Objective:To analyze the characteristics of non-seroconverted cases after rabies vaccination and observe the effect of booster vaccination.Methods:A retrospective collection of data was conducted from March 2022 to March 2023 across 409 rabies vaccination clinics in 27 provinces in China, focusing on cases with rabies virus neutralizing antibody (RVNA) levels less than 0.5 IU/ml after vaccination.Results:A total of 77 cases were identified in whom seroconversion was not observed within 30 days post-vaccination with the rabies vaccine. The gender distribution was 51.9% male and 48.1% female, with ages ranging from 2 to 83 years old. Delayed vaccination was observed in 11 cases (14.3%), and 63 cases (81.8%) received human rabies immunoglobulin (HRIG) injections. None of the cases had a confirmed immunosuppressive disease or taking immunosuppressive drugs, and the body mass index (BMI) distribution ranged from 14.37 to 34.74 kg/m 2. Seventy-six cases seroconverted after 1 to 3 doses of rabies vaccines as a booster vaccination. One case that did not seroconvert after the initial booster vaccination seroconverted after receiving additional 2 doses of vaccine. All patients were followed up for one year, with no cases of rabies reported. Conclusions:The characteristics of cases that failed to seroconvert after the full course of rabies vaccination lacked specificity, and booster vaccination could lead to seroconversion.

Purpose To investigate the clinicopathological characteristics of nephrogenic adenoma/metaplasia(NA/M)of the bladder and analyze key points for diagnosis and differential diagnosis.Methods A retrospective a-nalysis was conducted on 10 cases of NA/M of the bladder,including clinical data,cystoscopic findings,microscopic morphology,and immunohistochemistry(IHC)results.Subsequently,a whole-exome sequencing(WES)was per-formed and a comprehensive literature review was supplemented.Results The cohort included 6 cases female and 4 cases male,aged 20-72 years(median:46.5 years).Three patients had a history of hydronephrosis(2 cases with nephrolithiasis and hydronephrosis,1 case with acute leukemia and bone marrow transplantation),2 cases had renal tuberculosis,1 case had erectile dysfunction,3 cases had a history of invasive high-grade urothelial carcinoma of the bladder,and 1 case had bladder endometriosis.All patients underwent cystoscopic biopsy,with pathological confirma-tion of NA/M.IHC showed that all 10 cases expressed PAX-8 and CK7 but were negative for GATA-3,p63/CK5/6,and PSA.The Ki67 proliferation index ranged from 1％to 10％.WES analysis of 7 cases revealed somatic single nu-cleotide variants(SNVs)involving multiple genes,with the highest mutation frequencies in FAM186A(86％),GOL-GA6L2(86％),and AQP7(86％).Conclusion NA/M is a benign but recurrent lesion,with rare malignant trans-formation after multiple recurrences.Comprehensive evaluation of histomorphological atypia and IHC results is recom-mended for accurate diagnosis and differential diagnosis to avoid misdiagnosis.Long-term follow-up is advised.WES findings suggest associations between NA/M and mutations in FAM186A,GOLGA6L2,and AQP7,providing potential directions for future research.

Purpose To investigate the clinicopathological characteristics of nephrogenic adenoma/metaplasia(NA/M)of the bladder and analyze key points for diagnosis and differential diagnosis.Methods A retrospective a-nalysis was conducted on 10 cases of NA/M of the bladder,including clinical data,cystoscopic findings,microscopic morphology,and immunohistochemistry(IHC)results.Subsequently,a whole-exome sequencing(WES)was per-formed and a comprehensive literature review was supplemented.Results The cohort included 6 cases female and 4 cases male,aged 20-72 years(median:46.5 years).Three patients had a history of hydronephrosis(2 cases with nephrolithiasis and hydronephrosis,1 case with acute leukemia and bone marrow transplantation),2 cases had renal tuberculosis,1 case had erectile dysfunction,3 cases had a history of invasive high-grade urothelial carcinoma of the bladder,and 1 case had bladder endometriosis.All patients underwent cystoscopic biopsy,with pathological confirma-tion of NA/M.IHC showed that all 10 cases expressed PAX-8 and CK7 but were negative for GATA-3,p63/CK5/6,and PSA.The Ki67 proliferation index ranged from 1％to 10％.WES analysis of 7 cases revealed somatic single nu-cleotide variants(SNVs)involving multiple genes,with the highest mutation frequencies in FAM186A(86％),GOL-GA6L2(86％),and AQP7(86％).Conclusion NA/M is a benign but recurrent lesion,with rare malignant trans-formation after multiple recurrences.Comprehensive evaluation of histomorphological atypia and IHC results is recom-mended for accurate diagnosis and differential diagnosis to avoid misdiagnosis.Long-term follow-up is advised.WES findings suggest associations between NA/M and mutations in FAM186A,GOLGA6L2,and AQP7,providing potential directions for future research.

Objective:To analyze the characteristics of non-seroconverted cases after rabies vaccination and observe the effect of booster vaccination.Methods:A retrospective collection of data was conducted from March 2022 to March 2023 across 409 rabies vaccination clinics in 27 provinces in China, focusing on cases with rabies virus neutralizing antibody (RVNA) levels less than 0.5 IU/ml after vaccination.Results:A total of 77 cases were identified in whom seroconversion was not observed within 30 days post-vaccination with the rabies vaccine. The gender distribution was 51.9% male and 48.1% female, with ages ranging from 2 to 83 years old. Delayed vaccination was observed in 11 cases (14.3%), and 63 cases (81.8%) received human rabies immunoglobulin (HRIG) injections. None of the cases had a confirmed immunosuppressive disease or taking immunosuppressive drugs, and the body mass index (BMI) distribution ranged from 14.37 to 34.74 kg/m 2. Seventy-six cases seroconverted after 1 to 3 doses of rabies vaccines as a booster vaccination. One case that did not seroconvert after the initial booster vaccination seroconverted after receiving additional 2 doses of vaccine. All patients were followed up for one year, with no cases of rabies reported. Conclusions:The characteristics of cases that failed to seroconvert after the full course of rabies vaccination lacked specificity, and booster vaccination could lead to seroconversion.

Non-neonatal tetanus is an acute, specific, toxic disease in patients over 28 days of age, characterized by continuous rigidity and paroxysmal spasms of the skeletal muscles throughout the body caused by the intrusion of Clostridium tetani through skin or mucosal membrane into the body and reproducing in anaerobic environments to produce exotoxins. The mortality rate of severe patients is close to 100% without medical intervention. Even with aggressive comprehensive treatment, the global mortality rate remains at 30%-50%, making it a potentially fatal disease. In order to standardize the diagnosis, treatment and prevention of non-neonatal tetanus, based on "Regulation for Diagnosis and Treatment of Non-neonatal Tetanus (2019 Edition)", experts have revised this regulation according to clinical practice and recent research progress in this field to guide medical institutions in the prevention and control of non-neonatal tetanus. This article interprets the key points and basis for updating the 2024 edition regulation to guide clinical implementation and application.

Since 2007, the annual incidence of human rabies in China has been continuously decreasing, and China has entered the critical stage of eliminating human rabies. China will prioritize the control of rabies among dogs as the primary task for human rabies prevention and control, and implement surveillance and containment strategies, while also focusing on improving the standardization of post-exposure prophylaxis (PEP) for rabies. The sufficient production capacity of rabies immune preparations in China provides good biological product guarantee conditions for rabies prevention and control. However, dog management issues are prominent in China, not only affecting canine immunization, but also leading to a high number of canine injuries, resulting in huge costs for human rabies PEP. China lags behind in developing cheaper and more efficient rabies vaccines, which can help more rabies-exposed individuals obtain PEP. There are no insurmountable technical barriers in rabies prevention and control in China, and the prospect of achieving the elimination of human rabies by 2030 in China is promising.

Objective:To analyze the epidemiological characteristics of rabies in China from 2007 to 2023, and to provide reference evidence for tailoring strategies to facilitate the elimination of rabies in the country.Methods:Case data from 2007 to 2023 were obtained from China′s National Notifiable Infectious Disease Reporting Information System, and the spatial, temporal, and demographic features of cases were analyzed.Results:From 2007 to 2023, a total of 18 751 human rabies cases were reported in China, with an average annual incidence rate of 0.08 per 100 000. The average annual percentage change (AAPC) in incidence rate was -18.58% (95% CI: -21.32% to -15.75%, P<0.05), with three significant turning points in 2011, 2018, and 2021. Based on the trend of the epidemic, Chinese provinces can be roughly divided into five categories. The geographical range affected by rabies has decreased from 23 provinces and 984 counties (districts) in 2007 to 17 provinces and 101 counties (districts) in 2023. Since 2019, the high-incidence counties (districts) have been mainly concentrated in the southwestern part of Hunan, the southern part of Henan, and the western part of Anhui. Fourteen provinces have reported no cases for at least two consecutive years. Males (70.24%) and farmers (72.18%) were the main affected groups, and the proportion of cases aged 65 and above increased from 17.43% in 2007 to 36.07% in 2023. Conclusions:The incidence of rabies in China has changed from endemic in many areas to sporadic, with the remaining endemic regions mainly located in parts of the middle and lower reaches of the Yangtze River. The main vulnerable groups are middle-aged and elderly farmers. The current prevention and control measures can effectively curb the transmission of rabies, but the decline of cases has slowed down recently.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Rabies is one of the important zoonotic infectious diseases, with a mortality rate of almost 100%. Rabies is a vaccine preventable disease, and proper rabies exposure prophylaxis can effectively prevent the occurrence of human rabies. In recent years, there has been significant progress in clinical research on the rabies exposure prophylaxis both domestically and internationally. World Health Organization (WHO) released the Rabies Vaccine: WHO Position Paper-April 2018. In order to guide medical institutions of all levels in rabies exposure prophylaxis, the National Administration of Disease Prevention and Control, in conjunction with the National Health Commission of the People's Republic of China, organized the Rabies Vaccine Working Group of the National Immunization Program Technical Working Group and invited experts to revise and issue the National Regulation for the Rabies Exposure Prophylaxis (2023 Edition). This article compares the National Regulation for the Rabies Exposure Prophylaxis (2009 Edition) and interprets the updated key points and supporting basis of the new version of the guidelines to guide clinical application and implementation.

The purified Vero cell rabies vaccine (PVRV) has been used in rabies prevention for more than 40 years. A comprehensive review of the relevant researches on PVRV in rabies prevention at local and overseas in recent years shows that in the simplified Zagreb immunization program, PVRV has the similar immunogenicity and safety as in the standard Essen program. PVRV, purified chicken embryo cell rabies vaccine (PCECV) and human diploid cell rabies vaccine (HDCV) have similar immunogenicity and safety. PVRV also has good immunogenicity and safety in special populations such as those with diseases. The combined vaccination of PVRV and acellular diphtheria, tetanus, pertussis and inactivated poliomyelitis combined vaccine (DTP-IPV) or others did not find immune interference, which provided feasibility for children to vaccinate against rabies at the same time of vaccinating with planned vaccines. The combination of PVRV and equine rabies immunoglobulin can also achieve better prevention effect. PVRV plays an important role in the prevention of rabies, and its wide application will make a positive contribution to achieving the goal of eliminating rabies transmitted from dogs to humans by 2030 proposed by World Health Organization (WHO).