ObjectiveThis study aimed to investigate the HIV genotypic subtypes and molecular transmission clusters among men who have sex with men （MSM） with newly reported HIV infections in Dehong Dai and Jingpo Autonomous Prefecture （Dehong Prefecture）， Yunnan Province， China， between 2010 and 2019. The study aimed to identify potential high-risk transmitters and provide reference data for screening， management， and intervention of infection sources. MethodsPlasma samples from newly reported HIV-positive MSM individuals in Dehong Prefecture between 2010 and 2019 were collected. The viral pol gene fragments were amplified， sequenced， and genotyped. Genetic distances （GD） between pairwise sequences were analyzed and calculated. MEGA 7.0 and Gephi were used for phylogenetic and molecular transmission network analysis. ResultsA total of 159 newly reported HIV infections among MSM were included in the study， with successful genotyping of 100 cases. Nine HIV-1 subtypes were identified， with the most prevalent being CRF01_AE subtype （52%）， followed by CRF07_BC subtype （31%）， CRF55_01B subtype （10%）， and others （7%）. Cluster analysis revealed a total network access rate of 67%， forming three transmission clusters. CRF01_AE subtype formed two transmission clusters with 38 and 3 infected individuals， while CRF07_BC subtypes formed one transmission cluster with 26 infected individuals. The transmission network within the CRF01_AE clusters exhibited a more complex relationship. Significant differences in educational level were observed between the two main transmission clusters. ConclusionThe predominant HIV subtypes among newly reported MSM cases in Dehong Prefecture between 2010 and 2019 were CRF01_AE and CRF07_BC. Significant cultural differences are observed between the main transmission clusters. Continued monitoring of genotypic subtypes and targeted interventions within transmission clusters are warranted.

OBJECTIVE To establish the met hod for the purific ation of test sample of Banxialu granules ，and to determine the contents of 4 ephedrine components such as ephedrine ，pseudoephedrine，norpseudoephedrine and methylephedrine. METHODS Three batches of Banxialu granules were extracted with methanol（containing 1％formic acid ）and pretreated with QuEChERS method of N-propyl ethylenediamine adsorbent （PSA）and octadecyl bonded silica gel adsorbent （C18）. Ultra high performance liquid chromatography tandem triple quadrupole mass spectrometry （UHPLC-MS/MS）was adopted. The separation was performed on an Agilent XDB-C 18 column with 5 mmol/L ammonium acetate solution （containing 0.1％ formic acid ）-acetonitrile as mobile phase（gradient elution ）at the flow rate of 0.40 mL/min. The column temperature was set at 30 ℃，and sample size was 2 μL. The electrospray ionization source was adopted ，and positive ion scanning was performed in multiple reaction monitoring mode. The ion pairs used for quantitative analysis were m/z 166.2→148.1（ephedrine，pseudoephedrine），m/z 152.2→134.1（norpseudoephedrine）， m/z 180.2→162.2（methylephedrine）. RESULTS The solution obtained by QuEChERS purification method was clear and nearly colorless. The linear ranges of ephedrine ， pseudoephedrine， norpseudoephedrine and methylephedrine were 1.38-206.82， 1.41-212.13，1.29-19.34，1.99-59.83 ng/mL（r＞0.99）. The limits of detection were 0.41，0.42，0.39 and 0.60 ng/mL. The limits of quantitation were 1.38 ，1.41 ，1.29 and 1.99 ng/mL，respectively. RSDs of precision ，stability（48 h）and repeatability tests were all lower than 2％. The average recoveries were 95.75％-100.87％（RSD＜2％，n＝9）. The contents of above 4 ephedrine components were 20.62-26.02，20.96-24.90，2.26-2.63，5.36-6.32 μg/g， respectively. CONCLUSIONS Established method is simple ，rapid，sensitive and suitable for simultaneous determination of 4 ephedrine components in Banxialu granules.

Objective:To learn about the epidemic law of animal plague in natural plague focus of Himalayan Marmot in Yumen City of Gansu Province, to explore the epidemiological characteristics of plague in the area and to provide scientific basis for formulating prevention and control strategies of the plague. Methods:The animal plague surveillance data of natural plague focus of Himalayan Marmot in Yumen City, Gansu Province from 2014 to 2021 were collected, main host density, rate of infected with fleas, flea index, small rodent species, bacteriology, serology were studied. Excel 2007 software was used to analyze the plague epidemic situation in the focus. Results:From 2014 to 2021, the total average density was 0.06 per hm 2 of the marmots. A total of 19 300 traps were placed, and 209 rats were caught, with an average catch rate of 1.08%. Among them, Dipus sagitta (59.81%, 125/209) and Mongolian Five-toed Jerboa(31.10%, 65/209) were dominant small rodent species. Totally 877 marmots were checked, 184 with flea. The rate of infected with fleas of marmots was 20.98%, with a flea index of 1.00, Callopsylla dolabris (52.69%, 461/875) and Oropsylla silantiewi (47.20%, 413/875) were dominant species in vector. The rate of infected with fleas of burrow was 7.72% (173/2 241), with a flea index of 0.20. A total of 39 strains of Yersinia pestis were isolated from infected animals. Among them, 35 strains from the marmots, and 4 strains from vectors. Totally 913 serum samples were checked from marmots and shepherd dog, the positive serum was 34. Among them, the positive rate of shepherd dog was 13.98% (33/236). Conclusions:The plague epidemic situation in natural plague focus of Himalayan Marmot in Yumen City of Gansu Province is still serious. The monitoring of plague should be strengthened, and the comprehensive measures for prevention and control of the plague should be carried out to prevent a outbreak of the plague in human being.

Objective:To explore the value of multi-parametric MRI for thyroid gland in differentiating benign and malignant thyroid nodules.Methods:From December 2018 to May 2020, 78 patients with 91 post-surgically pathologically confirmed thyroid nodules were enrolled in Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. For each patient, the following MRI findings were obtained including the nodules′ location, size, shape, margin, signal intensity, cystic change, degree and pattern of contrast enhancement, involvement of surrounding structure, and ADC values. The time-intensity curve (TIC) were plotted and subtyped based on dynamic contrast enhancement MRI. The MRI findings between the benign and malignant thyroid nodules were compared using Mann-Whitney U test, χ 2 test or Fisher exact test. Multiple logistic regression analysis was used to select independent predictive variables and build a combined model, and the ROC curve was used to evaluate the diagnostic performance of each MRI finding and the combined model. Results:Between the benign and malignant thyroid nodules, the significant differences were found in size, shape, margin, presence of cystic changes, T 1WI signal intensity, ADC value, enhancement homogeneity, TIC subtypes and presence of thyroid capsule involvement ( P<0.05). Multivariate logistic analysis showed that ill-defined margin (OR=77.61), no presence of cystic changes (OR=36.11) and difference between TIC subtypes (OR=83.41) were independent predictive variables, and the area under the ROC curve (AUC) was 0.879, 0.788, and 0.751, respectively. The AUC, sensitivity and specificity of the combined model were 0.977, 0.986, and 0.904, respectively. Conclusions:Thyroid multi-parametric MRI derived findings can be used for the differential diagnosis of benign and malignant nodules. Combined with the independent risk factors with ill-defined margin, no presence of cystic changes, TIC of type plateau or washout, the diagnostic model has a higher diagnostic efficiency.

A 35-year-old male patient was admitted in October, 2018 to Burn and Plastic Surgery Department, Sanya Central Hospital (Hainan Third People’s Hospital) with diagnosis of complex pressure ulcer, hip arthritis, urethral fistula. The patient was treated with systemic support, debridement, negative pressure drainage, bilateral gluteus maximus myocutaneous flap and scrotal flap. After the two-week treatment with this method, the wounds were healed completely.

A 35-year-old male patient was admitted in October, 2018 to Burn and Plastic Surgery Department, Sanya Central Hospital (Hainan Third People’s Hospital) with diagnosis of complex pressure ulcer, hip arthritis, urethral fistula. The patient was treated with systemic support, debridement, negative pressure drainage, bilateral gluteus maximus myocutaneous flap and scrotal flap. After the two-week treatment with this method, the wounds were healed completely.

Objective: To explore the value of chest CT features and clinical indexes in the differential diagnosis between suspected COVID-19 with two or more negative nucleic acid tests and confirmed COVID-19. Methods: The clinical data and chest CT images of 105 cases withconfirmedCOVID-19 (55 males and 50 females, aged from 2 month to 88 years) and 97 cases with suspected COVID-19(59 males and 38 females, aged from 1 month to 93 years) were analyzed retrospectively in Shiyan Taihe Hospital from January 21 to February 10, 2020. χ²test and two independent sample t test were used to analyze the clinical data and CT signs of the two cases, with P<0.05 for the difference statistically significant. Results: Compared with the suspected patients, the average age of diagnosis of covid-19 was higher (t = 2.460, P = 0.01). The main pathological changes were pure ground glass (68 cases) and mixed ground glass density (53 cases) (χ² = 50.016, P< 0.01). Interstitial thickening (83 cases) (χ² = 55.395, P< 0.01), vascular thickening (73 cases) (χ² = 57.527, P< 0.01), air bronchoscopic sign or bronchiectasis Zhang (67 cases) (χ² = 17.899, P< 0.01), cord focus (54 cases) (χ² = 5.500, P = 0.02), easily distributed under the pleura and the long axis of the lesion was parallel to the pleura (89 cases) (χ² = 23.597, P< 0.01), most of them had no pleural effusion (χ² = 7.017, P< 0.01); both lesions were mainly distributed in patches (89 cases were confirmed, 87 suspected) (χ² = 19.573, P< 0.01). In addition, the lesions of patients with confirmed covid-19 showed progress in short term (72 / 87, 82.76%), and those with suspected covid-19 showed remission in short term (63 / 89, 70.78%). The difference was statistically significant (χ² = 51.114, P< 0.01). There was no significant difference in gender and distribution of pulmonary lobes (χ² = 1.462, P= 0.23; χ² = 7.381, P= 0.19). The number of white blood cells (χ² = 17.891, P< 0.01) and the percentage of lymphocytes (χ² = 11.151,P< 0.01) of covid-19 were mostly normal or decreased, creatine kinase (χ² = 9.589, P< 0.01) were mostly normal, and erythrocyte sedimentation rate was mostly normal or increased (χ² = 4.240, P= 0.04). Conclusions The imaging features and biochemical indexes of diagnosed COVID-19 are different from those of suspected COVID-19. The comparative analysis of imaging features, clinical indexes and reexamination are helpful for the differential diagnosis of COVID-19 and suspected COVID-19.

Objective The aim of this study was to determine whether multi?parameters MRI of tongue carcinoma have the potential to predict cervical lymph node metastases. Methods A total of 46 patients with tongue carcinoma, who underwent MRI scan preoperatively, were investigated retrospectively and were divided into cervical lymph node (LN) metastases group (unilateral LN+, n=16;bilateral LN+, n=14) and no cervical lymph node metastases group (LN-, n=16) according to their pathological grading. Of the 40 patients with tongue carcinoma underwent plain and contrast MRI scan, 6 patients have plain MRI scan, and 32 have DWI examination.The ADC value, tumor length, tumor thickness, sublingual distance between tumor and sublingual space, and para?lingual distance between tumor and tongue midlinedetermined from MRI, were preoperatively estimated and compared with the pathological findings of cervical lymph nodes. A unpaired t test was used to analyze normal distributed continuous data, and a Mann?Whitney U test was used to analyze abnormally distributeddata. The ROC was used to evaluate the efficacy of MRI in predicting the metastasis of cervical lymph nodes. Results The indexes of ADC value, tumor length, tumor thickness, and para?lingual distance between tumor and tongue midline, which all showed significant difference between LN+group and LN-group (all P<0.05), and the index of sublingual distance between tumor and sublingual space showed no significantly association with LN+ (P>0.05). The index of ADC value showed significant difference between unilateral LN+group and bilateral LN+group (P<0.05), and the other indexes, which all showed no significantly association with bilateral LN+ (all P>0.05). The ROC curve analysis of the ADC value, tumor length, tumor thickness, and para?lingual distance between tumor and tongue midline of the neck lymph node metastasis were carried out, with the cutoff set as 1.13×10?3 mm2/s, 31.08 mm, 17.33 mm and-2.26 mm. The corresponding area under curve(AUC), sensitivity, and specificity were 0.878, 90.9%and 90.0%; 0.822, 83.3% and 81.3%; 0.834, 86.7% and 81.3%; 0.794, 86.7% and 75.0%, respectively. The ROC curve analysis of the ADC of the bilateral neck lymph node metastasis was also carried out, with the cutoff of ADC value set as 1.07×10?3 mm2/s, the corresponding AUC, sensitivity, and specificity were 0.806, 80.0%and 75.0%. Conclusion The ADC value, tumor length ,tumor thickness and para?lingual distance between tumor and tongue midline,determined from MR imaging, all can be used as independent factors in predicting cervical lymph node metastasis, where ADC value may be helpful to predict bilateral neck lymph node metastasis.

Objective To evaluate the discrepancy of parameters generated on dual-energy spectral CT (DECT)imaging in the different pathological grade of laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC),and to provide helpful information of the prognosis and the guide of clinical treatment.Methods 61 patients with pathologically confirmed LHSCC who underwent contrastenhanced DECT before therapy were retrospectively analyzed.The enhanced monochromatic data were analyzed with workstation.Iodine concentration of lesion (IC),water concentration of lesion (WC)and slope of spectral HU curve (s-SHC)were acquired.According to cell differentiation,all patients were divided into well,moderately and poorly differentiated groups.The difference of IC,WC,s-SHC,constituent ratio of T stage were compared among different groups.Results The IC and s-SHC had significant difference among well,moderately and poorly differentiated groups(F =3.56,3.96 respectively,P <0.05).The two-two paired comparisons demonstrated that there were significant difference of IC between poorly and well differentiated group(P <0.05).The others two-two paired comparisons demonstrated no significant difference (P>0.05).There were no significant difference of WC among three groups respectively (H =0.84,P >0.05).χ2 test showed that there was no significant difference for the constituent ratio of T stage among three groups (P >0.05).Conclusion IC and s-SHC can help to judge the pathological grade of LHSCC,and they may be useful to evaluate the prognosis of LHSCC.

Objective To summarize the CT features of anaplastic thyroid carcinoma (ATC).Methods CT manifestations of 12 patients with ATC confirmed by surgery or biopsy were analyzed retrospectively.Results 1 1 (91.7%)patients had single lesion. The lesions appeared as low attenuation mass with cord-like,flocculent or patchy high attenuation areas.The lesions had mild to moderate enhancement in 1 1 cases (91.7%).Coarse calcifications were detected in 8 cases (66.7%),4 of them were incomplete rim or eggshell.11 cases (91.7%)showed invasion into adjacent structures,including trachea (6 cases,50%),esophagus (4 cases,33.3%),strap muscles (7 cases,58.3%),larynx (2 cases,1 6.7%),blood vessels (6 cases,50%).5 cases (41.7%)had tumor thrombus in the internal jugular vein.10 cases (83.3%)had lymph nodes metastasis.The enhancements of lymph nodes were divided into 3 types:mild homogeneous enhancement (4 cases,40%),mild enhancement with internal low-attenuation areas (7 cases,70%)and ring-like enhancement without internal enhancement (7 cases,70%).Conclusion CT features of ATC include low-density mass with cords,flocculent and patchy high-density areas,coarse calcification and mild to moderate enhancement,invasion to adjacent structure and lymph node metastasis with necrosis are common.