Abstract:Q fever manifests with diverse and nonspecific clinical presentations,primarily characterized by high fever,headache,myalgia,and generalized fatigue.The pathogen can disseminate through small blood vessels and capillaries to involve multiple organ systems including the heart,liver,spleen,kidneys,and brain.This article reports a rare case of Q fever encephalitis in which cerebrospinal fluid(CSF)examination revealed changes consistent with tuberculous meningitis,including lymphocytic pleocytosis,elevated protein,and decreased glucose.Although the interferon-gamma release assay(IGRA)was confirmed by metagenomic next-generation sequencing(mNGS)of CSF,which detected Coxiella burnetii nucleic acid sequences.Treatment with doxycycline combined with rifampin resulted in normalization of CSF parameters and significant clinical improvement.This case highlights that Q fever should be considered in patients with suspected central nervous system infections refractory to conventional therapy,and prompt application of mNGS technology can enhance diagnostic accuracy.

Abstract:Objective To analyze the characteristics of hepatitis B virus(HBV)preS gene mutations in patients with hepatocellular carcinoma(HCC),and to evaluate the diagnostic value of HBV preS gene mutations in HBV-associated HCC.Methods Clinical data were retrospectively collected frompatients with chronic hepatitis B(CHB,CHB group)and HBV-associated HCC(HCC group)who admitted to the Gastroenterology,Dazhou Central Hospital,from September 2019 to September 2023.PreS mutations were analyzed by sanger sequencing.Results Patients in HCC group were older,had more genotype C,lower HBV DNA,and higher alpha-fetoprotein(AFP)level(P＜0.05).Among all patients,a total of 24.41%(31/127)patients had preS1 deletion,and 47.90%(57/119)point mutations were found in preS1 region.A total of 16.54%(21/127)patients had preS2 deletion,and 65.45%(36/55)point mutations were found in the preS2 region.PreS1 region W4P/R/Y,D27G/S,N51Y/T/S/Q/P,I/N56H/W,K57Q/K,A60V,D/A62S/T,G73S/N,A90T/S/G,V95A and L108V/I,The incidence of T125S/N/P,F141V/L/I and V158A point mutations in preS2 region was higher in HCC group than in CHB group(P＜0.05).Genotype C,HBV DNA,and W4P/R/Y(preS1),A90T/S/G(preS1),L108V/I(preS1),F141V/L/I(preS2)point mutations can independently diagnose HCC in CHB patients.Conclusion W4P/R/Y(preS1),A90T/S/G(preS1),L108V/I(preS1),F141V/L/I(preS2)in preS region are associated with HCC.The use of these point mutation tests may contribute the clinical diagnosis of HBV related HCC.

Abstract:Objective Analyze the vaccination status of EV7 inactivated vaccine for children aged 0～5 in Baoji City from 2017 to 2023,explore the impact of age,period,and cohort on vaccination rate,and provide a basis for formulating vaccination strategies.Methods We Collected EV71 vaccination case information of 0～5-year-old children in Baoji City from 2017 to 2023 through the Shaanxi Province Comprehensive Vaccination Service Management Information System,describe the overall vaccination situation and the age,period,and queue trends of vaccination rates,and analyze them using the age-period-cohort model.The annual percentage change(APC)and Annual percentage change(AAPC)are calculated to evaluate the trend changes in EV71 vaccination rates,with cohort effects based on 2018 as a reference.Results From 2017 to 2023,a total of 112 500 people were vaccinated with EV71 vaccine once in Baoji City,with a cumulative vaccination rate of 27.97%,and a total of 99 000 people were immunized during the whole process,with a cumulative vaccination rate of 24.60%.The analysis of age-period-cohort model showed that the vaccination rate of EV71 vaccine for children aged 0～5 in our city increased with the year(AAPC 1 dose=13.3%,95%CI:8.56%～18.25%)(AAPC 2 dose=18.92%,95%CI:13.53%～24.57%).There was a significant difference between AAPC in different age groups and the whole population(1 dose:P＜0.05;2 doses:P＜0.05),but with the increase of age,the annual change percentage of each age group showed a downward trend.After adjusting the period and birth cohort effect,the age-specific incidence rate was the lowest in the 0-year-old group(1 dose:1.14%,2 doses:0.47%),and the highest in the 1-year-old group(1 dose:11.99%,2 doses:11.90%).The vaccination rate in the age group over 1 year showed a downward trend with the increase of age.After adjusting for age and birth cohort effect,the vaccination rate first increased and then decreased,and the highest vaccination rate was in 2020(1 dose:16.59%,2 doses:16.02%),and then decreased.After adjusting for age and period effects,the birth cohort effect is statistically significant on the whole(P＜0.05),and locally:compared with 2018,the coverage rate of EV71 vaccine among people born in 2019-2023 is on the rise.Conclusion The vaccination rate of children's EV71 vaccine in Baoji City has obvious characteristics of age,period and birth cohort.After 2020,the vaccination rate will continue to decline.Among all age groups,the vaccination rate of 0-year-old group is the lowest,and the vaccination age is late.It is necessary to strengthen the publicity of EV71 vaccine and improve the vaccination rate and timeliness.

Abstract:Objective To explore the prognostic value of prognostic nutritional index(PNI)in evaluating outcomes of patients with hepatitis B virus related acute-on-chronic liver failure(HBV-ACLF)treated with artificial liver support system.Methods A total of 123 patients with HBV-ACLF who received artificial liver treatment in Jincheng Major Hospital from January 2022 to December 2023 were enrolled.After 3-month follow-up,they were divided into the good prognosis group and the poor prognosis group according to their outcomes.Baseline data of the two groups of patients,changes in the levels of laboratory-related indicators(at baseline,3rd,7th,14th day after admission),as well as PNI,PNI1(PNI at 7th day after admission minus baseline PNI),and PNI2(PNI at 14th day after admission minus baseline PNI)were compared.Multivariate Logistic regression analysis was used to identify independent risk factors for poor prognosis of HBV-ACLF patients treated with artificial liver support treatment;The Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of PNI(baseline value and dynamic change value)alone and in combination with other indicators for the prognosis of patients with HBV-ACLF treated with artificial liver.Results Compared with the poor prognosis group,patients in the good prognosis group had lower white blood cell counts,neutrophil counts,Child-Turcotte-Pugh(CTP)scores,total bilirubin,interleukin-6(IL-6)levels,and the number of artificial liver treatments;and higher albumin,baseline PNI,hemoglobin(Hb),PNI at 7th day after admission,lymphocyte count,PNI at 14th day after admission,prothrombin activity level,PNI2,and serum sodium(all P＜0.05).Multivariate Logistic regression analysis showed that the factors affecting the poor prognosis of HBV-ACLF patients treated with artificial liver included PNI2,serum sodium,Hb,lymphocyte count,albumin,prothrombin activity,neutrophil count,total bilirubin,IL-6,leukocyte count,the number of artificial liver treatments,CTP scores,and the baseline PNI.ROC curve analysis showed that the accuracy and sensitivity of PNI2 was higher than that of baseline PNI and other single indicators,and the sensitivity and accuracy of the combined test of total bilirubin,Hb,prothrombin activity,neutrophil count,white blood cell count,albumin,lymphocyte count,serum sodium,CTP score,IL-6,baseline PNI,PNI2,and the number of artificial liver treatments was higher than that of any single indicator.Conclusion PNI is an effective indicator for evaluating the prognosis of patients with HBV-ACLF treated with artificial liver,and the combined detection of total bilirubin,Hb,prothrombin activity,neutrophil count,white blood cell count,albumin,lymphocyte count,serum sodium,CTP score,IL-6,baseline PNI,PNI2 and the number of artificial liver treatments has higher predictive value.

Abstract:Objective To investigate the effects of people living with human immunodeficiency virus(PLWH)combined with combination antiretroviral therapy(cART)on the risk of blood lipids and cardiovascular diseases,and to analyse the risk factors for hyperlipidaemia.Methods retrospective cohort study was conducted,selecting newly treated PLWH patients in the Infection and Immunity Clinic of Henan Provincial Infectious Disease Hospital from June 2018 to January 2020.Data on serum lipids,blood pressure,diabetes mellitus,HIV load,and CD4+T cell levels were collected at baseline,and after 1,3,and 5 years of cART,respectively.The 10-year CVD risk was evaluated using the Framingham score,and the risk factors for hyperlipidaemia in PLWH were analysed by univariate and multivariate analysis.Results A total of 318 cases of PLWH were enrolled,including 289 males(90.88%).Age 35(29,46)years.The changes in blood lipids after cART in PLWH showed an increase in the incidence of hyperlipidemia and a decrease in the incidence of low high-density lipoprotein cholesterol(HDL-C).The incidence of hypertriglyceridemia increased from 23.58%at the initiation of treatment to 35.53%at 5 years of cART,with hypertriglyceridemia(TG)being the main contributor to the increase,and the non-nucleoside reverse transcriptase inhibitor and protease inhibitor regimens changed significantly at 1 year of cART(P＜0.017).There was no significant change in the incidence of hypercholesterolemia and ow-density lipoprotein cholesterol(P＞0.017).The incidence of low HDL-C decreased from 45.28%at the initiation of treatment to 11.32%at 5 years of cART,and the change in the incidence at 1 year of cART was significant(P＜0.05).The results of multivariate analysis showed that smoking,body mass index＞25 kg/m2,and tenofovir lamivudine and lopinavir ritonavir regimens were risk factors for the development of hyperlipidemia(P＜0.05).The Framingham score did not show a significant change in the 10-year cardiovascular risk of PLWH during 5 years with cART.Conclusions The changes in blood lipids in PLWH during the 5-year cART were mainly manifested by the increase in the incidence of hypertriglyceridemia and the decrease in the incidence of low HDL-C,which changed significantly at 1 year of cART.Individuals who smoke,have a body mass index greater than 25 kg/m2,and use enofovir+lamivudine+lopinavir/ritonavir regimens are prone to hyperlipidemia and should be monitored for lipids.Five years of cART had no significant effect on the 10-year risk of cardiovascular disease in PLWH.

Abstract:In China,hepatitis B virus(HBV)infectionis the predominant cause of primary liver cancer,and 77.0%of patients are HBV-related liver cancer.Recent years,with the advanceand diversification of treatment methods,the survival rate of primary liver cancer patients has gradually improved,and the detection rate of extrahepatic bone metastasis has also shown an upward trend.Once bone metastasis occurs,the disease progresses rapidly with poor treatment response,leading to significantly shortened survival.This review summarizes the progress of serum markers for bone metastasis of hepatitis B-related primary liver cancer,including alpha fetoprotein,carcinoembryonic antigen,γ-glutamyl transpeptidase and serum alkaline phosphatase related to the metabolism of primary liver cancer cells,as well as,markers such as bone glaprotein and bone specific alkaline phosphatase related to bone remodeling activities and bone metabolism status,and discusses the application value of these serum markers in the early diagnosis,intervention therapy and prognosis evaluation of bone metastasis cases of liver cancer.

Abstract:Objective To validate the methodological performance of the isothermal amplification technique for detecting hepatitis B virus(HBV)ribonucleic acid(RNA),and explore the application value of HBV RNA quantitative detection in the condition monitoring of chronic hepatitis B(CHB)patients.Methods Validation of the precision,lower limit of detection,linearity,and accuracy of RNA capture method for detecting HBV RNA.A total of 128 CHB patients diagnosed and hospitalized at the Shaanxi Provincial Hospital of Traditional Chinese Medicine from July to September 2022 were enrolled.All patients had"＜10 IU/mL"or"undetected"results in high-sensitivity HBV DNA quantitative tests.Simultaneous HBV RNA quantitative testing was conducted to analyze the relationship between HBV RNA levels,HBV DNA,HBeAg,and liver injury markers in the patients.Results The within-run precision for low and high values was 3.01%and 2.56%respectively,while the between-run precision was 3.74%and 2.60%respectively.The detection rate for samples close to the lower limit of detection,repeated 20 times,was 100%.The method demonstrated linearity within the range of HBV RNA concentration from 1.0×102 to 1.0×108 copies/mL(R2=0.996 7).The HBV RNA positivity rate in the group with HBV DNA quantitative results below the detection limit was 70.73%,while it was 43.68%in the group with undetected HBV DNA,showing a significant difference(P=0.004).There were also statistically significant differences in HBV RNA quantitative detection values between the 2 groups(P=0.000).The HBV RNA positivity rate in HBeAg-positive individuals was 89.47%,with an ALT abnormality rate of 57.89%.In HBeAg-negative individuals,the HBV RNA positivity rate was 45.87%,and the ALT abnormality rate was 49.54%.The difference in HBV RNA positivity rates between the 2 groups was statistically significant(P=0.000),while the difference in ALT abnormality rates was not statistically significant(P=0.502).The abnormal rate of ALT in HBV RNA-positive patients is 66.7%,compared to 37.1%in patients with negative HBV RNA detection,showing a significant difference(P=0.001).Conclusion The isothermal amplification method for detecting HBV RNA has reliable performance.It can still effectively detect viral RNA in treated CHB patients with HBV DNA below the detection limit,making it applicable for monitoring the condition of such patients.

Abstract:Objective To evaluate the predictive efficacy of the Xpert Mycobacterium tuberculosis/rifampicin test(Xpert MTB/RIF)for bronchoalveolar lavage fluid(BALF)in discontinuation airborne infection isolation(AII)for hospitalized patients with suspected pulmonary tuberculosis(PTB).Methods A total of 184 AII patients admitted to Tuberculosis Provincial Tuberculosis Prevention and Control Hospital(the Fifth People's Hospital of Shaanxi Province)for suspected PTB from November 2022 to January 2024 were prospectively included.At the time of AII cessation(based on receipt of discharge notification),patients were divided into PTB group(n=35)and non PTB group(n=149)according to the positive or negative Mycobacterium tuberculosis(MTB)culture results of the last BALF sample.The results of sputum smear microscopy of acid fast bacteria(AFB),MTB culture of BALF samples,and real-time fluorescence quantitative nucleic acid amplification(Xpert MTB/RIF)detection for rifampicin resistance were collected.Accuracy in predicting AII cessation=non-PTB patients/patients with BALFXpert MTB/RIF negative test×100(%).Results With MTB culture as the gold standard,the specificity and positive predictive value of 3 consecutive AFB smear of sputum samples and Xpert MTB/RIF of BALF samples were 100%.The sensitivity of Xpert MTB/RIF detection in BALF samples(77.14%vs.71.43%)and negative predictive value(94.90%vs.93.71)were slightly higher than 3 consecutive AFB smears of sputum samples,respectively.Compared with three consecutive sputum smear tests,BALF Xpert MTB/RIF significantly shortened the test time(24 h vs.59 h,P=0.000).Among all the patients,a total of 8(4.35%)patients had hypoxemia events,12(6.52%)patients had fever after bronchoscopy,but no patients had postoperative pneumonia.Conclusion A negative BALF Xpert MTB/RIF test can be used as a reliable basis for the safe release of AII in suspected PTB patients,significantly shortening the isolation time.

Abstract:Objective To analyze the risk factors of lower respiratory tract infection and the predictive value of interferon gamma inducible protein 10(IP-10)and alpha 1-acidic glycoprotein(AAG)in the intensive care unit(ICU)patients undergoing tracheostomy.Methods From March 2019 to September 2024,296 patients who underwent ICU tracheostomy in our hospital were included as subjects.They were separated into an infected group(n=119)and an uninfected group(n=177)based on the occurrence of lower respiratory tract infection,and the infected group was divided into mild group(n=58),moderate group(n=37)and severe group(n=24)according to the extent of the disease.Logistic regression was applied to analyze the influencing factors of lower respiratory tract infections in ICU patients undergoing tracheostomy.Receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of IP-10 and AAG for lower respiratory tract infections in ICU patients undergoing tracheostomy.Spearman correlation was used to analyze the correlation between IP-10,AAG levels and the severity of the disease.Results Compared with the uninfected group,the ICU stay time,airway opening time,the percentage of use of ventilator＞7 d,antibiotics＞2 classes,antibiotic use＞2 weeks and the levels of serum IP-10,AAG,C-reactive protein(CRP)and procalcitonin(PCT)in the infected group were obviously increased(P＜0.05).The ICU stay time,airway opening time,ventilator use time,antibiotic use time,antibiotic type,and the levels of serum IP-10,AAG,CRP and PCT were all risk factors that affecting the occurrence of lower respiratory tract infections in patients(P＜0.05).The AUC of the IP-10,AAG combined prediction was obviously better than IP-10 and AAG alone(P＜0.05).Compared with the mild group,the serum IP-10 and AAG levels in the moderate group and severe group were obviously increased(P＜0.05).The levels of IP-10 and AAG were positively correlated with the severity of the disease(r=0.409,0.428,P＜0.05).Conclusions The ICU stay time,airway opening time,ventilator use time,antibiotic use time,types of antibiotic,and the levels of serum IP-10,AAG,CRP and PCT are risk factors affecting lower respiratory tract infection in ICU tracheostomy patients.Among patients with secondary lower respiratory tract infection after tracheostomy in ICU,serum IP-10 and AAG levels are obviously increased.IP-10 and AAG have certain early auxiliary predictive value for lower respiratory tract infection in patients.

Abstract:Objective To describe and analyze the current status and progress of domestic AIDS qualitative research in China on the family members and sexual partners of HIV infected individuals through literature analysis,and provide scientific basis for effective AIDS prevention and intervention.Methods Retrieve relevant literature on qualitative research on AIDS conducted by Chinese scholars,targeting the family members and sexual partners of HIV-infected individuals,in both Chinese and English databases using a combination of subject terms and free terms.The search period was from the establishment of the databases to April 30,2024.The literature that met the inclusion criteria was selected,summarized,organized,and analyzed.Results A total of 63 documents were included,published between 2005 and 2024.There were 37 qualitative studies(58.73%)and 26 mixed-methods studies(41.27%);39 journal papers(61.90%),23 dissertations(36.51%),and 1 conference paper(1.59%).The research covered a wide geographical area,with a focus on areas with high incidence of AIDS.There were 14 documents(22.22%)that solely targeted the families and sexual partners of the infected individuals,while 49 documents(77.78%)included multiple populations.The families and sexual partners included female spouses and negative male sexual partners of HIV-positive homosexual men,single-positive family members and family caregivers,etc.The themes of research are diverse,exploring the impact of AIDS on the infected individuals,families,and society from multiple dimensions.Among them,psychological experiences and social support have always been the focus of attention,shifting from single psychological and preventive studies to comprehensive care and family studies.However,the application forms of research methodology are relatively limited,and the literature reports lack standardization.Conclusion Qualitative research on the families and sexual partners of HIV-infected individuals provides a rich perspective for AIDS research.Future research should improve the methodological strategies,deepen the application of multi-level research methods,and improve the quality of literature reports,so as to provide high-quality evidence for scientific research and practice.

Abstract:Objective To explore the lipid metabolic characteristics in people living with HIV(PLWH),providing clinical reference.Methods Lipid profiles were collected from 1 422 PLWH(PLWH group)who visited the Sixth People's Hospital of Xinjiang Uygur Autonomous Region between January 2023 and October 2024.These were compared with lipid profiles from 1 115 health-screened employees(non-HIV-infected individuals,PWoH group)serving as controls to conduct a comparative analysis of lipid metabolism characteristics between the two groups.Results The prevalence of dyslipidaemia in the PLWH group(88.05%)was 1.49 times higher than that in the PWoH group(58.92%)(P＜0.05),and the rate of carotid plaque formation in PLWH(38.17%)was 2.29 times higher than that in PWoH(16.67%)(P＜0.05).Among PLWH,the incidence of dyslipidemia was 91.91%,92.31%,and 92.64%in the HIV load＜40 copies/mL group,CD4+T cell count＜200/mm3 group,and not yet receiving combination antiretroviral therapy(cART)group,respectively,which were higher than those in the HIV load≥40 copies/mL group(86.04%),CD4+T cell count 200～500/mm3 group(84.67%)and＞500/mm3 group(85.32%),and cART treatment group(86.09%)(P＜0.05).Conclusion PLWH exhibit elevated dyslipidemia risk,particularly pronounced among those with high HIV viral loads or low CD4+T cell counts.Regular cART recipients demonstrate lower dyslipidemia incidence compared to untreated individuals.Close monitoring of lipid profiles in PLWH is imperative,coupled with early initiation of personalized cART regimens to mitigate dyslipidemia development and reduce cardiovascular risk.

Abstract:Objective To explore the clinical and microbiological characteristics of skin infections caused by Staphylococcus lugdunensis and provide a basis for clinical diagnosis and treatment.Methods A total of 84 Staphylococcus lugdunensis isolates were collected from skin infections specimens at the First People's Hospital of Foshan from January 2013 to December 2023.Bacterial identification and antibiotic susceptibility test were performed using the Vitek 2 Compact automated system and MALDI-TOF MS.Results The cohort comprised 46 males(54.76%)and 38 females(45.24%).The mean age was 47.25±24.51 years.Common infection sites are the feet,the buttocks and the groins.46.43%of the patients had underlying diseases such as diabetes,kidney disease,lymphoma,herpes zoster,lung cancer,prostate cancer,etc.The specimen types include abscesses,wounds,secretions and exudates.The clinical manifestations mainly include abscesses,wound ulcers,necrotizing fasciitis and folliculitis.The resistance rates of Streptococcus lugdunensis to penicillin,clindamycin,erythromycin and oxacillin were 38.10%,14.29%,11.90%and 5.95%respectively,and it was sensitive to all other antibiotics.Conclusions Isolating Staphylococcus lugdunensis from skin infection specimens is of great significance.Selecting appropriate antibiotics based on the drug sensitivity results can achieve better therapeutic effects.

Abstract:Objective To investigate the clinical efficacy of fructose-1,6-diphosphate sodium combined with recombinant human interferon α1b in the treatment of rotavirus enteritis and its effect on myocardial enzyme profiles in children.Methods A total of 200 children with rotavirus enteritis complicated with diabetic ketoacidosis admitted to our hospital(San Tai County People's Hospital)from June 2021 to June 2024 were selected.They were divided into a control group and an observation group using a random number table method,with 100 cases in each group.The control group received recombinant human interferon α1b treatment,while the observation group received fructose-1,6-diphosphate sodium combined with recombinant human interferon α1b.The improvement time of clinical symptoms was compared and statistically analyzed between the two groups.Levels of inflammatory factors[Tumor Necrosis Factor Alpha(TNF-α),Interleukin-6(IL-6),High Mobility Group Protein B1(HMGB1)],gastrointestinal function indicators[Gastrin(GAS),Motilin(MTL),Diamine Oxidase(DAO),Intestinal Fatty Acid Binding Protein(I-FABP)],myocardial enzymes[Creatine Kinase(CK),Lactate Dehydrogenase(LDH),Creatine Kinase Isoenzyme(CK-MB)],neural factors[Nerve Growth Factor(NGF),Brain-Derived Neurotrophic Factor(BDNF),Neurotrophic Factors(NTF),Myelin Basic Protein(MBP),Neuron Specific Enolase(NSE)],and T cell subsets[CD4+T cells,CD8+T cells,CD4+/CD8+ratio]were measured.Results After treatment,compared with the control group:The observation group showed significantly shortened clinical symptom improvement time(P＜0.05).Levels of TNF-α,IL-6,HMGB1,MBP,NSE,CD8+T cells,GAS,MTL,DAO,I-FABP,CK,LDH,and CK-MB were significantly reduced(P＜0.05).Levels of NGF,BDNF,NTF,CD4+T cells,and the CD4+/CD8+ratio were significantly higher(P＜0.05).The total effective rate in the observation group was significantly higher than that in the control group(P＜0.05).Conclusion For children with rotavirus enteritis,the treatment regimen of fructose-1,6-diphosphate sodium combined with recombinant human interferon α1b can effectively reduce inflammatory responses,improve gastrointestinal function,alleviate myocardial injury,relieve clinical symptoms,demonstrating significant clinical efficacy.