OBJECTIVE To investigate the result of human immunodeficiency virus(HIV)screening for the people visiting to a three-A hospital of Sichuan Province and analyze the prevalence of complications with hepatitis B virus(HBV)infection,hepatitis C virus(HCV)infection and Treponema pallidum(TP)infection in the emerging HIV infection patients.METHODS The result of HIV screening for the people who visited to Ziyang Central Hos-pital from Jan.1,2020 to Dec.31,2024 and the test results of HBV,HCV and TP for the emerging HIV infec-tion patients were collected and were summarized and statistically analyzed by SPSS.0 software.RESULTS Totally 289 891 case-times were tested for HIV,1529 cases were previously diagnosed with HIV,465 of whom were tested posi-tive for the first time,there was significant difference in the positive rate of test for the first time among the 5 years(x2=15.998,P=0.003).Totally 353 cases were confirmed positive among the 465 primary positive screening cases.Among the emerging HIV infection patients,the positive rate was higher in the male than in the female(x2=141.141,P＜0.001),and the positive rate was high among the population aged more than 40 year old(x2=11.448,P＜0.001),mi-grant workers(x2=270.110,P＜0.001)and low education level population(x2=25.911,P＜0.001).The detection rate of gp41 was up to 100.00％in strip type testing.The analysis of the ratio of relative light unit(RLU)to Cutoff val-ue(COI)in the initial screening experiment showed that when COI was greater than 50,all of the confirmed tests were positive,when COI ranged between 1 and 5,the false positive rate was 97.06％.The incidence of complica-tion with HBV infection in the emerging HIV infection patients was increased year by year(x2=20.355,P＜0.001),and the incidence of complication with HCV infection was increased in recent two years(x2=10.690,P=0.030).CONCLUSIONS There is no obvious rise of positive rate of HIV screening among the people visiting to the hospital in recent 5 years.The sensitivity of the primary screening of clinical laboratory is high without posi-tive missing test.The positive rates of HBV and HCV are increased among the emerging HIV infection patients.

OBJECTIVE To investigate the result of human immunodeficiency virus(HIV)screening for the people visiting to a three-A hospital of Sichuan Province and analyze the prevalence of complications with hepatitis B virus(HBV)infection,hepatitis C virus(HCV)infection and Treponema pallidum(TP)infection in the emerging HIV infection patients.METHODS The result of HIV screening for the people who visited to Ziyang Central Hos-pital from Jan.1,2020 to Dec.31,2024 and the test results of HBV,HCV and TP for the emerging HIV infec-tion patients were collected and were summarized and statistically analyzed by SPSS.0 software.RESULTS Totally 289 891 case-times were tested for HIV,1529 cases were previously diagnosed with HIV,465 of whom were tested posi-tive for the first time,there was significant difference in the positive rate of test for the first time among the 5 years(x2=15.998,P=0.003).Totally 353 cases were confirmed positive among the 465 primary positive screening cases.Among the emerging HIV infection patients,the positive rate was higher in the male than in the female(x2=141.141,P＜0.001),and the positive rate was high among the population aged more than 40 year old(x2=11.448,P＜0.001),mi-grant workers(x2=270.110,P＜0.001)and low education level population(x2=25.911,P＜0.001).The detection rate of gp41 was up to 100.00％in strip type testing.The analysis of the ratio of relative light unit(RLU)to Cutoff val-ue(COI)in the initial screening experiment showed that when COI was greater than 50,all of the confirmed tests were positive,when COI ranged between 1 and 5,the false positive rate was 97.06％.The incidence of complica-tion with HBV infection in the emerging HIV infection patients was increased year by year(x2=20.355,P＜0.001),and the incidence of complication with HCV infection was increased in recent two years(x2=10.690,P=0.030).CONCLUSIONS There is no obvious rise of positive rate of HIV screening among the people visiting to the hospital in recent 5 years.The sensitivity of the primary screening of clinical laboratory is high without posi-tive missing test.The positive rates of HBV and HCV are increased among the emerging HIV infection patients.

Background::Acute pulmonary embolism (APE) is a fatal cardiovascular disease, yet missed diagnosis and misdiagnosis often occur due to non-specific symptoms and signs. A simple, objective technique will help clinicians make a quick and precise diagnosis. In population studies, machine learning (ML) plays a critical role in characterizing cardiovascular risks, predicting outcomes, and identifying biomarkers. This work sought to develop an ML model for helping APE diagnosis and compare it against current clinical probability assessment models.Methods::This is a single-center retrospective study. Patients with suspected APE were continuously enrolled and randomly divided into two groups including training and testing sets. A total of 8 ML models, including random forest (RF), Na?ve Bayes, decision tree, K-nearest neighbors, logistic regression, multi-layer perceptron, support vector machine, and gradient boosting decision tree were developed based on the training set to diagnose APE. Thereafter, the model with the best diagnostic performance was selected and evaluated against the current clinical assessment strategies, including the Wells score, revised Geneva score, and Years algorithm. Eventually, the ML model was internally validated to assess the diagnostic performance using receiver operating characteristic (ROC) analysis.Results::The ML models were constructed using eight clinical features, including D-dimer, cardiac troponin T (cTNT), arterial oxygen saturation, heart rate, chest pain, lower limb pain, hemoptysis, and chronic heart failure. Among eight ML models, the RF model achieved the best performance with the highest area under the curve (AUC) (AUC = 0.774). Compared to the current clinical assessment strategies, the RF model outperformed the Wells score ( P = 0.030) and was not inferior to any other clinical probability assessment strategy. The AUC of the RF model for diagnosing APE onset in internal validation set was 0.726. Conclusions::Based on RF algorithm, a novel prediction model was finally constructed for APE diagnosis. When compared to the current clinical assessment strategies, the RF model achieved better diagnostic efficacy and accuracy. Therefore, the ML algorithm can be a useful tool in assisting with the diagnosis of APE.

Objective To explore the influencing factors of gastric cancer and construct the clinical prediction model.Methods From December 2020 to October 2023,the clinical data of 1000 patients with stomach neoplasm admitted to Putuo Hospital,Shanghai U-niversity of Traditional Chinese Medicine and Shuguang Hospital,Shanghai University of Traditional Chinese Medicine were collected.Af-ter data cleaning and eliminating abnormal values,the patients were divided into gastric polyps group(n=487)and gastric cancer group(n=479).Non-parametric test was used to screen out meaningful indicators,Lasso regression to screen out the characteristic factors re-lated to gastric cancer with non-zero coefficient,and stepwise Logistic regression analysis to screen out the factors with significant correla-tion,and Lasso-Logistic regression model was constructed.The receiver operator characteristic(ROC)curve was plotted to calculate the area under the curve(AUC)and the confusion matrix to evaluate the model efficiency.Results The results of multivariate Logistic re-gression analysis showed that age,white blood cell(WBC)count,monocyte(M)count,alanine amiontransferase(ALT),cancer anti-gen 724(CA724),cancer antigen 242(CA242),cancer antigen 50(CA50)and carcinoembryonic antigen(CEA)were independent factors affecting gastric cancer.Based on the results of multivariate Logistic regression analysis,the risk prediction nomogram model of gas-tric cancer was constructed.The AUC of test set was 0.91,the accuracy rate was 100％,and the recall rate was 100％;the AUC of valida-tion set was 0.93,the accuracy rate was 93.63％,and the recall rate was 74.1％.The model has good prediction efficiency.Conclusion In this study,8 common predictors of gastric cancer were constructed,and the Lasso-logistic regression prediction model had good differen-tiation,which could be used to complete the early screening of gastric cancer based on the physical examination reports of patients.

Objective To investigate the methylation levels of the HIF-3α gene,as well as the expression of HIF-3α mRNA and DDIT4 mRNA in peripheral blood samples from pregnant women with gestational diabetes mellitus(GDM),and their association with pregnancy outcomes,aiming to provide insights for pregnancy monitoring and clinical diagnosis and treatment of GDM patients,thereby mitigating the risk of adverse pregnancy outcomes.Methods From March 2023 to March 2024,a total of 80 pregnant women with GDM were randomly selected at the Affiliated Hospital of Xuzhou Medical University.They were divided into two groups based on glycemic control:GDM1(n=40)representing good glycemic control and GDM2(n=40)representing poor glycemic control.Addi-tionally,a control group consisting of 40 pregnant women without any pregnancy complications or comorbidities was included.Methylation-specific PCR was employed to determine the rate of HIF-3α methylation,while quantita-tive real-time PCR was used to assess the expressions of HIF-3α mRNA and DDIT4 mRNA.Adverse pregnancy outcomes were recorded across all three groups,and correlations between HIF-3α mRNA,DDIT4 mRNA,and various adverse pregnancy outcomes were analyzed using logistic regression analysis.Results Prior to pregnancy,GDM1 and GDM2 groups exhibited higher levels of FPG,HbA1c,TC,TG,LDL-C,FINS and HOMA-IR(P＜0.05),as well as lower levels of HOMA-β compared to the control group(P＜0.05).The incidence of adverse pregnancy outcomes was also higher in both GDM groups than in the control group;this difference was significant for GDM2(P＜0.05)but not for GDM1(P＞0.05).Furthermore,methylation rates of the HIF-3α gene were higher in both GDM groups compared to controls while expression levels of HIF-3α and DDIT4 mRNA were lower;these differences were significant for the GDM2 group versus controls(P＜0.05)but not for the GDM1 group ver-sus controls(P＞0.05).Finally,all adverse pregnancy outcomes among women with gestational diabetes mellitus showed a negative correlation with expression levels of both HIF-3α and DDIT4 mRNA(r＜0,P＜0.05);moreover,these two mRNAs served as protective factors against such outcomes occurring(OR＜1,P＜0.05).Conclusion The higher methylation rate of HIF-3α and the decreased expression of HIF-3α and DDIT4 genes are associated with the development of GDM and may serve as significant factors contributing to adverse pregnancy outcomes.

Background and Aims:Fine-needle aspiration cytology (FNA) has limitations due to the small sample size obtained,including nondiagnostic specimens,indeterminate cytological results,and false-negative or false-positive results,potentially leading to misdiagnosis or missed diagnoses. The BRAF gene mutation,specifically BRAFV600E,is a specific biomarker for papillary thyroid carcinoma (PTC). However,studies on its diagnostic value in FNA benign high-risk thyroid nodules are limited. This study was conducted to further explore the clinical value of adding BRAFV600E mutation testing in FNA benign thyroid nodules.Methods:A retrospective analysis was conducted on the clinical data of 549 patients who underwent 668 ultrasound evaluations indicating high risk of PTC and were classified as TIRADS categories 4-5 thyroid nodules at the Thyroid Surgery Department of China-Japan Union Hospital of Jilin University from January 2019 to September 2022. All patients underwent surgical treatment,and paraffin pathological examination was performed on resected tissues after surgery. Based on inclusion and exclusion criteria,84 FNA benign thyroid nodules were included in this study. The clinicopathologic characteristics of nodules with BRAFV600E mutations were analyzed. Using postoperative pathology as the gold standard,the diagnostic performance of BRAFV600E mutation testing in FNA benign nodules was assessed. Results:Among the 84 FNA benign thyroid nodules,44 (52.4％) tested positive for the BRAFV600E mutation. Patients with BRAFV600E-positive nodules were more likely to be younger than 45 years (56.8％ vs. 35.0％,P=0.045),and their nodules had a smaller median long diameter compared to the BRAFV600E-negative group (0.49 cm vs. 0.61 cm,P=0.024). Postoperative pathology revealed 63 PTC nodules and 21 benign nodules. PTC nodules had a smaller median long diameter than benign nodules (0.50 cm vs. 0.70 cm,P=0.004) and a higher proportion of nodules<1 cm (95.2％ vs. 71.4％,P=0.007),with a higher BRAFV600E mutation rate (68.3％ vs. 4.8％,P<0.001). In terms of the ultrasound characteristics of thyroid nodules,BRAFV600E-positive nodules showed a significantly higher rate of blurred/irregular margins than the negative group (86.4％ vs. 60.0％,P=0.006). Similarly,PTC nodules showed a higher rate of blurred/irregular margins compared to benign nodules (81.0％ vs. 52.4％,P=0.010). Multivariate Logistic regression analysis indicated that BRAFV600E-positive thyroid nodules had a 39.184-fold higher risk of being diagnosed as PTC compared to BRAFV600E-negative nodules (P=0.001),with BRAFV600E mutation being an independent risk factor for PTC diagnosis. The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of BRAFV600E mutation testing for PTC diagnosis were 69.3％,95.2％,97.7％,50.0％,and 75.0％,respectively. Conclusion:BRAFV600E mutation testing demonstrates high positive predictive value and accuracy,and can reduce the risk of missed PTC diagnoses among FNA-reported benign thyroid nodules. It is recommended that thyroid nodules with highly suspicious ultrasound features and TIRADS categories 4-5 undergo combined FNA and BRAFV600E mutation testing.

Background and Aims:Fine-needle aspiration cytology (FNA) has limitations due to the small sample size obtained,including nondiagnostic specimens,indeterminate cytological results,and false-negative or false-positive results,potentially leading to misdiagnosis or missed diagnoses. The BRAF gene mutation,specifically BRAFV600E,is a specific biomarker for papillary thyroid carcinoma (PTC). However,studies on its diagnostic value in FNA benign high-risk thyroid nodules are limited. This study was conducted to further explore the clinical value of adding BRAFV600E mutation testing in FNA benign thyroid nodules.Methods:A retrospective analysis was conducted on the clinical data of 549 patients who underwent 668 ultrasound evaluations indicating high risk of PTC and were classified as TIRADS categories 4-5 thyroid nodules at the Thyroid Surgery Department of China-Japan Union Hospital of Jilin University from January 2019 to September 2022. All patients underwent surgical treatment,and paraffin pathological examination was performed on resected tissues after surgery. Based on inclusion and exclusion criteria,84 FNA benign thyroid nodules were included in this study. The clinicopathologic characteristics of nodules with BRAFV600E mutations were analyzed. Using postoperative pathology as the gold standard,the diagnostic performance of BRAFV600E mutation testing in FNA benign nodules was assessed. Results:Among the 84 FNA benign thyroid nodules,44 (52.4％) tested positive for the BRAFV600E mutation. Patients with BRAFV600E-positive nodules were more likely to be younger than 45 years (56.8％ vs. 35.0％,P=0.045),and their nodules had a smaller median long diameter compared to the BRAFV600E-negative group (0.49 cm vs. 0.61 cm,P=0.024). Postoperative pathology revealed 63 PTC nodules and 21 benign nodules. PTC nodules had a smaller median long diameter than benign nodules (0.50 cm vs. 0.70 cm,P=0.004) and a higher proportion of nodules<1 cm (95.2％ vs. 71.4％,P=0.007),with a higher BRAFV600E mutation rate (68.3％ vs. 4.8％,P<0.001). In terms of the ultrasound characteristics of thyroid nodules,BRAFV600E-positive nodules showed a significantly higher rate of blurred/irregular margins than the negative group (86.4％ vs. 60.0％,P=0.006). Similarly,PTC nodules showed a higher rate of blurred/irregular margins compared to benign nodules (81.0％ vs. 52.4％,P=0.010). Multivariate Logistic regression analysis indicated that BRAFV600E-positive thyroid nodules had a 39.184-fold higher risk of being diagnosed as PTC compared to BRAFV600E-negative nodules (P=0.001),with BRAFV600E mutation being an independent risk factor for PTC diagnosis. The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of BRAFV600E mutation testing for PTC diagnosis were 69.3％,95.2％,97.7％,50.0％,and 75.0％,respectively. Conclusion:BRAFV600E mutation testing demonstrates high positive predictive value and accuracy,and can reduce the risk of missed PTC diagnoses among FNA-reported benign thyroid nodules. It is recommended that thyroid nodules with highly suspicious ultrasound features and TIRADS categories 4-5 undergo combined FNA and BRAFV600E mutation testing.

Objective To investigate the methylation levels of the HIF-3α gene,as well as the expression of HIF-3α mRNA and DDIT4 mRNA in peripheral blood samples from pregnant women with gestational diabetes mellitus(GDM),and their association with pregnancy outcomes,aiming to provide insights for pregnancy monitoring and clinical diagnosis and treatment of GDM patients,thereby mitigating the risk of adverse pregnancy outcomes.Methods From March 2023 to March 2024,a total of 80 pregnant women with GDM were randomly selected at the Affiliated Hospital of Xuzhou Medical University.They were divided into two groups based on glycemic control:GDM1(n=40)representing good glycemic control and GDM2(n=40)representing poor glycemic control.Addi-tionally,a control group consisting of 40 pregnant women without any pregnancy complications or comorbidities was included.Methylation-specific PCR was employed to determine the rate of HIF-3α methylation,while quantita-tive real-time PCR was used to assess the expressions of HIF-3α mRNA and DDIT4 mRNA.Adverse pregnancy outcomes were recorded across all three groups,and correlations between HIF-3α mRNA,DDIT4 mRNA,and various adverse pregnancy outcomes were analyzed using logistic regression analysis.Results Prior to pregnancy,GDM1 and GDM2 groups exhibited higher levels of FPG,HbA1c,TC,TG,LDL-C,FINS and HOMA-IR(P＜0.05),as well as lower levels of HOMA-β compared to the control group(P＜0.05).The incidence of adverse pregnancy outcomes was also higher in both GDM groups than in the control group;this difference was significant for GDM2(P＜0.05)but not for GDM1(P＞0.05).Furthermore,methylation rates of the HIF-3α gene were higher in both GDM groups compared to controls while expression levels of HIF-3α and DDIT4 mRNA were lower;these differences were significant for the GDM2 group versus controls(P＜0.05)but not for the GDM1 group ver-sus controls(P＞0.05).Finally,all adverse pregnancy outcomes among women with gestational diabetes mellitus showed a negative correlation with expression levels of both HIF-3α and DDIT4 mRNA(r＜0,P＜0.05);moreover,these two mRNAs served as protective factors against such outcomes occurring(OR＜1,P＜0.05).Conclusion The higher methylation rate of HIF-3α and the decreased expression of HIF-3α and DDIT4 genes are associated with the development of GDM and may serve as significant factors contributing to adverse pregnancy outcomes.

【Objective】 To investigate the resource allocation status of blood testing laboratories in 14 blood stations in Gansu Province, explore the impact of differences in basic conditions on the comprehensive testing ability of laboratories, so as to promote the homogenization and standardization of blood screening capacity in blood stations in Gansu and improve blood safety and effectivenes. 【Methods】 An evaluation index system of laboratory resource allocation was constructed and a question-naire was designed. The data of human resources, infrastructure and key equipment of 14 blood stations were collected. The entropy weight -TOPSIS method was used to evaluate and rank the resource allocation of 14 blood stations. 【Results】 In the comprehensive evaluation of blood testing laboratory resource allocation in 14 blood stations in Gansu, the top three were laboratories A, B and I, and the last three were laboratories G, M and J. On the whole, the main issue was unreasonable structure of human resources: most laboratories had unreasonable age structure; except for Laboratory A, there was no personnel with bachelor's degree or above in laboratories; most laboratories had not established a team with intermediate professional titles. In terms of infrastructure, the size of seven laboratories could not meet the needs of modern laboratory testing, and all eight blood stations had no spare nucleic acid laboratories nor a mutual spare laboratory with other blood stations As for the key equipment, 5 laboratories had no automatic blood grouping diagnostic instrument, 5 laboratories only had one set of enzyme immunoassay detection system, 3 laboratories had no spare equipment for the key equipment, which means if the equipment failure could not be repaired in time, the release of results would be affected. 【Conclusion】 There were significant differences in human resources, infrastructure and key equipment of blood testing laboratories in 14 blood stations in Gansu, which had a great impact on laboratory testing capacity and subsequent development. It is suggested that governments at all levels and health administrative departments optimize the input of laboratory resource allocation according to the blood collection volume of blood stations to gradually narrow the differences in resource distribution between different regions, improve the degree of laboratory automation and optimize the personnel structure, so as to build high-quality and efficient blood testing laboratories and ensure the safety of clinical blood use.

Objective:To evaluate the safety and tolerance of sequential thoracic radiotherapy combined with PD-1/PD-L1 inhibitors in patients with extensive-stage small cell lung cancer (ES-SCLC) after induction systemic therapy.Methods:ES-SCLC patients from a phase I trial and a real-world study were enrolled for those who received thoracic radiotherapy after induction systemic treatment (chemotherapy/chemotherapy combined with PD-1/PD-L1 inhibitors) and consolidated with PD-1/PD-L1 inhibitors. These two studies were both approved by the Ethics Committee of Chinese Academy of Medical Sciences Cancer Hospital (Clinical Trials.gov number, NCT03971214, NCT04947774).Results:Between January 2019 and March 2021, a total of 11 patients with ES-SCLC were analyzed, aged 52-73 years, with a median age of 62 years. Among them, five patients (45.5%) received induction chemotherapy and six patients (54.5%) received chemotherapy combined with PD-1/PD-L1 inhibitor, and then all received intensity-modulated thoracic radiotherapy after evaluation of systemic treatment efficacy. Two patients developed treatment-related grade G3-5 toxicity (18.2%, 1 treatment-related pneumonitis and 1 radiation esophagitis). G 1-G 2 hematologic toxicity, pneumonia, and anorexia were common mild toxicities. Only one patient (9.1%) terminated immunotherapy due to immune-related pneumonitis. During a median follow-up time of 12.5 months (range: 3.5-16.4 months), the median disease progression-free survival and overall survival was 7.4 months (95% CI: 6.9-8.0 months) and 14.6 months (95% CI: 9.0-20.2 months), respectively. Conclusions:Sequential thoracic radiotherapy followed by PD-1/PD-L1 inhibitor is safe and feasible in patients with ES-SCLC after induction therapy. Given that both thoracic radiotherapy and immunotherapy benefits the ES-SCLC in survival, this comprehensive treatment modality warrants further investigation.