Objective:This study evaluates the performance of chemiluminescence assay, which is designed to detect Hepatitis D Virus (HDV) Immunoglobulin G (IgG) antibodies.Methods:A comparative analysis was conducted among chemiluminescence anti-HDV IgG reagent, the magnetic particle-based domestic reagent A and domestic reagent B, and the Robo Gene HDV RNA kit, using 1909 HBsAg-positive plasma samples. This comparison aimed to delineate clinical specificity and detection accuracy. The anti-HDV IgG reagent precision was assessed at three different concentration levels following the Clinical Laboratory Standards Institute EP5-A2 guidelines. The specificity of the assay was validated using 200 HAV IgM positive, 545 HBsAg-positive but anti-HDV IgG-negative, 350 anti HCV positive plasma samples and 200 healthy human blood samples. Additionally, a concordance study was conducted with 545 HBsAg-positive and 37 anti-HDV IgG-positive plasma samples, comparing the anti-HDV IgG reagent against reagent A.Results:1 909 HBsAg-positive plasma samples were tested using 3 anti HDV IgG reagent and 1 HDV RNA reagent, 19 samples were identified as anti-HDV IgG-positive. The anti-HDV IgG demonstrated superior accuracy and specificity. The assay exhibited excellent precision, with intra-assay coefficient of variation (CV) values ranging from 1.57% to 4.30%, and inter-assay CV values between 1.71% and 4.67% for detecting samples at high, medium, and low concentration levels. Concordance with Reagent A showed consistent results in both positive and negative detections.Conclusion:In this study, the anti-HDV IgG reagent (chemiluminescence method) displayed outstanding specificity in detecting clinical samples and exhibited a high conformity rate with commercialized reagents, making it potentially suitable for screening anti-HDV IgG in HBsAg-positive samples.

Objective:This study aims to evaluate the quality and explore the preliminary clinical applications of a domestically developed hepatitis D virus nucleic acid quantification reagent (abbreviated as"domestic HDV RNA reagent").Methods:The sensitivity and accuracy of the reagent were evaluated in accordance with the WHO HDV RNA international standard, employing the Bio-Rad CFX Opus 96 real-time fluorescence quantitative PCR analysis system. Serial dilutions of pseudo-viruses or cell culture-derived virus were used to determine the linear range of the domestic HDV RNA reagent. Specificity was assessed using positive samples of HAV, HBV, HCV infection, and HEV national reference materials. Precision was evaluated with samples at both high and low concentrations. In a comparative analysis, 30 HDV IgG positive samples were tested using both the domestic HDV RNA reagent and the RoboGene HDV RNA kit based on the ABI 7500 FAST DX system. The Pearson correlation coefficient (r) was used to examine the correlation between the two reagents.Results:The domestic HDV RNA reagent demonstrated a high sensitivity of up to 6 IU/ml, consistent with that of the comparator reagent. The calibration curve for WHO HDV RNA standards had a slope of -3.286, with an amplification efficiency of 101.6%. The linear detection range spanned from 10 to 10 8 IU/ml for eight HDV genotypes. The domestic HDV RNA reagent exhibited exceptional specificity, without cross-reactivity observed with HAV, HBV, HCV, or HEV. Accuracy assessments at five concentration levels met the required standards, with intra-assay precision coefficient of variation ( CV) ranging from 1.20% to 4.20%, and inter-assay precision CV from 1.20% to 7.90%. The detection results for HDV IgG positive samples were highly correlated with the comparator reagent ( r=0.984, P<0.001), achieving a diagnostic accuracy of 100% compared to sequencing results. Conclusion:In this study, the domestic HDV RNA reagent possesses excellent specificity, accuracy, precision, and a broad linear range, attaining a sensitivity level on par with international reagents of the same type.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

Artemisia annua is the main natural source of artemisinin production. In A. annua, extended drought stress severely reduces its biomass and artemisinin production while short-term water-withholding or abscisic acid (ABA) treatment can increase artemisinin biosynthesis. ABA-responsive transcription factor AabZIP1 and JA signaling AaMYC2 have been shown in separate studies to promote artemisinin production by targeting several artemisinin biosynthesis genes. Here, we found AabZIP1 promote the expression of multiple artemisinin biosynthesis genes including AaDBR2 and AaALDH1, which AabZIP1 does not directly activate. Subsequently, it was found that AabZIP1 up-regulates AaMYC2 expression through direct binding to its promoter, and that AaMYC2 binds to the promoter of AaALDH1 to activate its transcription. In addition, AabZIP1 directly transactivates wax biosynthesis genes AaCER1 and AaCYP86A1. The biosynthesis of artemisinin and cuticular wax and the tolerance of drought stress were significantly increased by AabZIP1 overexpression, whereas they were significantly decreased in RNAi-AabZIP1 plants. Collectively, we have uncovered the AabZIP1-AaMYC2 transcriptional module as a point of cross-talk between ABA and JA signaling in artemisinin biosynthesis, which may have general implications. We have also identified AabZIP1 as a promising candidate gene for the development of A. annua plants with high artemisinin content and drought tolerance in metabolic engineering breeding.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Objective To discover the existing problems and provide appropriate suggestions and countermeasures through the quality control inspection.MethodsA comprehensive quality control inspection was conducted for the radiotherapy equipment in 45 hospitals in Zhejiang province.The physical,technical,clinical and radiotherapy process and the parameters related to quality control were evaluated.Results As of December 31,2017,a total of 62 linear accelerators from 45 hospitals have been assessed.In the radiotherapy process,multiple quality control problems were identified in terms of radiotherapy equipment configuration,clinical work quality,radiotherapy technology and personnel qualifications.Besides,unreasonable equipment configuration,shortage of radiotherapy staff,clinical work flow and the quality assurance of physical radiotherapy remained to be resolved.Conclusion Regular quality control of radiotherapy plays a pivotal role in ensuring the accuracy,effectiveness and medical safety of radiotherapy.

BACKGROUNDL-shaped incision of pronator quadratus (PQ) muscle along its radial and distal borders was always taken for distal radius fractures reduction and internal fixation. Repair of the PQ muscle was always recommended at the end of operation for some instructive reasons. But repair of PQ is not satisfied because of poor quality of muscle and fascial tissues which may cause pain or impede forearm pronation and supination for post-operative scarring around PQ. Inserting the locking palmar plate to pass under the pronator quadratus muscle and the locking screws are inserted through mini-incisions in pronator quadratus in some patients with distal radius fractures is a reasonable technique which can preserve the pronator quadratus. The purpose of this study was to evaluate and compare the clinical effects after volar plating of the distal radius fractures while preserving the pronator quadratus and pronator quadratus repair.

METHODSBetween September 2010 and April 2012, 65 patients (42 males and 23 females; aged 20-68 years and a mean age of 42.5 years) with distal radius fracture underwent open reduction and internal fixation using the volar locking palmar plates (Depuy or Smith companies). The patients were classified as 23A-2 through 23C-3 according to the Orthopaedic Trauma Association (OTA) classifications. All surgeries were completed by the same trained team. The volar locking palmar plates of distal radius performed with preserving pronator quadratus group involved 30 patients including 19 males and 11 females and performed with pronator quadratus repair group involved 35 patients including 23 males and 12 females. We compared the two groups for wrist pain, forearm range of motion, grip strength, perioperative complications and wrist functional recovery score.

RESULTSThe minimum follow-up for the whole cohort was one year. The differences between the two groups were significant with regard to wrist pain, forearm range of motion, grip strength and wrist function at 1, 2, and 6 weeks postoperatively, but insignificant at 6 and 12 months postoperatively. No significant differences were found in the perioperative complications and radiographs postoperatively.

CONCLUSIONSPreservation of the pronator quadratus muscle is a satisfactory method for the treatment of majority of the fractures of the distal radius with volar locking palmar plates, as this technique can yield better early wrist function and shorten the rehabilitation.

Adult ; Aged ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Palmar Plate ; surgery ; Radius Fractures ; surgery

Objective To summarize the clinical experience of intractable epistaxis under nasal endoscope in the treatment of elderly people .Methods 312 cases of endoscope of intractable epistaxis patients were retrospectively analyzed.Results Nasal septum and olfactory corresponding head of middle turbinate bleeding site was mainly the upper part of the nasal cavity and the split-plot,back-end middle turbinate at the back of the nose and nasal were fol-lowed,as well as inferior turbinate and the rear end of inferior nasal meatus ,the Littell nasal septum of the front nose were bleeding less .After nasal endoscopic radio hemostatic therapy or local packing treatment with expansive sponge , 310 cases were cured,2 cases were invalid.The total efficiency was up to 99.4%.During the following 3 months,there was no recurrence .Conclusion For the elderly intractable epistaxis hemostatic therapy ,under nasal endoscope oper-ation method,radio hemostatic therapy or local packing treatment with expansive sponge is simple and effective ,which is worthy of popularization and application .

Objective To investigate the impact of palliative radiotherapy to the prognosis of patients with stage Ⅳ non-small cell lung cancer (NSCLC).Methods Two hundred and forty-four cases of stage Ⅳ NSCLC were collected from our hospital.The study group (n =129) received the treatment of primary tumor and metastases palliative radiotherapy after chemotherapy.The control group (n =115) received only chemotherapy.Followed-up and compared 1-year and 2-year survival rate of the patients,and explored the factors affecting palliative radiotherapy.Results The 129 patients in the study group were followed up for 2 years,and 16 patients survived and 110 patients died.Three patients were lost to follow-up.The median survival time was 8 months.1-year and 2-year survival rates was 29.46％ (38/129) and 12.40％ (16/129) respectively.In the control group,7 patients survived,and 106 patients died.Two patients were lost to follow up.The median survival time was 6 months.1-year and 2-year survival rates was 11.30％ (13/115) and 6.09％ (7/115)respectively.Survival rates between the two groups were significantly different (x2 =8.451,P =0.014)Univariate regression analysis found that factors affecting the prognosis of stage Ⅳ NSCLC were KPS score (x2 =5.057,P =0.031),occurrence of brain metastases (x2 =4.781,P =0.029),number of organs of metastasis (x2 =6.341,P =0.010),and the primary stove radiotherapy dose (x2 =5.893,P =0.015) ; Cox regression model analysis showed that the number of organs of metastasis (HR =1.719,95％ CI 为 1.172-3.126,P =0.008),the primary focal radiotherapy dose (HR =1.560,95％ CI 为 1.082-2.761,P =0.022) were independent prognostic factors.Conclusion Palliative radiotherapy plays a role of prolonging survival time in the treatment of Ⅳ NSCLC.In palliative radiotherapy,we should pay attention to the control of the primary tumor and metastases radiotherapy dose,therefore prolonging the survival time of patients.

Objective To observe the influence of local-anaesthetic combined with dezocine on brachial plexus block and postoperative analgesia.Methods 60 patients scheduled for unilateral upper limb operation were randomly divided into two groups of C group and D group with 30 cases in each group.The brachial plexus block was performed under ultrasound guiding.Two groups received a bolus injection of local anesthetic 30ml,but the local bolus injection of D group consisted of Dezocine 10mg.The tine of sensory blocked producing effect,anesthesia effect,sensory blocked duration were observed.Two hours after sensory nerve recovered,the scores of VAS pain and Ramsay Sedation were recorded.Adverse reactions of perioperation were also observed(nausea,vomiting,dizzy,respiratory,urine retention,pruritus).Results The sensory blocked duration in D group was(7.1±1.1)h,which was significantly longer than that of C group[(4.5±0.8)h](t=10.47,P＜0.01);Two hours after sensory nerve recovered,the score of VAS pain in D group was(1.7±0.7)points,and significantly lower than that of C group[(3.9±1.0)points](t=9.87,P＜0.01).Both two groups had no adverse reactions.Conclusion Addition dezocine 10mg to local anesthetic solutions for interscalene brachial plexus block,it could prolong the sensory block duration,provide satisfactory postoperative analgesia,have no adverse reactions.