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IntroductionThis study aimed to assess the diagnostic values of bronchoalveolar lavage fluid (BALF) real-time polymerase chain reaction (PCR) and BALF metagenomic next-generation sequencing (mNGS) for Pneumocystis jirovecii pneumonia (PJP) in patients infected with human immunodeficiency virus (HIV).MethodsA total of 99 HIV-infected PJP patients and 61 HIV-infected patients diagnosed with non-PJP pneumonia between March 2019 and December 2022 were enrolled. P. jirovecii and multiple other co-pathogens detected in BALF by mNGS were analyzed. The clinical final diagnosis was employed as a benchmark. We compared the diagnostic performance of mNGS in PJP with serum BDG and BALF real-time PCR. The mixed infections detected by mNGS and modifications of antimicrobial treatment were also analyzed.ResultsThe sensitivity of mNGS test of BALF samples reached 85.86%, which was significantly higher than serum BDG (39.39%, P < 0.001). The sensitivity of BALF P. jirovecii PCR (84.85%) was similar with mNGS (P > 0.05). The specificity of mNGS (100%) was also same as PCR (100.0%), and superior to serum BDG (88.52%, P < 0.001). Besides, mNGS performs remarkably well in identifying co-pathogens of PJP patients infected with HIV. In addition to P. jirovecii, 82 cases (82.83%) of other co-pathogens were identified based on mNGS. Moreover, thirty-four patients (34.34%) increased therapeutic dose of trimethoprim-sulfamethoxazole (TMP-SMZ) based on BALF P. jirovecii PCR. Based on the mNGS results, initial antimicrobial treatment was modified in 86.87% (86/99) of PJP patients.ConclusionBALF mNGS and real-time PCR are two powerful techniques for rapid diagnosis of PJP with high specificity and sensitivity. Moreover, the benefit of mNGS is that it may identify other organisms besides PJP and it may benefit proper and prompt treatment.

BackgroundSevere fever with thrombocytopenia syndrome (SFTS) is an emerging zoonosis caused by a novel bunyavirus. Until recently, the SFTS related acute kidney injury (AKI) was largely unexplored. This study aimed to investigate the clinical characteristics and outcomes of AKI in patients with SFTS.MethodsThe non-AKI and AKI groups were compared in terms of general characteristics, clinical features, laboratory parameters and cumulative survival rate. The independent risk factors for in-hospital mortality in patients with SFTS were analyzed by multivariate logistic regression to identify the population with poor prognosis.ResultsA total of 208 consecutive patients diagnosed with SFTS were enrolled, including 153 (73.6%) patients in the non-AKI group and 55 (26.4%) patients in the AKI group. Compared with patients without AKI, patients with AKI were older and had a higher frequency of diabetes. Among these laboratory parameters, platelet count, albumin and fibrinogen levels of patients with AKI were identified to be significantly lower than those of patients without AKI, while ALT, AST, ALP, triglyceride, LDH, BUN, uric acid, creatine, Cys-C, β2-MG, potassium, AMY, lipase, CK-MB, TnI, BNP, APTT, thrombin time, D-dimer, CRP, IL-6, PCT and ESR levels were significantly higher in patients with AKI. A higher SFTS viral load was also detected in the AKI patients than in the non-AKI patients. The cumulative survival rates of patients at AKI stage 2 or 3 were significantly lower than those of patients without AKI or at AKI stage 1. However, there was no significant difference in the cumulative survival rates between patients without AKI and those with stage 1 AKI. Univariate and multivariate binary logistic regression analyses demonstrated that stage 2 or 3 AKI was an independent risk factor for in-hospital mortality in patients with SFTS.ConclusionAKI is associated with poor outcomes in patients with SFTS, especially patients at AKI stage 2 or 3, who generally have high mortality. Our findings support the importance of early identification and timely treatment of AKI in patients with SFTS.

BackgroundTo analyze the changing characteristics of continuous monitoring of refined lymphocyte subsets in people living with HIV/AIDS (PLWHA) during ART period.MethodsRefined lymphocyte subsets was continuously monitored using flow cytometry for 173 PLWHA, who were hospitalized in Zhongnan Hospital of Wuhan University from August 17, 2021 to September 14, 2022. The effect of ART status and duration of ART on changes of refined lymphocyte subsets were compared in different groups. Then, the levels of refined lymphocyte subsets in PLWHA treated for more than 10 years were compared to those of 1086 healthy individuals.ResultsIn addition to conventional CD4+ T lymphocytes and CD4+/CD8+ ratio, gradually increasing in numbers of CD3+CD4+CD45RO cells, CD3+CD4+CD45RA cells, CD45RA+CD3+CD4+CD25+CD127low and CD45RO+CD3+CD4+CD25+CD127low cells were found with the increase of ART duration. The number of CD4+CD28+ cells and CD8+CD28+ cells were 174/ul and 233/ul at 6 months post-ART, which gradually increased to 616/ul and 461/ul after ART initiation more than 10 years. Moreover, in ART ≤ 6 months, 6 months-3years, 3-10 years and >10 years groups, the percentage of CD3+CD8+HLA-DR+/CD8 were 79.66%, 69.73%, 60.19% and 57.90%, respectively, and the differences between groups showed statistical significance (F=5.727, P=0.001). For those PLWHA with ART more than 10 years, the levels of CD4+ T lymphocytes, CD3+CD4+CD45RO cells, CD3+CD4+CD45RA cells, CD4+CD28+ cells and CD8+CD28+ cells can increase to levels similar to those of healthy control. However, for those PLWHA with ART more than 10 years, CD4+/CD8+ ratio was 0.86 ± 0.47, which was lower than that of healthy control (0.86 ± 0.47 vs 1.32 ± 0.59, t=3.611, P=0.003); absolute counts and percentage of CD3+CD8+HLA-DR+ cells were 547/ul and 57.90%, which were higher than those of healthy control(547/ul vs 135/ul, t=3.612, P=0.003; 57.90% vs 22.38%, t=6.959, P

Global change has generated challenges for oceans, from individuals to the entire ecosystem, and has raised contemporary issues related to ocean conservation and management. Specifically, coral reef ecosystems have been exposed to various environmental and human disturbances. In this study, the Ecopath with Ecosim model was used to explore the impacts of ocean warming and fishing on Xisha Islands coral reef ecosystem in the South China Sea. The variables in this model included two ocean warming scenarios and three fishing scenarios. The model consisted of 23 functional groups including algae, coral, sea birds, and sharks. Our results showed that by the middle of the century, ocean warming and fishing led to a 3.79% and 4.74% decrease in total catch compared with 2009, respectively. In addition, the combined effects of ocean warming and fishing caused a 4.79% decrease in total catch, and the mean trophic level of catch was predicted to decrease by 6.01% under the SSP585-High fishing scenario. Reducing the fishing effort mitigates the effects of ocean warming on some species, such as large carnivorous fish and medium carnivorous fish; however, under low fishing effort, some functional groups, such as small carnivorous and omnivorous fish, have low biomass because of higher predation mortality.

Sharks play an important role in marine ecosystems as top predators and have been increasingly accepted in recent years as a group for priority conservation worldwide. However, as one of the regions with the highest marine shark species richness, there is still a limited understanding of shark diversity patterns and conservation needs in China and the Association of Southeast Asian Nations (ASEAN) seas. In this study, we applied an ensemble species distribution model of five algorithms to investigate the diversity distribution patterns of 149 shark species in China and the ASEAN seas for the first time. A systematic conservation planning approach involving diversity, scarcity, and biogeographical distinctiveness was used to identify and compare conservation priority settings. Our results showed that bathymetry and dissolved oxygen were the most important variables contributing to shark distribution. The distribution pattern of shark species richness peaked on the continental shelves at 22–26°N, and a hotspot of shark diversity was identified around the Taiwan Strait. The spatial distribution of shark species in the nine orders and the 72 threatened shark species varied considerably. The existing marine protected area network only protects 2.1% of the ocean, 32.9% of the shark species, and 43.1% of the threatened species, highlighting a substantial conservation gap. Among the conservation priorities identified, the high conservation target scenario (30%) protects only 10%–15% more species than the low conservation target scenario (10%). However, under the high conservation target scenario, the conservation range of species tripled. Our results show that low conservation targets were only suitable for addressing the number of protected species, and that high targets would bring about improved outcomes for the number of protected species and the protected range of threatened species. Furthermore, planned priorities with a large clump pattern had slightly higher conservation achievements than those with small clumps. The results of this study will contribute to the development of a priority area network for sharks and provide a scientific basis for shark conservation and management in the China and ASEAN seas.

Although China possesses a large number of islands, knowledge of their overall ecological condition is limited on a national scale. Accordingly, this study developed a comprehensive and quantitative island ecosystem assessment framework that incorporates environmental quality, biological structure, and landscape patterns. The framework was applied to 42 typical, representative islands within China’s coastal regions, including different climatic zones, area sizes, populations, and substratum lithologies. Results showed that the value range of the comprehensive index of island ecosystem condition (CIisland) was significant (from 52.33 to 89.53, 71.72 average), and 85.4% of islands scored either “high” or “good,” indicative of their exceptional condition. However, conditions varied among different island components, indicating different challenges. Environmental quality index (Ienv) values ranged from 60.70 to 94.80 (79.72 average), where primary threats were seawater nutrient pollution, petroleum, and marine organism metal contamination. Biological structure index (Ibio) values ranged from 43.50 to 89.40 (66.10 average), where primary threats were vegetation destruction and a reduction in marine biodiversity within intertidal and subtidal zones. Landscape pattern index (Iland) values varied significantly (from 6 to 100, 72.36 average), where a key characteristic of highly developed islands was low natural landscape (vegetation) coverage. Conditions also varied among island climate zones, lithologies, area sizes, and levels of human habitation. Additionally, island ecosystem conditions were influenced by both natural and anthropogenic factors as well as area size, population, and GDP. Although distance to the mainland significantly correlated to (Ibio), and (CIisland), these parameters did not significantly correlate to (Ienv), which might be explained by that environmental quality was generally conditional on large-scale environments. This assessment is intended to provide a holistic perspective on island conditions in China while identifying key challenges and associated driving factors, which will greatly aid in establishing island-specific sustainable management practices.

PurposeTo develop a risk stratification system that can predict axillary lymph node (LN) metastasis in invasive breast cancer based on the combination of shear wave elastography (SWE) and conventional ultrasound.Materials and MethodsA total of 619 participants pathologically diagnosed with invasive breast cancer underwent breast ultrasound examinations were recruited from a multicenter of 17 hospitals in China from August 2016 to August 2017. Conventional ultrasound and SWE features were compared between positive and negative LN metastasis groups. The regression equation, the weighting, and the counting methods were used to predict axillary LN metastasis. The sensitivity, specificity, and the areas under the receiver operating characteristic curve (AUC) were calculated.ResultsA significant difference was found in the Breast Imaging Reporting and Data System (BI-RADS) category, the “stiff rim” sign, minimum elastic modulusof the internal tumor and peritumor region of 3 mm between positive and negative LN groups (p < 0.05 for all). There was no significant difference in the diagnostic performance of the regression equation, the weighting, and the counting methods (p > 0.05 for all). Using the counting method, a 0–4 grade risk stratification system based on the four characteristics was established, which yielded an AUC of 0.656 (95% CI, 0.617–0.693, p < 0.001), a sensitivity of 54.60% (95% CI, 46.9%–62.1%), and a specificity of 68.99% (95% CI, 64.5%–73.3%) in predicting axillary LN metastasis.ConclusionA 0–4 grade risk stratification system was developed based on SWE characteristics and BI-RADS categories, and this system has the potential to predict axillary LN metastases in invasive breast cancer.

Antibacterial and osteogenic functionalization of titanium (Ti) implants will greatly expand their clinical indications in immediate implant therapy, accelerate osteointegration, and enhance long-term prognosis. We had recently shown that the high-energy shot peening (HESP)-assisted micro-arc oxidation (MAO) significantly improved the bioactivity and coating stability of Ti-based substrates. In this study, we further functionalized Ti with antibacterial and osteogenic properties by doping silicon (Si) and/or copper (Cu) ions into HESP/MAO-treated coatings. Physicochemical characterization displayed that the doping of Si and Cu in HESP/MAO-treated coatings (Si/Cu-MAO) did not significantly change their surface topography, roughness, crystal structure, coating thickness, bonding strength, and wettability. The results of X-ray photoelectron spectroscopy (XPS) showed that Si and Cu in the Si/Cu-MAO coating was in the form of silicate radical (SiO32–) and bivalent copper (Cu2+), respectively. The total amounts of Si and Cu were about 13.5 and 5.8 μg/cm2, which released about 33.2 and 31.3% within 14 day, respectively. Compared with the control group (MAO), Si doping samples (MAO-Si) significantly increased the cell viability, alkaline phosphatase (ALP) activity, mineralization and osteogenic genes (ALP, collagen I and osteocalcin) expression of MC3T3-E1 cells. Furthermore, the addition of Cu presented good bactericidal property against both Staphylococcus aureus and Streptococcus mutans (even under the co-culture condition of bacteria and MC3T3-E1 cells): the bacteriostatic rate of both bacteria was over 95%. In conclusion, the novel bioactive Si/Cu-MAO coating with antibacterial and osteogenic properties is a promising functionalization method for orthopedic and dental implants, especially in the immediate implant treatment with an infected socket.

BackgroundDifferent types of Helicobacter pylori (H. pylori) were analyzed to determine their infection characteristics using serology, pathology, and non-magnification white light endoscopy combined with the Kimura–Takemoto classification, and the regular arrangement of collecting venules (RAC) as well.Materials and methodsA retrospective analysis of 685 inpatients who have completed the 14C-urea breath test, the H. pylori antibody typing classification, the serum gastric function tests (PGI/PGII/G-17), the endoscope detection, and the pathological examinations.ResultsThe levels of PGI, PGII, and G-17 were in descending order from the type I H. pylori infection group to the type II H. pylori infection group than the control group (F = 14.31; 26.23; 9.12, P