Objective To explore the application of nucleic acid test in the diagnosis of HIV western blotting (WB) indeterminate and negative samples. Methods A total of 2 518 HIV samples to be confirmed were collected from the Hubei HIV Confirmation Center Laboratory from 2014 to 2022. The results of follow-up antibody test and nucleic acid test of WB indeterminate and negative samples were analyzed, and the diagnostic rate, sensitivity, specificity and coincidence rate of the two detection strategies were compared. Results There were totally 133 indeterminate or negative samples by WB test. Of the 99 indeterminate samples , 76 (76.77%) had nucleic acid test results >5000 copies/mL. 40 cases were followed up, of which 33 cases (82.50%) turned positive and 7 (17.50%) were still uncertain. Of the 7 samples with 20~5000 copies /mL (7.07%), 2 cases were followed up and both turned positive during the follow-up. 1 case (1.01%) with nucleic acid <20 copies/mL turned positive during follow-up. Among the 34 WB negative samples, 15 cases (45.45%) were > 5 000 copies/mL, 9 of which were seroconversion. The diagnostic rates of ^“antibody confirmation^” and ^“nucleic acid test^” were 96.78% (2 437/2 518) and 99.60% (2 508/2 518), respectively. The sensitivities were 98.02% (2 430/2 479) and 99.88% (2476/2 479), and the specificities were 78.13% (25/32) and 100.00 % (32/32), respectively. The coincidence rates were 97.77% (2 455/2 511) and 99.88% (2 508/2 511), respectively. Conclusion Nucleic acid supplemental test strategy has high diagnostic rate, sensitivity, specificity and coincidence rate. WB indeterminate and negative samples can be diagnosed as early as possible through nucleic acid supplemental testing.

The construction of smart hospital is an important part of modern hospital management system,and it is also the key way to build the new system of high-quality hospital development.In terms of building smart hospitals,multi-campus hos-pitals face more difficulties and challenges than single campus hospitals,such as the lack of top-level design,the difficulty of in-tegrated management,the uneven development of hospitals and the widespread phenomenon of information islands.This study summarizes and analyzes the difficulties encountered in the construction and application of smart hospitals in multi-hospital areas.Guided by problems,it puts forward countermeasures and suggestions for the construction of refined and high-quality smart hospi-tals in multi-campus hospitals,including strengthening overall and forward-looking awareness,integrating management according to hospital conditions,characteristic development under demand guidance,establishing a data integration center for smart hospi-tals,scientific planning of talent reserve and discipline layout,etc.

Objective:To explore the clinical outcomes of locking compression plating (LCP) in the treatment of periprosthetic fracture (PPF) of the distal femur in the aged patients.Methods:A retrospective study was performed to analyze the 31 aged patients who had been treated at Department of Orthopedic Surgery, The Affiliated Hospital to Nantong University for PPF of the distal femur with LCP between June 2012 and May 2023. There were 27 females and 4 males with an age of (80.2±6.1) years. According to the Unified Classification System (UCS), 18 PPFs were classified as type Ⅴ.3B1 and 6 PPFs as type Ⅴ.3B2 after total knee arthroplasty and 7 PPFs as type Ⅳ.3C after total hip arthroplasty. The patients were fixated with a lateral single plate in 25 cases, and with lateral and medial dual plates in 6 cases. The surgical time, intraoperative blood loss, hospitalization time, postoperative weight-bearing time, fracture healing time, and knee joint function and complications during follow-up were recorded.Results:For the 25 patients undergoing fixation with a lateral single plate, the surgical time was (58.7±7.9) minutes, the intraoperative blood loss (78.0±15.1) mL, the hospitalization time (6.9±1.6) days, the postoperative weight-bearing time (5.9±1.4) days, and the follow-up time 37 (15, 51) months. For the 6 patients undergoing fixation with lateral and medial dual plates, the surgical time was (186.6±9.8) minutes, the intraoperative blood loss (1,256.7±231.2) mL, the hospitalization time (17.8±3.3) days, the postoperative weight-bearing time (3.6±0.6) days, and the follow-up time 17 (16, 21) months. The fracture healing time was (14.9±2.0) and (18.7±2.6) weeks, respectively, for patients fixed with single and double steel plates. By the scoring criteria of the American Hospital for Special Surgery (HSS), the knee joint function was evaluated at the last follow-up as excellent in 10 cases and as good in 15 cases for the 25 patients undergoing fixation with a lateral single plate, and as good for all the 6 patients undergoing fixation with lateral and medial dual plates. No patient experienced such complications as incision infection, bone nonunion, or internal fixation failure during the follow-up period.Conclusions:LCP fixation can achieve satisfactory outcomes in the treatment of PPF of the distal femur in the aged patients. As fixation with a single lateral femoral plate is suitable for most of the aged patients with PPF of the distal femur, it can be used as the first choice. Fixation with dual plates can provide stronger stability, but its indications should be strictly controlled.

Objective:To investigate the combination of internal fixation for periprosthetic fractures of the proximal femur (PFFF) after hip arthroplasty.Methods:The data of 58 patients with periprosthetic fractures after hip arthroplasty from May 2008 to March 2022 were retrospectively analyzed, including 31 males and 27 females. The average age was 75.5±18.2 years (range, 35-95 years). There were 39 total hip arthroplasty and 19 hemiarthroplasty; 37 biological prosthesis and 21 cemented prosthesis. Intraoperative periprosthetic fractures occurred in 6 cases and 52 cases postoperatively. Unified classification system (UCS): UCS IV.3A1 type 2 cases, 3A2 type 1 case, 3B1.1 type 19 cases, 3B2.1 type 25 cases, 3B3 type 2 cases, 3C type 9 cases. Fracture site: 3 cases in zone A (greater trochanter), 46 cases in zone B (around the femoral stem), and 9 cases in zone C (distal to the tip of the femoral stem. Internal fixation is composed of primary and secondary fixation, the main fixation method was the cerclage of steel wire or titanium cable, locking compression plate, and locking attachment plate fixation. The secondary fixation method was the cerclage of titanium cable, which was required to cover three zones A, B and C to form an overall balanced fixation. The modified Harris hip scores (mHHS), plate length, working length and screw number of different internal fixation combinations were compared.Results:The follow-up time was 54.2±21.6 months (range, 11-86 months). All patients showed signs of fracture healing at 10.2±1.5 weeks (range, 7-13 weeks) after operation, and bony union was observed at 19.6±1.3 weeks (range, 17-22 weeks) after operation. No delayed union or nonunion was observed. After operation, one case had a stress fracture and was revised with double-plate internal fixation; one case had a failed internal fixation and was revised with double-plate internal fixation and a large allograft bone graft. The mHHS score of UCSIV.3B2.1 group (80.3±4.6) was the lowest at 6 months after operation, and the difference between the groups of different types was statistically significant ( F=256.72, P<0.001). The score of simple internal fixation group (91.6±4.2) was higher than that of revision combined with internal fixation group (81.9±4.1), and the difference was statistically significant ( t=8.32, P<0.001). The plate length and working length were 24.9±2.5 cm and 12.6±1.7 cm for UCS IV.3B1.1, 25.4±2.6 cm and 13.6±1.8 cm for 3B2.1 and 28.1±2.5 cm and 4.9±1.9 cm for 3C, respectively ( F=5.33, P=0.005; F=6.78, P<0.001). The number of screws in zone A was significant difference among different UCS types ( F=52.67, P<0.001); UCS IV.3B1.1 (6.5±2.3) and 3B2.1 (6.7±2.2) were more than 3B3 (3.5±1.5) and 3C (3.7±1.6). The number of screws in zone B was significant difference among different UCS types ( F=42.15, P<0.001); The number of UCS IV.3B1.1 (2.3±1.6) and 3B2.1 (2.8±1.9) were significantly more than that of 3B3 (1.0±0.5) and 3C (1.2±0.6). The number of screws in zone C was significant differences among different UCS types ( F=39.62, P<0.001); The number of UCS IV.3B1.1 (3.8±1.9) and 3B2.1 (3.9±1.7) were more than that of 3B3 (2.0±0.5), the difference was statistically significant ( P<0.05). Conclusion:The function of hip after simple internal fixation of proximal femoral periprosthetic fractures was better than that of those who underwent revision at the same time; the number of screws of UCSIV.B1 and B2 is more than that of B3.

Surgery for periprosthetic fractures (PPF) is one of the most complex procedures in orthopedics. It is difficult, highly risky and extremely challenging, because the patients are usually advanced in age and suffering from essential organ dysfunction, numerous comorbidities, poor overall body condition, poor bone quality combined with osteolysis and even bone loss, and because the surgeons have to apply the concepts and techniques of Modern Orthopedic Trauma and artificial joint revision techniques in fracture fixation and prosthesis revision. This paper expounds on the clinical challenges due to the characteristics of PPF in order to call on clinical surgeons to update their concepts, deal with seriously and standardize their PPF treatment, and effectively improve their efficacy.

Objective To analyze HIV-1 drug resistance gene mutations in AIDS patients who failed first-line antiviral therapy in Hubei Province from 2017 to 2018, and to provide references for clinical treatment. Methods Plasma samples of HIV patients who had received first-line antiviral treatment for more than 12 months and had a viral load greater than 103 copies / ml were collected in Hubei Province, and drug resistance genotypes were detected. The prevalence and characteristics of drug resistance were analyzed. Results A total of 198 patients were selected, and 182 target gene sequences were successfully detected. The gene subtypes were mainly CRF01_{_}AE, with a total drug resistance rate of 69.23%. The proportion of NRTIs, NNRTIs and PIs resistance mutations was 46.15%, 65.38% and 0.55%, respectively. The occurrence of cross resistance mutations of NRTIs and NNRTIs reached 40.66%. The mutation sites related to NRTIs were mainly M184V and K65R, while the mutation sites related to NNRTIs were mainly V179D, K103N and Y181C. There was only one case of PIs related mutation at the site of M46I. Conclusion HIV-1 genotyping demonstrated a high proportion of drug resistance in the HAART failure population in Hubei Province, and multi-drug resistance occurred frequently. It is necessary to strengthen the monitoring of drug resistance, implement timely adjustments to antiviral treatment programs, and reduce the occurrence and spread of drug-resistant strains.

Objective:To measure and analyze the distribution characteristics of the micro-hardness of the middle-upper thoracic vertebrae (T 1-T 10) in the human body. Methods:T 1-T 10 vertebrae from three fresh cadavers were divided into vertebral body area and attachment area. 3 mm specimens were cut by a high-precision slow saw and 11 regions were selected and measured on each vertebrae by a Vickers microhardness tester (cortical bone: 1-9, cancellous bone: 10-11). The micro-hardness distribution of T 1-T 10 vertebrae was recorded and analyzed. Results:A total of 330 measurement areas from 30 vertebrae were measured, and 1 650 hardness values were collected. The average hardness values of the overall cortical bone of the middle-upper thoracic vertebrae of the 3 cadavers were 30.55±5.44 HV, 29.94±4.86 HV, and 29.55±4.36 HV, respectively. The difference among the groups was statistically significant ( F=4.680, P=0.009). The average hardness values of the overall cancellous bone were 27.93±5.61 HV, 28.21±4.96 HV, 27.98±3.94 HV, respectively. There was no significant difference among the groups ( F=0.091, P=0.913). There were statistically significant differences between the hardness values in the attachment area and vertebral body area of each cadaver ( t=7.467, 4.750, 6.621, P<0.001); the hardness of the cancellous bone in the attachment area of each cadaver was higher than that of the cancellous bone in the vertebral body ( t=1.785, 3.159, 3.103, P=0.077, 0.002, 0.003). The distribution of microhardness in 11 measurement areas of 3 cadavers were similar: the hardness of the cortical bone of pedicle, lamina and inferior endplate cortex (1, 2, 7) were higher; the hardness of the cortical bone of upper endplate and peripheral cortex (6, 8, 9) were lower. The distribution patterns of the microhardness in different vertebral segments of the 3 cadavers were similar: The hardness values gradually increased from T 1 to T 10. The vertebra with the largest hardness of the cortical bone was T 8; and the vertebra with the largest hardness of the cancellous bone were T 7, T 7 and T 6, respectively. Conclusion:The hardness of the upper endplate and peripheral cortex was low, which could disperse the load to protect the fragile cancellous bone. The hardness of the pedicle was the highest. The hardness of the cortical bone was higher than that of the cancellous bone, and the values of different segments gradually increased from top to bottom, which may be related to the physiological and anatomical morphology, and the gradual increase of the load of muscle force and body weight.

Objective: To understand the status quo of social support for and social adaptation of HIV/AIDS patients in Henan province, analyze the relationship between social support and social adaptation, and provide reference for improving the quality of life of HIV/AIDS patients. Methods: A multi-stage stratified random sampling method was adopted to select HIV/AIDS patients in high HIV prevalence areas (Shangcai, Shenqiu), middle epidemic areas (Queshan, Yongcheng), low prevalence areas (Jiyuan, Sanmenxia) in Henan province. A social support scale was used to investigate the three dimensions of objective support, subjective support and support utilization. A social adaptation scale was used to investigate the three dimensions of patient cognitive willingness, social interaction and role adaptation. Finally, the characteristics of the social support, social adaptation and their relationships were analyzed. Results: The overall score of 506 HIV/AIDS patients’ social support was 36.30±9.34, the score of objective support was 7.48±3.01, the score of subjective support was 22.35±5.79, and the score of support utilization was 6.28±2.38, the overall score and the scores of three dimensions of social support of HIV/AIDS patients were lower than the national levels, and the differences were statistically significant (P<0.05). The overall score of patients’ social adaptation was39.10±7.10, the score of cognitive willingness was 9.96±3.23, the score of social interaction was 18.57±3.25, and the score of role adaptation was 10.57±2.52. The average score of social adaptation of patients was less than 2/3 of the overall score, and the average cognitive willingness score was less than 1/2 of the overall score. The differences in social support score and social adaptation score among patients with different gender, age, marital status, occupation, transmission route, number of symptoms were statistically significant (P<0.05). For the HIV/AIDS patients, there was a correlation between the social support and the social adaptation (r=0.14, P<0.05). Conclusion HIV/AIDS patients had a low level of social support and social adaptation, and social support might be a contributing factor to the social adaptation of HIV/AIDS patients.

Objective To explore the effect of L-ascorbic acid(AA) for reducing the fibroblast cells induced by cobalt(co)cytotoxicity.Methods The experiment was divided into the blank control group,Co2+ group,Co2++AA group,cobalt nanoparticles(CoNPs) group,CoNPs+AA group and AA group.The AA pretreated for 1 h was performed in advance.The CCK8 assay was used to detect the CoNPs and Co2+ induced and AA-treated cytotoxicity.The fluorescence staining was used to measure the production of ROS in mitochondria.The real-time polymerase chain reaction(PCR) and Western blot were used to measure the expression of related protein and related molecular mRNA respectively.Moreover the cytochrome-C level in cytoplasml was detected.Results After treating the cells by CoNPs and Co2+,the cells appeared apoptosis.CoNPs could significantly induce ROS generation;the proapoptotic factors(caspases-3,and Bax) were significantly increased,while the anti-apoptotic factor Bcl-2 expression was decreased;cytochrome C and AIF expressions were up-regulated and released from mitochondria into the cytoplasm,after AA pretreatment,these changes caused by CoNPs were decreased.Conclusion AA can reduce the CoNPs caused cytotoxicity by reducing ROS generation and release,but can not weaken the Co2+ toxic effect.