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.

Medical ethics not only reflects the individual professional conduct of medical professionals， but also serves as the cornerstone for the operation of the healthcare system， directly linking to patients’ health rights and interests and overall social trust. The outbreak of public health emergencies has exerted a tremendous impact on people’s lives. During this period， clinicians in China have stood the test and demonstrated fearless dedication， which highlights the importance of medical ethics education. Clinicians possess dual identities as both medical professionals and patients. Their thoughts and perceptions evolve with the times， posing new challenges to medical ethics education of clinicians and carrying profound significance for improving the quality of medical services and safeguarding public health. This study adopted Strengths-Weaknesses-Opportunities-Threats （SWOT） theory to analyze and summarize the current situation， strengths， weaknesses， opportunities， and threats of medical ethics education， highlighting the urgent need to explore novel educational pathways. These will provide guidance for promoting the moral development of medical professionals and improving the quality of medical services， contribute to cultivating more physicians with dedication to serve society effectively， and drive the healthy development of China’s medical industry.

ObjectiveTo investigate the processing technology of calcined Haematitum based on the concept of quality by design（QbD） and to assess its health risk. MethodsTaking whole iron content， Fe²⁺ dissolution content and looseness as critical quality attributes（CQAs）， and calcination temperature， calcination time， spreading thickness and particle size as critical process parameters（CPPs） determined by the failure mode and effect analysis（FMEA）， the processing technology of calcined Haematitum was optimized by orthogonal test combined with analytic hierarchy process-criteria importance through intercriteria correlation（AHP-CRITIC） hybrid weighting method. The contents of heavy metals and harmful elements were determined by inductively coupled plasma mass spectrometry， and the health risk assessment was carried out by daily exposure（EXP）， target hazard quotient（THQ） and lifetime cancer risk（LCR）， and the theoretical value of the maximum limit was deduced. ResultsThe optimal processing technology for calcined Haematitum was calcination at 650 ℃， calcination time of 1 h， particle size of 0.2-0.5 cm， spreading thickness of 1 cm， and vinegar quenching for 1 time［Haematitum-vinegar（10：3）］. The contents of 5 heavy metals and harmful elements in 13 batches of calcined Haematitum were all decreased with reductions of up to 5-fold. The cumulative THQ of 2 batches of samples was>1， while the cumulative THQ of all batches of Haematitum was>1. The LCR of As in 1 batches of Haematitum was 1×10^-6-1×10^-4， and the LCR of the rest was<1×10^-6， and the LCRs of calcined Haematitum were all<1×10^-6， indicating that the carcinogenic risk of calcined Haematitum was low， but special attention should still be paid to Haematitum medicinal materials. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg were formulated as 1 014， 25， 17， 27， 7 mg·kg^-1. ConclusionThe optimized processing technology of calcined Haematitum is stable and feasible， and the contents of heavy metals and harmful elements are reduced after processing. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg are formulated to provide a scientific basis for the formulation of standards for the limits of harmful elements in Haematitum.

ObjectiveTo investigate the processing technology of calcined Haematitum based on the concept of quality by design（QbD） and to assess its health risk. MethodsTaking whole iron content， Fe²⁺ dissolution content and looseness as critical quality attributes（CQAs）， and calcination temperature， calcination time， spreading thickness and particle size as critical process parameters（CPPs） determined by the failure mode and effect analysis（FMEA）， the processing technology of calcined Haematitum was optimized by orthogonal test combined with analytic hierarchy process-criteria importance through intercriteria correlation（AHP-CRITIC） hybrid weighting method. The contents of heavy metals and harmful elements were determined by inductively coupled plasma mass spectrometry， and the health risk assessment was carried out by daily exposure（EXP）， target hazard quotient（THQ） and lifetime cancer risk（LCR）， and the theoretical value of the maximum limit was deduced. ResultsThe optimal processing technology for calcined Haematitum was calcination at 650 ℃， calcination time of 1 h， particle size of 0.2-0.5 cm， spreading thickness of 1 cm， and vinegar quenching for 1 time［Haematitum-vinegar（10：3）］. The contents of 5 heavy metals and harmful elements in 13 batches of calcined Haematitum were all decreased with reductions of up to 5-fold. The cumulative THQ of 2 batches of samples was>1， while the cumulative THQ of all batches of Haematitum was>1. The LCR of As in 1 batches of Haematitum was 1×10^-6-1×10^-4， and the LCR of the rest was<1×10^-6， and the LCRs of calcined Haematitum were all<1×10^-6， indicating that the carcinogenic risk of calcined Haematitum was low， but special attention should still be paid to Haematitum medicinal materials. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg were formulated as 1 014， 25， 17， 27， 7 mg·kg^-1. ConclusionThe optimized processing technology of calcined Haematitum is stable and feasible， and the contents of heavy metals and harmful elements are reduced after processing. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg are formulated to provide a scientific basis for the formulation of standards for the limits of harmful elements in Haematitum.

Objective: To investigate prevalence of hepatitis E virus (HEV) infection among voluntary blood donors in Dalian and provide evidence for enhancing blood screening strategies. Methods: A total of 3 277 blood donor samples collected between December 2023 and February 2024 at Dalian Blood Center underwent routine blood screening (ALT, HBsAg, anti-HCV, HIV Ag/Ab, anti-TP, and HBV/HCV/HIV NAT). Subsequently, HEV antigen (Ag) was detected using chemiluminescence immunoassay (CLIA). HEV-Ag reactive samples were further tested for HEV RNA, IgM and IgG antibodies. Blood donors with repeated reactive HEV Ag results were followed up to clarify the status of infection. Results: Among the 3 277 blood donor samples, 6 (0.18%) were repeatedly reactive for HEV Ag. However, supplemental testing for HEV RNA, anti-HEV IgM, and anti-HEV IgG on these samples yielded non-reactive results. One of these six blood donors was successfully followed up. On day 218 after the initial detection of HEV Ag reactivity, HEV Ag, HEV RNA, HEV IgM and IgG antibody were found to be non-reactive. Conclusion: The reaction rate for HEV antigen screening among voluntary blood donors in Dalian is low. CLIA method for detecting HEV antigen is easy to operate and cost-effective, but demonstrates some false reactivity. Improving the specificity of the assay and combining it with nucleic acid testing (NAT) would be valuable for implementing a selective HEV screening strategy for blood donors.

Objective To observe the clinical efficacy of Zishen Shujing decoction in the treatment of kidney deficiency and liver depression type premature ovarian failure(POF).Methods A total of 70 female POF patients who visited the Fourth Clinical Medical College of Guangzhou University of Traditional Chinese Medicine from July 2023 to April 2024 were selected as the research subjects,they were divided into traditional Chinese medicine(TCM)treatment group(n=35)and Western medicine treatment group(n=35)by using a random number table method.Western medicine treatment group was treated with femostone,and TCM treatment group was treated with Zishen Shujing decoction.Differences of TCM syndrome scores and clinical efficacy were compared between two groups before and after treatment,and changes of peripheral blood follicle-simulating hormone(FSH),anti-Müllerian hormone(AMH),anal follicle count(AFC)and interleukin(IL)-4,IL-6 before and after treatment were compared.Results The effective rate of TCM treatment group was higher than that of Western medicine treatment group,the difference was statistically significant(P<0.05).The TCM syndrome scores after treatment were lower than before treatment,and TCM treatment group was lower than Western medicine treatment group,the difference was statistically significant(P<0.05).After treatment,FSH levels in two groups were lower than before treatment,AMH and AFC levels were higher than before treatment,and improvement of hormone levels,AMH and AFC in TCM treatment group was better than that in Western medicine treatment group,with statistical significance(P<0.05).After treatment,the anti-inflammatory factors IL-4 were increased,and the pro-inflammatory factors IL-6 were decreased,and the increase effect of anti-inflammatory factors and the decrease effect of pro-inflammatory factors in TCM treatment group were better than those in Western medicine treatment group with statistical significance(P<0.05).Conclusion Zishen Shujing decoction can improve the clinical symptoms,serum hormone levels of POF patients with kidney deficiency and liver depression,improve ovarian function,reduce immune inflammation,reduce oxidative stress,and effectively improve the quality of life of patients.

Objective:To analyze the factors associated with the occurrence of peritoneal dialysis-associated peritonitis (PDAP) in patients with diabetic nephropathy and to establish a risk model.Methods:The clinical data of 90 patients with diabetic nephropathy who underwent peritoneal dialysis using Einkorn dextrin dialysate at Yiwu Central Hospital from January 2021 to December 2023 were analyzed retrospectively. Patients were classified into the PDAP group and the non-PDAP group based on the occurrence of PDAP as recorded in the medical records system. The clinical data and laboratory indicators of the two patient groups were collected and compared. Collinearity analysis was performed on the significantly different variables, and those without collinearity issues were included in a logistic regression model to identify factors associated with infection. The statistically significant variables from the regression analysis were used as predictors to construct a nomogram risk prediction model for the occurrence of infections in patients, and the model was subsequently validated.Results:Among the 90 patients, 21 (23.33%) developed PDAP and were included in the PDAP group, while the remaining 69 patients (76.67%) did not develop PDAP and were included in the non-PDAP group. The differences in baseline systemic inflammatory response index (SIRI), serum albumin (ALB), blood potassium levels, hemoglobin (Hb) levels, and dialysis duration between the two groups were statistically significant [(1.53 ± 0.45) vs. (1.31 ± 0.32), (28.67 ± 3.64) g/L vs. (34.61 ± 4.13) g/L, (3.13 ± 0.47) mmol/L vs. (3.97 ± 0.51) mmol/L, (90.83 ± 10.15) g/L vs. (107.27 ± 10.66) g/L, 43.00 (38.50, 48.00) months vs. 34.00 (32.00, 38.00) months, t/ Z = 3.17, 5.92, 6.72, 6.25, 7.03, all P < 0.05]. None of the indicators exhibited collinearity issues (variance inflation factor ≤ 10, tolerance ≥ 0.1), allowing for their inclusion in the logistic regression model. According to the logistic regression analysis, baseline SIRI ( OR = 5.816, 95% CI: 1.404-24.097) and dialysis duration ( OR = 1.412, 95% CI: 1.214-1.643) were identified as independent risk factors for the occurrence of PDAP in patients with diabetic nephropathy. In contrast, ALB ( OR = 0.653, 95% CI: 0.533-0.801), blood potassium levels ( OR = 0.025, 95% CI: 0.005-0.132), and Hb levels ( OR = 0.867, 95% CI: 0.811-0.926) were protective factors against the occurrence of PDAP. A prediction model incorporating these five predictors was established using logistic regression, and corresponding nomograms were plotted along with a decision curve and calibration curve. The net benefit rate of the prediction model within the threshold range was high, indicating that the accuracy of the model was good. Conclusions:Baseline SIRI, ALB, blood potassium levels, Hb levels, and dialysis duration in patients with diabetic nephropathy are all related risk factors for the occurrence of PDAP after peritoneal dialysis treatment. The nomogram model constructed based on these indicators can aid in the clinical screening of high-risk populations and provide a theoretical basis for the implementation of preventive and therapeutic measures.

Objective To observe the clinical efficacy of Zishen Shujing decoction in the treatment of kidney deficiency and liver depression type premature ovarian failure(POF).Methods A total of 70 female POF patients who visited the Fourth Clinical Medical College of Guangzhou University of Traditional Chinese Medicine from July 2023 to April 2024 were selected as the research subjects,they were divided into traditional Chinese medicine(TCM)treatment group(n=35)and Western medicine treatment group(n=35)by using a random number table method.Western medicine treatment group was treated with femostone,and TCM treatment group was treated with Zishen Shujing decoction.Differences of TCM syndrome scores and clinical efficacy were compared between two groups before and after treatment,and changes of peripheral blood follicle-simulating hormone(FSH),anti-Müllerian hormone(AMH),anal follicle count(AFC)and interleukin(IL)-4,IL-6 before and after treatment were compared.Results The effective rate of TCM treatment group was higher than that of Western medicine treatment group,the difference was statistically significant(P<0.05).The TCM syndrome scores after treatment were lower than before treatment,and TCM treatment group was lower than Western medicine treatment group,the difference was statistically significant(P<0.05).After treatment,FSH levels in two groups were lower than before treatment,AMH and AFC levels were higher than before treatment,and improvement of hormone levels,AMH and AFC in TCM treatment group was better than that in Western medicine treatment group,with statistical significance(P<0.05).After treatment,the anti-inflammatory factors IL-4 were increased,and the pro-inflammatory factors IL-6 were decreased,and the increase effect of anti-inflammatory factors and the decrease effect of pro-inflammatory factors in TCM treatment group were better than those in Western medicine treatment group with statistical significance(P<0.05).Conclusion Zishen Shujing decoction can improve the clinical symptoms,serum hormone levels of POF patients with kidney deficiency and liver depression,improve ovarian function,reduce immune inflammation,reduce oxidative stress,and effectively improve the quality of life of patients.

Objective:To explore the influencing factors of hematoma enlargement in patients with hypertensive intracerebral hemorrhage and construct a corresponding risk prediction nomogram. The screening effects of the constructed model and different hematoma enlargement risk assessment tools were compared and analyzed.Methods:Two hundred and thirty-two patients with hypertensive intracerebral hemorrhage from the Department of Neurosurgery, Lianyungang First People's Hospital from April 2021 to February 2022 were selected as the research subjects. Multivariate Logistic regression was used to analyze the risk factors of hematoma expansion in patients with hyperhemamic intracerebral hemorrhage, and R software was used to construct a nomo diagram. The receiver operating characteristic curve (ROC) and Hosmer-Lemeshow (H-L) goodness-of-fit were used to evaluate the discrimination and calibration of the model, and the decision curve was used to analyze the clinical validity of the model. The constructed Nomo diagram, nine-point method and BRAIN score were used to assess the risk of hematoma enlargement in the included patients and used them as test variables, and the ROC curve was plotted to compare and analyze the area under the ROC curve, sensitivity and specificity of the constructed Nomo diagram, nine-point method and BRAIN score. The Kappa test was used to analyze the consistency between the Nomo diagram, the nine-point method, and the BRAIN score and the hematoma expansion results.Results:The results of multivariate logistic regression analysis showed that blood pressure was poorly controlled ( OR=13.290, 95% CI: 3.676-48.049), ventricular penetration ( OR=4.825, 95% CI: 1.458-15.975), early neurological deterioration ( OR=27.740, 95% CI: 8.713-88.314), Glasgow Coma Scale(GCS)≤8 points ( OR=25.883, 95% CI: 6.542-102.404) was the main influencing factor for hematoma expansion in patients with hypertensive intracerebral hemorrhage (The P values were <0.001, 0.010, <0.001, and <0.001, respectively). The H-L test results of Nomogram for predicting hematoma enlargement were χ2=3.20, P=0.525, the calibration curve was close to the ideal curve, and the mean absolute error was 0.015, and the decision curve analysis showed that the model had good clinical validity. The ROC results showed that the area under the ROC curve of the constructed Neumo diagram, nine-point method and BRAIN score were 0.971 (95% CI: 0.941-0.989), 0.696 (95% CI: 0.632-0.755), and 0.778 (95% CI: 0.719-0.830)(all P<0.001). The sensitivities were 94.37%, 71.83%, and 84.51%, and the specificities were 90.68%, 58.39%, and 65.84%, respectively. The results of Kappa test showed that the Kappa values of Nuomo diagram, nine-point method and BRAIN score were 0.806 , 0.264 and 0.429 (all P<0.001). Conclusion:The main influencing factors of hematoma enlargement in patients with hypertensive intracerebral hemorrhage were poor blood pressure control, intraventricular hemorrhage, early neurological deterioration, and GCS score. The effect of the constructed Nuomo diagram model in predicting hematoma expansion in patients with hypertensive intracerebral hemorrhage is better than that of the nine-point method and the BRAIN score, which has clinical application value.