging technology, such as computed tomography, magnetic resonance imaging, optical coherence tomography, has introduced a new dimension to the evaluation of lens injury, which is crucial for assessing the transparency, texture, location, morphology, and integrity of the lens, as well as the zonules and nearby intraocular structures.However, the use of tomographic imaging technology is somewhat limited due to the limitations of relying on a single method.With the ongoing advancement of imaging technologies and the rapid development of big data and artificial intelligence, tomographic imaging will become an increasingly essential tool in the future management of lens injury.Our expert group reviewed the epidemiological characteristics and classification of lens injury and the major challenges currently faced in the diagnosis and treatment of lens injury, and provided expert recommendations mainly focusing on the application, shortcomings and limitations of current tomographic imaging technology in the diagnosis and treatment of lens injury, and future development directions.

Objective:To identify the pathogenic gene in a family with cone-rod dystrophy (CRD).Methods:A pedigree study was conducted.Clinical data were collected from three generations of six people from a family with CRD who visited Henan Eye Hospital in December 2019, including one patient.After detailed collection of the patient's medical history, the proband and his family members underwent best-corrected visual acuity, slit-lamp microscope+ front-lens examination, optometry, non-mydriatic fundus photography, spectral-domain optical coherence tomography (SD-OCT), and full-field flash electroretinography (ff-ERG). Peripheral venous blood (5 ml) was collected from the proband, his parents and siblings, and the whole genome DNA was extracted.The proband's DNA was sequenced using whole exome sequencing.Hemizygous and potentially pathogenic mutations were verified by Sanger sequencing.Pathogenicity was assessed according to the American College of Medical Genetics and Genomics (ACMG) guidelines.Tools such as SpliceAI and dbscSNV were used to predict the impact of mutations on mRNA splicing.This study strictly followed the Declaration of Helsinki, and the study protocol was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2019[15]). All subjects and guardians of minor subjects signed informed consent forms.Results:The proband (Ⅲ: 1), a 5-year-old boy, presented with recessive nystagmus in both eyes and a best corrected visual acuity of 0.2.Color vision examination revealed red-green color blindness without night blindness.SD-OCT showed the presence of neuroepithelial structures in both eyes, but the interdigitation zone was blurred in both eyes.ff-ERG showed a slight decrease in rod function and a moderate-severe decrease in cone function in the right eye, and a slight decrease in cone and rod function in the left eye.Gene sequencing results showed that the proband had the hemizygous splice site variant c. 1911-3C>A of the CACNA1F gene on the X chromosome.Sanger sequencing showed that neither his mother nor his younger sister carried the variant, suggesting it was novel.This variant site was not recorded in the normal population database (PM2). Bioinformatics tools SpliceAI and dbscSNV consistently predicted that this variation affects on splicing.According to the ACMG guidelines, this variation is pathogenic. Conclusions:A novel variant c. 1911-3C>A in the CACNA1F gene was found in a family with CRD, and this variant may be a pathogenic variant site in this CRD family.This discovery expands the spectrum of pathogenic variations in CRD.

Objective:To analyze the clinical characteristics of pulmonary mucormycosis (PM) in children with leukemia, and explore its diagnosis and treatment strategies and prognosis.Methods:In this case-series study, the clinical data of 19 children who were diagnosed with leukemia complicated by PM at the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2024 were retrospectively analyzed.Their gender, age, type of leukemia, clinical manifestations, chest CT findings, bronchoscopy results, etiology, treatment regimens, and prognosis were summarized.The patients were divided into a survival group and a death group.The clinical data were compared between the 2 groups.Categorical variables were compared using the Fisher′s exact test, and continuous variables were compared using the Wilcoxon rank-sum test.Results:A total of 19 children aged 2 to 17 years with leukemia complicated by PM were involved, including 9 boys and 10 girls, with most cases (15 cases) occurring in the autumn and winter.The median time from the first leukemia chemotherapy to infection with mucor was 1 month.Clinical manifestations mainly included fever (100%), cough (94.7%), hemoptysis (42.1%), and pneumothorax (21.1%).Chest CT findings primarily showed extensive lung consolidation (84.2%), pleural effusion (84.2%), pulmonary nodules (78.9%), halo signs (73.7%), cavitation (36.8%), crescent signs (26.3%), and reverse halo signs (21.1%).Fourteen children underwent bronchoscopy, which primarily revealed tracheal obstruction, pale or congested mucosa, mucosal edema, mucosal necrosis, bronchial stenosis, and bronchial cavitary fistulas.Mucor was detected using various methods including metagenomic next-generation sequencing (mNGS), cultures, and lung tissue microscopy.Patients were mainly treated with intravenous administration of Amphotericin B in different formulations combined with oral Posaconazole.Three patients also underwent surgical resection of the affected lung lobe in addition to medical treatment.After treatment, 14 patients had a good prognosis, while 5 patients died.The causes of death were massive hemoptysis in 2 cases, severe respiratory failure in 1 case, and treatment withdrawn due to critical condition in 2 cases.There were no statistically significant differences in age, gender, type of leukemia, whether to undergo bronchoscopy and surgery, time from the first chemotherapy to onset of infection, presence of comorbid infection, chest CT characteristics, and time to start treatment between survival and death groups(all P>0.05). Conclusions:There is no specificity in clinical manifestations of leukemia complicated by PM, which, however, still exhibits some characteristics.mNGS plays a crucial role in early diagnosis.Intravenous administration of Amphotericin B combined with oral Posaconazole and surgical intervention are an effective treatment regimen.

Objective:To analyze the characteristics of anonymous online dating and related factors of not being tested for HIV among men who have sex with men and to provide the basis for developing targeted HIV prevention strategies and intervention measures.Methods:Using a cross-sectional study design, respondents were recruited with the assistance of MSM social organizations from April to July 2023 in eight cities in Shandong Province. Snowball sampling, activity venues, and networks were employed, targeting a sample size of 400 people per city. A face-to-face questionnaire survey collected data on sociodemographic characteristics, drug use, sexual intercourse, and online informed dating. Blood samples were also collected for HIV and syphilis antibody testing.Results:In the past six months, 2 787 MSM sought homosexual partners through the Internet, and 78.26% (2 181/2 787) chose to make anonymous online dating. Before having homosexual sex with online sexual partners, 10.41% (290/2 787) of them did not ask each other about HIV infection status and 33.37% (930/2 787) of them not being tested for HIV. There were statistically significant differences in the distribution of age, marital status, household registration, education level, sexual orientation, ways to find male sexual partners, not asking online sexual partners about their HIV status before sexual intercourse, no mutual HIV testing with online sexual partners before sexual intercourse, and syphilis antibody between anonymous and non-anonymous online dating persons (all P<0.05). The results of multivariate logistic regression analysis showed that <25 years old (a OR=1.43, 95% CI: 1.15-1.77) and ≥35 years old age group (a OR=1.61, 95% CI: 1.29-2.01), people with no AIDS knowledge (a OR=2.37, 95% CI: 1.25-4.49), drug users (a OR=1.38, 95% CI: 1.17-1.63), online dating anonymous (a OR=2.19, 95% CI: 1.76-2.73), HIV antibody positive (a OR=3.61, 95% CI: 2.22-5.88) and no intervention services in the last 1 year (a OR=1.58, 95% CI: 1.05-2.38) were the related factors of MSM not being tested for HIV before having sexual intercourse through online dating. Conclusions:The phenomenon of anonymous online dating was common among MSM in Shandong Province, and the proportion of MSM not being tested for HIV before having sexual intercourse through anonymous online dating was relatively high. It is necessary to strengthen health publicity and promote informed dating in MSM.

Objective:To understand the related factors of new-type drugs use and high-risk behaviors in online-dating men who have sex with men (MSM) in Shandong Province, and provide evidence for the development of targeted HIV prevention and intervention strategies.Methods:A cross-sectional study was conducted from April to July 2023 in eight sentinel surveillance sites across cities in Shandong, recruiting MSM participants. Each city enrolled a sample of 400 individuals. Face-to-face questionnaire surveys were conducted to collect data on socio-demographic characteristics, drug use and sexual behaviors, risk perception, and online-dating practices of the MSM, and χ2 test was used to compare the differences between online-dating MSM who used new-type drugs and those who didn't use. Logistic regression model was used to analyze the related factors of group sex behavior and the lack of HIV detection before sexual behavior in the online-dating MSM. Statistical analysis was performed by using software SPSS 29.0. Results:A total of 3 235 MSM were surveyed, in whom 2 787 (86.15%) used online-dating platforms to find partners in the past six months. The majority were those who were aged 25-34 years (39.18%, 1 092/2 787), unmarried/divorced/widowed (71.51%, 1 993/2 787), had an education level of college or above (69.36%, 1 933/2 787), and primarily identified as homosexual gays (77.97%, 2 173/2 787), 37.78% (1 053/2 787) believed that they were at low risk for HIV infection and 10.88% (303/2 786) believed that using new-type drugs was less harmful and 57.59% (1 605/2 787) reported new-type drugs use. Multivariate logistic regression analysis indicated that MSM who used new-type drugs had higher risk for group sex in the past six months (a OR=1.31, 95% CI: 1.06-1.63) and sexual activity without pre-HIV testing (a OR=1.57, 95% CI:1.14-2.15) compared with those who didn't use new-type drugs.MSM who believed that the risk of using new-type drugs was general, higher and very high had higher risks for group sex in the past six months (a OR=1.54, 95% CI: 1.09-2.18) and sexual activity withou pre-HIV testing (a OR=2.02, 95% CI:1.34-3.05) compared with those who believed using new-type drugs was less harmful. Conclusions:The use of new-type drugs was relatively common in the online-dating MSM in Shandong, with widespread high-risk behaviors and poor awareness of risks to health. A gap between knowledge awareness and behavior exists. It is necessary to strengthen the health education and promotion of HIV informed dating practices in MSM.