Objective: To investigate the prevalence and influencing factors of hepatitis C virus (HCV) infection among drug users in Baoshan District, Shanghai Municipality, so as to provide insights into strengthening HCV intervention among drug users. Methods: Drug users under community management in Baoshan District from 2017 to 2023 were recruited. Demographic information, drug use behaviors, sexual behaviors and receipt of intervention service were collected through questionnaire surveys. Blood samples were collected for HCV antibody testing, and the prevalence of anti-HCV antibody was analyzed. Factors affecting the prevalence of anti-HCV antibody among drug users were analyzed using a multivariable logistic regression model. Results: A total of 2 801 drug users were surveyed, including 2 233 males (79.72%) and 568 females (20.28%). The majority of drug users were aged 40 to <60 years (1 663 drug users, 59.37%). The prevalence of anti-HCV antibody was 28.35%, showing an overall upward trend from 2017 to 2023 (P<0.05). Multivariable logistic regression analysis showed that females (OR=1.468, 95%CI: 1.169-1.844), 40 years and over (40 to <50 years, OR=2.441, 95%CI: 1.838-3.242; 50 to <60 years, OR=2.377, 95%CI: 1.787-3.161; 60 to 97 years, OR=1.637, 95%CI: 1.163-2.304), using traditional drugs (OR=2.488, 95%CI: 1.967-3.147) or mixed drugs (OR=2.950, 95%CI: 1.974-4.409), having injected drugs (not share needles, OR=3.649, 95%CI: 2.849-4.673; share needles, OR=3.532, 95%CI: 1.851-6.738) and never using condoms during sexual contacts with spouses/cohabitants in the past year (OR=1.975, 95%CI: 1.354-2.879) were associated with a higher prevalence of anti-HCV antibody; the educational level of high school/technical secondary school (OR=0.483, 95%CI: 0.280-0.835) or college and above (OR=0.280, 95%CI: 0.129-0.608) was associated with a lower prevalence of anti-HCV antibody. Conclusions The prevalence of anti-HCV antibody among drug users in Baoshan District showed an upward trend from 2017 to 2023. Gender, age, educational level, type of drugs, history of drug injection and never using condoms during sexual contacts with spouses/cohabitants were influencing factors for prevalence of anti-HCV antibody among drug users.

Abstract In April 2021, type Ⅰ vaccine-derived poliovirus (VDPV) was detected from two fecal samples of a male infant with acute flaccid paralysis (AFP) in Zhejiang Province when he was admitted to the Children's Hospital Affiliated to Fudan University in Shanghai, with 12 and 14 nucleotide mutations in the VP1 region, respectively. The case had a history of immunization with three doses of poliovirus vaccines, and grade Ⅲ proximal muscle strength and grade Ⅱ distal muscle strength of the right lower limb. After symptomatic treatment, the activity of the right lower limb and the muscle strength was significantly restored, thus he was discharged. VDPV was not detected from subsequent (the 8th to 12th) fecal samples of the case and fecal samples of close contacts. No similar cases were found in medical institutions in the county, surrounding areas, neighboring villages or towns. Since the case did not exhibit clinical symptoms of poliomyelitis caused by VDPV, poliomyelitis was excluded, and the case was diagnosed with hemophilia type A based on the epidemiological investigation, laboratory tests, and the history of poliomyelitis vaccination. This event involved cross-provincial (municipal) cooperation and was responsed promptly, preventing further spread of the virus. It suggested that the sensitivity of the AFP case surveillance system should be maintained, environmental monitoring methods should be increased, and the poliomyelitis vaccination should be promoted to prevent the spread of the virus.

Based on the theoretical reflection on the reflective function of medical records,the important findings in the practice of medical records writing in the field of palliative care,and conceptual analysis of narrative medicine tools,combined with empirical investigation materials and analysis,this paper focused on the practice of medical records writing for reflection and research.The main contents include defining the concept of narrative medical records,which are medical records used in clinical practice that incorporate narrative content;clarifying their characteristics and functions at different levels;and exploring practical paths for their application in clinical practice.Based on an in-depth exploration of the uniqueness of narrative medicine practice at Peking Union Medical College,it also emphasized the necessity of writing medical records with narrative thinking.Specifically,it focused on using narrative thinking and forms to enhance the improvement of current medical records writing,and further sought a general framework and multiple possibilities for narrative medicine clinical pathways.

Objective:To explore the clinical application of preimplantation genetic testing for monogenic disorders (PGT-M) in an unique case with Spinal muscular atrophy (SMA) type 2+ 0.Methods:A special SMA family presented at the Third Affiliated Hospital of Guangzhou Medical University on October 19, 2020 was selected as the study subject. Multiple ligation-dependent probe amplification (MLPA) and molecular tagging linkage analysis were carried out to identify the SMN1 genotype of the couple and their fetus. Subsequently, next-generation sequencing (NGS), molecular tagging linkage analysis, and chromosomal microarray analysis were employed to determine the haplotypes and validate the result of PGT-M on the 11 embryos derived for the couple. Results:The female partner was identified as a carrier of the rare SMN1[2+ 0] variant, and prenatal diagnosis confirmed the fetus to be affected by SMA. Ultimately, PGT-M has successfully selected four embryos free from the pathogenic SMN1 variants and X chromosome deletion. Conclusion:PGT-M can effectively prevent the transmission of rare genetic variants such as the SMA 2+ 0 subtype in the families. Above finding has provided guidance for genetic counseling and family planning for the couple.

Although significant progress has been made in the development of novel targeted drugs for the treatment of acute myeloid leukemia(AML)in recent years,chemotherapy still remains the mainstay of treatment and the overall survival is poor in most patients.Here,we demonstrated the antileukemia activity of a novel small molecular compound NL101,which is formed through the modification on bendamustine with a suberanilohydroxamic acid(SAHA)radical.NL101 suppresses the proliferation of myeloid malignancy cells and primary AML cells.It induces DNA damage and caspase 3-mediated apoptosis.A genome-wide clustered regularly interspaced short palindromic repeats(CRISPR)library screen revealed that phosphatase and tensin homologous(PTEN)gene is critical for the regulation of cell survival upon NL101 treatment.The knockout or inhibition of PTEN significantly reduced NL101-induced apoptosis in AML and myelodysplastic syndrome(MDS)cells,accompanied by the activation of protein kinase B(AKT)signaling pathway.The inhibition of mammalian target of rapamycin(mTOR)by rapamycin enhanced the sensitivity of AML cells to NL101-induced cell death.These findings uncover PTEN protein expression as a major determinant of chemosensitivity to NL101 and provide a novel strategy to treat AML with the combination of NL101 and rapamycin.

Objective:To explore the feasibility for reconstruction of soft tissue defects in limbs and trunk with perforator pedicled kite flap, and to summarise its clinical efficacy.Methods:A retrospective study was conducted on 14 patients with soft tissue defects and admitted to the Department of Hand Microsurgery of Xiangya Hospital, Central South University from January 2016 to September 2023. Among the 14 patients (6 males and 8 females), 7 had defects in calf, 2 in sacrococcygeal area, 2 in the back and 3 in forearm. All of the defects were reconstructed with the perforator pedicled kite flaps, of which 6 flaps had the pedicles of single perforator, 3 of 2 perforators, 4 of 3 perforators and 1 of 5 perforators. Single V-Y advancement flaps were used for defect reconstruction in 8 patients, and double V-Y advancement flaps were used in 6 patients. The size of the defects ranged from 2.2 cm×1.8 cm to 8.0 cm×16.0 cm, and the size of the flaps ranged from 3.0 cm×5.5 cm to 9.0 cm×23.0 cm. All donor sites were closed directly. Postoperative follow-up was conducted at outpatient clinic, by telephone reviews and WeChat after surgery, to observe the flap survival and postoperative complications.Results:All flaps survived completely. All the flaps and donor sites healed primarily. The postoperative follow-up lasted for 3 to 36 (mean, 14.5) months. Thirteen flaps presented with soft texture, good appearance, with similar texture to the surrounding skin and without obvious swelling. The patients were satisfied with the aesthetic outcomes. One patient had a local ulcer with exudation at the recipient site and the ulcer healed after removal of the steel plate and thoroughly debridement.Conclusion:With a perforator pedicled kite flap, vascular anastomosis or sacrifice of a second donor site can be avoided. A perforator pedicled kite flap can be applied to many recipient sites, with a simple surgical procedure and a good postoperative appearance. It is an ideal flap for reconstruction of small to medium-sized soft tissue defects in trunk and limbs. More studies are required to evaluate the feasibility of the flap to be applied in local hospitals.

Objective:To construct an analytic method aimed at the characteristics of the commonly method of supplementing and pouring of acupuncture based on the analysis and modeling of ultrasound images around acupoint region in the process of acupuncture.Methods:A total of 7 healthy subjects who underwent physical examination in Beijing Zhongguancun Hospital from June,2022 to June,2023 were selected,and their Kongzui acupoints were acupunctured by 10 acupuncturists with associate senior title as 4 kinds of acupuncture manipulations included reinforcing by twisting and rotating(RFTR),reducing by twisting and rotating(RDTR),reinforcing by lifting and thrusting(RFLT),and reducing by lifting and thrusting(RDLT).The B-ultrasound diagnostic device was used to collect the images of muscle and fascial tissue below the acupoint,so as to construct the model of images.The definition of virtual acupuncture point was adopted to study the regulation of perturbation of subcutaneous tissue that was caused after the skin was acupunctured by needle.The change regulation of the virtual acupuncture point of muscle bundle below skin at Zuikong acupoint of subjects was analyzed.Results:The difference value of average absolution value between peak and trough of the trajectory of virtual acupuncture point of twisting and rotating was 0.066±0.045,and the average value of amplitude of this method was less than that(0.428±0.276)of lifting and thrusting method,and the twisting and rotating method was uniform and symmetrical,and there was difference between two kinds of acupuncture methods.The characteristics of computer graphics was used to qualify the work effect of lifting and thrusting,and reinforcing and reducing,which showed the heavy insertion and light lifting of RFLT,and showed heavy lifting and light insertion of RDLT,thus distinguished the two methods[(RFLT)and(RDLT)].Conclusions:The ultrasound imaging and computer graphics can be used to analyze the regularity of the common"reinforcing and reducing"method of acupuncture and moxibustion.

Objective:To construct a prediction model for neurogenic shock in patients with traumatic cervical spinal cord injury and validate its effectiveness.Methods:A retrospective case-control study was conducted on the clinical data of 381 patients with traumatic cervical spinal cord injury admitted to the Third Hospital of Shanxi Medical University from January 2017 to December 2022, including 311 males and 70 females, aged 12-86 years [(55.1±12.9)years]. A total of 121 patients (31.8%) were complicated with neurogenic shock. The patients were randomly divided into training set ( n=267) and validation set ( n=114) with a ratio of 7∶3. The training set was divided into neurogenic shock group ( n=81) and non-neurogenic shock group ( n=186) according to whether they were complicated with neurogenic shock. The general data, clinical data, laboratory indicators and imaging data of the patients were collected. Univariate analysis was used to determine differences in the aforementioned indicators between the neurogenic shock group and non-neurogenic shock group in the training set. Multivariate Logistic regression analysis was conducted to screen the predictors for neurogenic shock in patients with traumatic cervical spinal cord injury, and regression equation was constructed. A nomogram prediction model based on the regression equation was plotted with R programming language. Receiver operating characteristic (ROC) curves of the training set and validation set were plotted, when the area under the curve (AUC) was calculated to determine the discriminability of the model. The calibration of the model was assessed with calibration curves. The clinical applicability of the model was evaluated by the decision curve analysis (DCA). Results:The univariate analysis showed that there were statistically significant differences in the American Spinal Injury Association (ASIA) grade, tracheal intubation, serum albumin concentration within 24 hours on admission, intramedullary lesion length (IMLL), maximum spinal cord compression (MSCC), increased signal intensity (ISI), and highest damaged segment between the neurogenic shock group and non-neurogenic shock group in the training set ( P<0.05). The multivariate Logistic regression analysis revealed that AISA grade (grade C vs. grade A: OR=0.13, 95% CI 0.03, 0.59, P<0.01; grade D vs.grade A: OR=0.04, 95% CI 0.01, 0.28, P<0.01), serum albumin concentration within 24 hours on admission ( OR=0.75, 95% CI 0.65, 0.86, P<0.01), IMLL ( OR=2.71, 95% CI 1.68, 4.38, P<0.01), ISI (grade 2 vs.grade 0: OR=5.62, 95% CI 1.07, 29.48, P<0.05), and highest damaged segment ( OR=0.49, 95% CI 0.29, 0.83, P<0.01) were predictors for neurogenic shock in patients with traumatic cervical spinal cord injury. Based on the 5 forementioned variables, the regression equation was constructed as follows: Logit[ P/(1- P)]=10.99-1.06×＂AISA grade＂-0.29×＂serum albumin concentration within 24 hours on admission＂+1.04×＂IMLL＂+0.89×＂ISI＂-0.74×＂highest damaged segment＂. In the prediction model constructed based on the equation, the AUC values of the training set and validation set were 0.97 (95% CI 0.97, 0.99) and 0.95 (95% CI 0.91, 0.99). Calibration curves of the training set and validation set demonstrated the prediction curve roughly overlapped with the reference curve and the mean absolute errors of the two sets were 0.013 and 0.050. DCA results showed that the net benefit rate of patients was greater than 0 when the threshold probability ranged from 0% to 97% for the training set and from 0% to 100% for the validation set. Conclusion:The prediction model based on the AISA grade, serum albumin concentration within 24 hours on admission, IMLL, ISI, and highest damaged segment demonstrates good discriminability, calibration and clinical applicability in predicting neurogenic shock in patients with traumatic cervical spinal cord injury.

Objective To analyze the concentration and exposure of vancomycin in children with gram-positive coccal infection,and the corresponding clinical efficacy and safety to support rational use of vancomycin in children.Methods We prospectively collected the clinical and laboratory data of 87 children with gram-positive coccal infection in the Children's Hospital of Fudan University from January 2012 to March 2021.Therapeutic drug monitoring(TDM)was conducted for vancomycin simultaneously,to acquire the data of serum through concentration(Cmin),peak concentration(Cmax),the area under the drug concentration-time curve in a 24-h interval(AUC0-24h)and the ratio ofAUC0-24h to the minimum inhibitory concentration(AUC0-24h/MIC).Results The median(P25,P75)age of the children enrolled in this study was 3.60(1.20,20.00)months.The median dose of vancomycin was 39.23(30.00,46.51)mg/kg.The median serum Cmin was 3.30(1.50,7.10)mg/L.Cmin achieved the target(5-15 mg/L)in 23 cases(26.4％).The median AUC0-24h was 213(174,293)mg·h/L and the median AUC0-24h/MIC was 221(128,349).Adaily dose of above 60 mg/kg in children could achieve the median value of AUC0-24h and AUC0-24h/MIC greater than 400,and the corresponding median age was 28.50(6.85,36.00)months.Multivariate logistic analysis showed a good correlation between Cmin and AUC0-24h(P=0.002).At the end of treatment,the clinical efficacy rate was 85.1％(74/87)and the bacterial eradication rate was 95.4％(83/87).No renal injury occurred during the treatment.Conclusions In this study,the median daily dosage,Cmin and A UC0-24h/MIC of vancomycin were below the recommended range at home and abroad.However,good clinical and microbiological efficacy were achieved in children at low vancomycin exposure.The probability of target attainment(PTA)for A UC0-24h and AUC0-24h/MIC ≥400 increased when the daily dose of vancomycin was＞60 mg/kg(corresponding to the median age of 28.50 months)or Cmin ≥ 5 mg/L.

For Perihilar cholangiocarcinoma (pCCA), surgical resection is the only effective way to cure this disease. However, it has high postoperative mortality and high recurrence rate. Domestic and foreign scholars have constructed statistics-based evaluation methods to predict patients′ postoperative survival and complications, such as nomogram, scoring system and other prognostic models. Based on these methods, clinicians can better select patients who can benefit from surgery and choose the optimal? treatment for more severe patients. Through the adoption of other treatments or some ways to ameliorate some preoperative condition, to improve the patient′s mortality and survival. This article reviews the prognostic risk factors and prognostic models of pCCA in order to provide a reference for clinicians to predict the prognosis about the surgery.