Chagas cardiomyopathy is an infectious heart disease caused by infection of Trypanosoma cruzi. The pathological process of Chagas cardiomyopathy is divided into a self-limiting acute phase and an irreversible chronic phase, which is characterized by progressive myocardial fibrosis and neurogenic disorders. The diagnosis should be combined with epidemiological history, serological detection and multimodal imaging technology, and the treatment strategy includes pathogen control and complication management at the same time. At present, the clinical challenges of Chagas cardiomyopathy are focused on the high rate of missed diagnosis in non-epidemic areas and the lack of means to reverse chronic pathological reversal. Establishing a multidisciplinary diagnosis and treatment pathway based on serological screening and improving the hierarchical prevention and control system are the key to improve the global burden of Chagas cardiomyopathy. With the progress of research technology, the diagnosis and treatment strategies of Chagas cardiomyopathy are updated. In 2024, the first non-imported case of Chagas disease in China was reported. This article systematically discusses the clinical manifestations, diagnostic and treatment strategies, and the latest research progress of patients with Chagas cardiomyopathy, aiming to enhance the understanding of this disease among medical professionals in China and provide a reference for early detection, screening and standardized treatment.

To investigate the impact of vitamin D deficiency on the risk of osteoporosis in middle-aged and elderly individuals after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Total of 388 middle-aged and elderly patients aged ≥ 55 years old previously infected with SARS-CoV-2 in the surrounding communities of Beijing Ditan Hospital, Capital Medical University from December 1st 2019 to August 31st 2024 were selected, who were divided into 25-OH-VD ≥ 20 ng/ml group (182 cases) and 25-OH-VD < 20 ng/ml group (206 cases) according to 25-OH-VD sufficiency or deficiency. The general data, bone and vertebral bone structure, and SARS-CoV-2 infection related indicators of the two groups were compared, respectively. The factors affecting osteoporosis in middle-aged and elderly people aged 55 years old and over after SARS-CoV-2 infection were analyzed by Logistic regression analysis.

Gender of patients between 25-OH-VD ≥ 20 ng/ml and 25-OH-VD < 20 ng/ml group was significantly different (χ² = 29.85, P < 0.001). Patients in 25-OH-VD < 20 ng/ml group had significantly lower levels of red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), white blood cells (WBC), eosinophil count (EO#), mean corpuscular hemoglobin concentration (MCHC), prealbumin (PAB), creatinine (CREA) and uric acid (URCA) compared with those of 25-OH-VD ≥ 20 ng/ml group (all P < 0.05); but phosphate ions (PHOS), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bile acids (TBA), parathyroid hormone (PTH), triiodothyronine (T3) and tetraiodothyronine (T4) were significantly higher than those of 25-OH-VD ≥ 20 ng/ml group (all P < 0.05). T values of the left hip, right hip and lumbar spine of patients in 25-OH-VD < 20 ng/ml group were significantly lower than those of 25-OH-VD ≥ 20 ng/ml group, with significant differences (Z =－4.45, P < 0.001; Z =－4.84, P < 0.001; Z =－3.03, P = 0.002). The incidence of fractures, thoracic hyperplasia, osteoporosis and FRAX^@ predicted 10-year osteoporosis of patients in 25-OH-VD < 20 ng/ml group were significantly higher than those of 25-OH-VD ≥ 20 ng/ml group, but the rate of thoracic degeneration was significantly lower than that of 25-OH-VD ≥ 20 ng/ml group, with significant differences (all P < 0.05). The number of typical symptoms of corona virus disease 2019 (COVID-19) of patients in 25-OH-VD < 20 ng/ml group was significantly higher than that of 25-OH-VD ≥ 20 ng/ml group, with significant difference (χ² = 9.89, P = 0.007). Multivariate Logistic regression analysis showed that patient gender (OR = 3.13, 95%CI: 1.17-8.37, P = 0.023), number of typical symptoms of COVID-19 (4-9: OR = 1.72, 95%CI: 1.01-2.96, P = 0.049; ≥ 10: OR = 5.90, 95%CI: 2.98-11.69, P < 0.001), ALP (OR = 1.02, 95%CI: 1.01-1.03, P < 0.001), CREA (OR = 0.97, 95%CI: 0.95-0.99,P = 0.041), CD3⁺ T% (OR = 0.96, 95%CI: 0.93-0.99, P = 0.044) and 25-OH-VD (OR = 0.96, 95%CI: 0.93-0.99,P = 0.048) were all independent influencing factors for osteoporosis.

After SARS-CoV-2 infection, middle-aged and elderly people with vitamin D deficiency are more likely to develop osteoporosis. Attention should be paid to middle-aged and elderly women, nutritional status, immune indicators and 25-OH-VD in the prevention and control of osteoporosis.

To investigate the predictive efficacy and effect of bacterial DNA level in ascites on prognosis of bacterial peritoneal inflammation (SBP) of cirrhosis patients with ascites after removing cell-free DNA.

A single-center prospective cohort design was adopted, and a total of 230 patients with ascites due to liver cirrhosis who were hospitalized in Beijing YouAn Hospital, Capital Medical University from September 2021 to December 2022 were enrolled. Ascitic fluid samples were collected at admission and pretreated with Benzonase to remove free DNA. Bacterial DNA levels were then quantitatively measured using droplet digital PCR (ddPCR). Based on the ascitic bacterial DNA load at admission, patients were divided into high bacterial DNA load group [log (bacterial DNA) ≥ 2, 38 cases] and low bacterial DNA load group [log (bacterial DNA) < 2, 192 cases]. Independent risk factors for SBP within 30-days after hospitalized were analyzed by Logistic regression analysis, while the impact of bacterial DNA load on 90-days and 360-days of hospitalized survival were assessed by Cox regression and ROC curve analysis.

The incidence of SBP in high bacterial DNA load group was 44.7% (17/38), significantly higher than that of low bacterial DNA load group (6.25%, 12/192), with significant difference (χ² = 42.81, P < 0.001). Multivariate Logistic regression analysis indicated that elevated bacterial DNA load in ascites [log (bacterial DNA) ≥ 2] (OR = 3.040, 95%CI: 1.605-5.756, P = 0.001), upper gastrointestinal bleeding (OR = 6.061, 95%CI: 2.315-15.625, P < 0.001), and chronic kidney disease (OR = 12.195, 95%CI: 4.504-32.258, P < 0.001) were all independent risk factors for the occurrence of SBP within 30 days in patients with cirrhotic ascites. A predictive model incorporating the MELD score, log (bacterial DNA) and neutrophil count was constructed to assess the risk of 90-days mortality. ROC curve analysis showed that the predictive performance of the combined model (AUC = 0.823) was superior to that of the MELD score alone (AUC = 0.754), with significant difference (Z = 2.823, P = 0.005). The 90-days and 360-days survival rates in high bacterial DNA load group (71.1% and 57.9%) were significantly lower than those of low bacterial DNA load group (84.4% and 79.2%), with significant differences (χ² = 2.99, P = 0.038;χ² = 6.68, P = 0.002).

Ascitic bacterial DNA levels after removal of free DNA have significant predictive value for the occurrence of SBP in patients with cirrhotic ascites. High bacterial DNA load in ascites is associated with lower survival rates of 90-days and 360-days after hospitalized, suggesting that bacterial translocation may play an important role in prognostic evaluation of liver cirrhosis.

To analyze the mother-to-child transmission (MTCT) of hepatitis B virus (HBV) infection in pregnant and postpartum women, and explore the MTCT rate and its influencing factors in the real-world where strict preventive interventions measures are implemented.

A cohort study was conducted on 10 250 mothers of HBV-exposed children in Beijing from January 1st, 2021 to December 31st, 2023. Socioeconomic data, HBV serological markers, HBV viral load and MTCT prevention interventions were analyzed, respectively. The relationship between year, maternal age and positivity of hepatitis B virus surface antigen (HBsAg) were analyzed by Poisson regression analysis. Data of HBsAg-positive mothers and HBV-exposed children were sourced from the National Prevention of Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B Information System. Post-vaccination serological testing (PVST) results and MTCT rates were described for 8 412 (82.07%) HBV-exposed children who completed follow-up serological testing after full vaccination. Mothers and children were grouped based on the HBV DNA load of infected mothers: pregnant women with high viral load group (1 780 cases) and pregnant women with low viral load group (8 470 cases), children with high-exposure group (1 664 cases) and children with low-exposure group (6 748 cases). The differences of basic information, fetal outcomes and prevention of MTCT interventions between two groups of pregnant women were analyzed by Chi-square test and Mann-Whitney test; the differences of MTCT rates under different socioeconomic, infection status and prevention of MTCT interventions were compared by Chi-square test.

From 2021 to 2023, there were a total of 403 368 deliveries in Beijing, including 10 093 HBsAg-positive delivery women (10 250 live born children were delivery women), the HBsAg positivity rate was 2.50% (95%CI: 2.45%-2.55%), with a downtrend that the younger of pregnant woman was, the lower the positive rate of HBsAg (RR = 0.93, P < 0.001). Timely vaccination rate of hepatitis B vaccine (99.94% vs. 99.76%) and timely injection rate of hepatitis B immunoglobulin (HBIG) (99.89% vs. 99.88%) of pregnant women in high viral load group and low viral load group were both higher than 99.50%, but without significant difference (χ² = 2.33, P = 0.127; χ² = 0.00,P = 0.950). The vaccination time of hepatitis B vaccine were 0.48 (0.26, 0.60) h and 0.53 (0.30, 1.15) h, respectively (Z = 12.83, P < 0.001); the injection time of HBIG in children with high exposure group and low exposure group were 0.41 (0.25, 0.51) h and 0.50 (0.28, 1.07) h, respectively (Z = 14.85, P < 0.001), both with significant differences. The antiviral treatment rate of pregnant women in high viral load group was 96.35% (1 715/1 780), significantly higher than that of the low viral load group (14.06%, 1 191/8 470) (χ² = 4 902.99, P < 0.001); the proportion of pregnant women in high viral load group delivered in specialized hospitals (89.94%, 1 601/1 780) was significantly higher than that of the low exposure group (34.90%, 2 956/8 470) (χ² = 1 805.80, P < 0.001), with significant difference. Total of 6 cases of MTCT were identified, the MTCT rate of HBV was 0.07% (95%CI: 0.02%-0.16%). Among different delivery ages, educational levels, types of delivery institutions and delivery methods, the MTCT rates of HBV were without significant difference (all P > 0.05). The MTCT rate of HBV in HBeAg positive pregnant women was higher than that of HBeAg negative pregnant women (0.28% vs. 0.00%: χ² = 17.15, P < 0.001), and the MTCT rate of HBV in high viral load pregnant women was higher than that of low viral load pregnant women (0.36% vs. 0.00%:χ² = 24.35, P < 0.001), both with significant differences.

Timely administration of HBIG and vaccination for all HBV-exposed children, combined with antiviral treatment starting in late pregnancy for mothers with high MTCT risk, could reduce the MTCT rate of HBV to an extremely low level.

To analyze Helicobacter pylori (Hp) subtypes infection in patients with different pathological types of colorectal polyps, and investigate the relationship with inflammatory characteristics.

Total of 480 patients with Hp positive colorectal polyps admitted to Beijing Shijingshan Hospital from January 1st 2020 to December 31st 2023 were collected as research subjects. According to the pathological types, the patients were divided into proliferative polyp group, inflammatory polyp group, adenomatous polyp group and colorectal cancer group, with 120 cases in each group. The general information and gastrointestinal imaging features of patients were analyzed, retrospectively, Hp subtype distribution and levels of inflammatory factors such as C-reactive protein (CRP), interleukin (IL)-1, IL-6, tumor necrosis factor-α (TNF-α), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in each group of patients were compared, respectively. The differences among the expression of inflammatory factors among different pathological types of colorectal polyps and subtypes were analyzed. The risk factors for colorectal cancer in patients with colorectal polyps, and the risk association between Hp subtypes and inflammatory factors were identified by multiple Logistic regression analysis. The interaction between Hp subtypes and inflammatory markers of colorectal cancer were analyzed by generalized multi factor dimensionality reduction (GMDR) method. The alcohol consumption history (χ² = 32.433, P < 0.001), hyperlipidemia history (χ² = 19.940, P < 0.001) and lesion size (χ² = 89.048, P < 0.001) among patients in proliferative polyp group, inflammatory polyp group, adenomatous polyp group and colorectal cancer group were significantly different. The distribution of Hp subtypes (type Ⅰ and type Ⅱ) among patients of the four groups (χ² = 51.193, P < 0.001), the levels of CRP (F = 2.871, P = 0.036), IL-1 (F = 109.747, P < 0.001), IL-6 (F = 51.959, P < 0.001), TNF-α (F = 26.770, P < 0.001) and NLR (F = 7.393, P < 0.001) were all significantly different among patients of hyperplastic polyp group, inflammatory polyp group, adenomatous polyp group and colorectal cancer group, while PLR level was without significant difference (F = 1.617, P = 0.185). Multivariate Logistic regression analysis showed that history of alcohol consumption (OR = 1.937, 95%CI: 1.420-2.763, P < 0.001), history of hyperlipidemia (OR = 2.856, 95%CI: 2.351-3.759, P < 0.001), lesion size > 2 cm (OR = 3.017, 95%CI: 2.215-3.823,P < 0.001), CRP > 7.01 pmol/L (OR = 2.235, 95%CI: 1.840-2.760, P < 0.001), IL-1 > 22.13 mmol/L (OR = 1.857, 95%CI: 1.148-2.996, P < 0.001), IL-6 > 30.24 mmol/L (OR = 1.592, 95%CI: 1.308-2.093, P < 0.001), TNF-α > 31.79 g/L (OR = 1.985, 95%CI: 1.290-3.225, P < 0.001), NLR > 2.08 (OR = 2.803, 95%CI: 1.922-3.474, P < 0.001) and type Ⅰ Hp infection (OR = 2.961, 95%CI: 2.158-3.510, P < 0.001) were all risk factors for colorectal cancer in patients with colorectal polyps. The levels of CRP, IL-1, IL-6, TNF-α, NLR and PLR in type Ⅰ Hp infected individuals were significantly higher than those of type Ⅱ Hp infected individuals among the proliferative polyp group, inflammatory polyp group, adenomatous polyp group and colorectal cancer group, with significant differences (allP < 0.05). Logistic regression analysis showed that CRP (R = 0.165, P = 0.042), IL-1 (R = 0.183, P < 0.001), IL-6 (R = 0.367, P < 0.001), TNF-α (R = 0.215,P = 0.006), NLR (R = 0.236,P = 0.038) were all risk factors for type Ⅰ Hp infection; PLR (R = 0.185, P = 0.010), IL-1 (R = 0.212, P = 0.006), IL-6 (R = 0.205, P = 0.023) and TNF-α (R = 0.189, P = 0.014) were all risk factors for type Ⅱ Hp infection. The six-order GMDR model based on CRP, IL-1, IL-6, TNF-α, NLR and type Ⅰ Hp infection was constructed to test the accuracy of the sample, the accuracy of which was 73.803%, the cross-validation consistency was 100%, the results of the significant test of the interaction effect of the model were significantly different (all P < 0.001).

The distribution of Hp subtypes varies among patients with different pathological types of colorectal polyps, and adenomatous polyps and colorectal cancer patients have a higher rate of type Ⅰ Hp infection. The levels of inflammatory factors differ among patients with colorectal polyps infected with different Hp subtypes, and the levels of inflammatory factors are generally higher in patients infected with type Ⅰ Hp than those of patients infected with type Ⅱ Hp.

To identify the risk factors that lead to maternal and infant adverse outcomes of bloodstream infection.

Total of 314 pregnant women with bloodstream infection were selected from the Department of Obstetrics, Obstetrics and Gynecology Hospital of Tongji University·Shanghai First Maternity·Infant Hospital From January 1st 2021 to January 31st 2024 as the study subjects (bloodstream infection group), during the same period, 300 pregnant women who had no bloodstream infection of the whole pregnancy period and had undergone prenatal examination were selected as control group, the clinical data of two groups of pregnant women were collected for retrospective analysis. According to the pregnancy outcome, 314 pregnant women with bloodstream infection were divided into normal outcome group (240 cases) and adverse outcome group (74 cases). The general information, clinical symptoms and indicators of bloodstream infection and pathogen isolation of patients in normal outcome group and adverse outcome group were analyzed by univariate analysis. The indicators with statistically significant differences were further analyzed by Logistic multivariate binary regression analysis to explore the risk factors affecting maternal adverse outcomes of bloodstream infection.

The incidence of adverse pregnancy outcomes of cases in bloodstream infection group was 23.57% (74/314), significantly higher than that of the control group (8.00%, 24/300), with significant difference (χ²= 27.717, P < 0.001). Between pregnant women in normal outcome group and adverse outcome group, age [(36.56 ± 4.56) years old vs. (29.45 ± 5.02) years old: t = 10.877, P < 0.001], pre-pregnancy body mass index (BMI) [(25.09 ± 2.21) vs. (22.64 ± 1.31): t = 12.245, P < 0.001], the highest body temperature distribution (χ² = 30.250, P < 0.001), occurrence of septic shock (χ² = 40.968,P < 0.001), level distribution of WBC (χ² = 65.677,P < 0.001), CRP (χ² = 13.977,P < 0.001) and PCT (χ²= 17.452, P < 0.001), and the number of original bacterial species (χ² = 29.216,P < 0.001) were all with significant differences. There was no significant difference in educational background, residence, working conditions, pregnancy and childbirth history, number of fetuses in this pregnancy, time of infection, source of infection, course of infection and pathogen type between the two groups (all P > 0.05). The results of multivariate Logistic regression analysis showed that the occurrence of septic shock (OR = 3.695, 95%CI: 1.627-5.462,P = 0.037), the number of infectious bacteria (OR = 18.746, 95%CI: 10.630-27.651, P = 0.049) and PCT level (OR = 33.683, 95%CI: 21.533-40.029,P = 0.011) were all risk factors for adverse maternal and infant outcomes in pregnant women with bloodstream infection.

Infectious shock, abnormal increase of PCT level and mixed pathogen infection are important indicators to evaluate maternal adverse outcomes of bloodstream infection.

To investigate the effect of continuity care intervention based on the knowledge, attitude and practice (KAP) theory on the clinical outcomes of patients with high-risk human papillomavirus (HR-HPV) persistent infection complicated with cervical intraepithelial neoplasia grade Ⅰ (CIN Ⅰ) undergoing aminolevulinic acid photodynamic therapy (ALA-PDT).

Total of 120 patients with HR-HPV persistent infection and CIN Ⅰ diagnosed at the Dermatovenereology Outpatient Department of Beijing Ditan Hospital, Capital Medical University, from July 1st 2022 to June 30th 2023 were selected by convenience sampling method. Patients were randomly divided into control group (60 cases) and observation group (60 cases) by random number table method. Both groups received ALA-PDT treatment. Patients in control group received routine care, while observation group underwent additional continuity care intervention based on KAP theory. Indexes of generalized self-efficacy scale (GSES scores) and short form health survey (SF-36 scores) were compared between the two groups at baseline, after 6 times of ALA-PDT, 3-month and 6-month after ALA-PDT by independent samples t-test. HPV genotyping results and colposcopy reexamine findings were evaluated at 3 months and 6 months after ALA-PDT by Chi-square test.

GSES and SF-36 scores between control group and observation group before treatment were not significantly different (t = 0.852, P = 0.398; t = 0.012,P = 0.991). After 6 times of ALA-PDT, 3-month and 6-month after ALA-PDT, the GSES scores of patients in observation group were (25.63 ± 4.34), (30.09 ± 4.34) and (34.21 ± 4.56), significantly higher than those of the control group [(22.23 ± 4.05), (25.78 ± 4.57) and (29.56 ± 5.13)], with significant differences (t = 3.137, 3.746, 3.711; P = 0.003, < 0.001, < 0.001); while the SF-36 scores of patients in observation group were (72.73 ± 3.58), (80.25 ± 4.20) and (89.34 ± 4.65), significantly higher than those of the control group [(64.59 ± 3.47), (72.78 ± 3.96) and (78.79 ± 4.11)], with significant differences (t = 8.547, 7.088, 9.311; all P < 0.001). At 3 and 6 months after ALA-PDT, the HPV-negative conversion rates of patients in observation group were 73.3% (44/60) and 70.4% (42/60), respectively, significantly higher than those of the control group [65% (39/60) and 61.7% (37/60)], with significant differences (χ² = 15.98, 13.76; both P < 0.001). At 6 months after ALA-PDT, the rate of lesion reversal in observation group was 80.0% (48/60), significantly higher than that of control group [68.3% (41/60)], with significant difference (χ² = 16.89, P < 0.001).

Continuity care intervention based on the KAP theory can significantly improve the self-efficacy and life quality of patients with HR-HPV persistent infection complicated with CIN Ⅰ, and optimize the clinical outcome of patients.

To improve the understanding of Actinotignum schaalii and expand clinical diagnosis and treatment approaches for infections caused by this bacteria.

The clinical data of a patient with complicated urinary tract infection caused by Actinotignum schaalii and admitted to Jiading Campus of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine in July 29th 2024 was analyzed, retrospectively. Relevant domestic and foreign literatures were searched to explore the characteristics, clinical diagnosis and treatment of this bacteria.

The patient, a female, 66 years old, was hospitalized for treatment due to urinary retention and repeated difficulty in urinating. Actinotignum schaalii was isolated from the clear mid-stream urine. CT urography showed bilateral renal pelvis and bilateral upper ureter dilation with hydrops, and bladder enlargement with multiple cords and diverticula, which may be caused by chronic cystitis. Transurethral resection of bladder tumor (TURBT) + transurethral resection of bladder neck (TURBN) were performed, and 1.5 g/time of Cefuroxime was intravenously infused twice a day. After three days’ anti-infection treatment, the patient improved and was discharged.

Actinotignum schaalii has atypical morphology and high culture requirements. Laboratory staff should pay attention to avoid missed detection. For urinary tract infections caused by this bacteria, β-lactam antibiotics such as Cephalosporins are recommended. Surgical patients should be alert to the occurrence of postoperative translocation infection.