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Our aim was to estimate the prevalence of HCV in a highly vulnerable population of substance users living with social difficulties and marginality who came into contact with the mobile harm reduction service in the city of Bologna (Northern Italy). Testing was offered in a van (mobile unit) by using a point-of-care HCV antibody test. For the HCV RNA test, the Xpert HCV Viral Load Fingerstick Test was used. Participants with a detectable HCV RNA were accompanied within two weeks to the Infectious Diseases Department Sant' Orsola Hospital Bologna to start HCV treatment. With regard to the main study findings, 54% reported having never been HCV tested before; a prevalence of HCV RNA of 6% among all participants and 22% among those injecting drugs was found; among the HCV RNA positive participants, 80% were accompanied to treatment. Our study suggests that mobile harm reduction services, in networks with healthcare facilities, are able to offer a continuous HCV screening service and linkage to care for people with drug use living in socially marginalized conditions.

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BACKGROUND: The outbreak of severe acute respiratory syndrome coronavirus (SARS-CoV-2) Omicron variant occurred in Tianjin, China, at the beginning of 2022. In the present study, we identified risk factors that may affect positive (RP) RNA re-testing in recovered patients infected with Omicron variants during recovery in hospital. METHODS: We retrospectively analyzed the medical records of 425 patients with Omicron variant infection admitted to our medical center from January 21, 2022 to February 24, 2022, based on the recurrence of RT-PCR positive results for SARS-CoV-2 after cure and discharge. Patients were divided into re-tested positive (RP) and non-re-detectable positive patients (NRP) groups, and clinical data from both groups were analyzed to investigate the characteristics and risk factors of RP patients. RESULTS: Univariate analysis showed significant differences in age, vaccination rate and dose, partial signs and symptoms, most co-existing disorders, and levels of CRP and IL-6 between the RP and NRP groups (all P < 0.05), while multifactorial logistic regression analysis showed that vaccination status and levels of IL-6 were independent risk factors for RP patients. CONCLUSION: Our results suggested that clinicians should assess the probability of "re-positive" nucleic acid tests after discharge, taking the following indicators into account: pre-admission underlying diseases, unvaccinated status, and high levels of CRP and IL-6. Post-discharge isolation and follow-up should also be strengthened.

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Purpose: At present, it has been found that managing patients with a redetected positive RNA test after recovery from foreign-imported coronavirus disease 2019 (COVID-19) cases in China is challenging. The purpose of the current study was to describe the clinical characteristics of these patients. Methods: This retrospective cohort study included 137 COVID-19 patients who were discharged from the Xi'an Public Health Center from 28 July 2020 to 31 December 2021. We compared the clinical characteristics between positive retest patients and non-positive retest patients. Results: 137 COVID-19 patients entered our study, 27 (19.7%) cases of COVID-19 with a redetected positive RNA test by the end of the follow-up period. Fever [(n = 31 (22.6%)], cough [n = 26 (18.9%)] and sore throat [n = 20 (14.5%)] were the most common initial symptoms among the foreign-imported COVID-19 patients, and there were almost no significant differences in initial symptoms between positive retest patients and non-positive retest patients. The positive retest patients had a higher lymphocyte count (p = 0.031) and lymphocyte percentage (p = 0.007) during readmission. There were generally no significant differences in other routine blood test findings, IgG and IgM antibody responses, between positive retest patients and non-positive retest patients, or in positive retest patients over time (before, during, or after positive patient detection). After readmission, positive retest patients displayed fewer symptoms or no obvious disease progression and more sustained remission by CT imaging. Conclusion: Our findings revealed that the clinical characteristics at the time of initial diagnosis were not closely related to redetected positive RNA tests after recovery from foreign-imported COVID-19 cases. Positive retest patients had virtually no symptoms and displayed no obvious disease progression during readmission. These findings provide important information and clinical evidence for the effective management of foreign-imported COVID-19 patients during their convalescent phase.

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Molecular testing of indeterminate thyroid nodules informs about the presence of point mutations, insertions/deletions, copy number variants, RNA fusions, transcript alterations and miRNA expression. American Thyroid Association (ATA) guidelines suggest molecular testing of indeterminate thyroid nodules may be considered to supplement risk of malignancy (ROM). Although these recommendations have been incorporated in clinical practices in the United States, molecular testing of indeterminate thyroid nodules is not common practice in Asia. Here, we performed molecular testing of 140 indeterminate nodules from Chinese patients using a novel molecular platform composed of RNA and DNA-RNA classifiers, which is similar to Afirma GEC and ThyroSeq v3. Compared with reports from North America, the new RNA and DNA-RNA classifiers had a higher positive predictive value (p1 = 0.000 and p2 = 0.020) but a lower negative predictive value (p1 = 0.004 and p2 = 0.098), with no significant differences in sensitivity (p1 = 0.625 and p2 = 0.179) or specificity (p1 = 0.391 and p2 = 0.264). Out of 58 resected nodules, 10 were borderline and 33 malignant, indicating a 74.1% ROM, which was higher than reports in North America (10-40% ROM). Our findings emphasize molecular testing with the newly reported RNA and DNA-RNA classifiers can be used as a 'rule-in' test when ROM is high.

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BACKGROUND: The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic. There have been reports that long-term SARS-CoV-2 RNA shedding and re-infection of COVID-19 patients existed. However, the specific mechanism, diagnosis, and treatment of COVID-19 are still unclarified. CASE PRESENTATION: In this case, we reported a 64-year-old patient who had a long-term course of COVID-19 for 174 days with two retests of SARS-CoV-2 RNA positive after discharging from the hospital. The patient's serum immunoglobulin G (IgG) of SARS-CoV-2 tested positive after the initial infection. And during treatment, the CD4 + T cell count and ratio to peripheral blood mononuclear cell (PBMC) were in dynamic change. CONCLUSIONS: Our results suggested that the host immune system responded with IgG production after SARS-CoV-2 infection, but was not protective enough for the patient. The reemergence of SARS-CoV-2 could be related to the cell count and proportion of CD4 + T cells in PBMC. And the increase of CD4 + T cells after treatment may help to clear the virus.

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Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) is still spreading around the globe causing immense public health and socioeconomic problems. As the infection can progress with mild symptoms that can be misinterpreted as the flu, self-testing methods that can positively identify SARS-CoV-2 are needed to effectively track and prevent the transmission of the virus. In this work, we report a point-of-care toolkit for multiplex molecular diagnosis of SARS-CoV-2 and influenza A and B viruses in saliva samples. Our assay is physically programmed to run a sequence of chemical reactions on a paper substrate and internally generate heat to drive these reactions for an autonomous extraction, purification, and amplification of the viral RNA. Using our assay, we could reliably detect SARS-CoV-2 and influenza viruses at concentrations as low as 50 copies/µL visually from a colorimetric analysis. The capability to autonomously perform a traditionally labor-intensive genetic assay on a disposable platform will enable frequent, on-demand self-testing, a critical need to track and contain this and future outbreaks.

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BACKGROUND: Previous studies have unveiled the occurrence of re-detectable positive (RP) RNA test result after hospital discharge among recovered COVID-19 patients, but the clinical characteristics of RP patients (RP patients) and the potential features affecting RP RNA test outcome remain unclear. METHODS: A total of 742 COVID-19 patients discharged between March 1st, 2020 and March 20th, 2020 were enrolled. All patients were followed-up for SARS-CoV-2 RNA test and RP patents were identified. The clinical characteristics between RP patients and NRP patients were compared, and the potential features affecting re-detectable RNA test outcome were further evaluated. RESULTS: Up to April 9th, 2020, 60 recovered patients (8.09%) had been re-detected to be SARS-CoV-2 RNA positive. Among those 60 RP patients, the median RP time was 12 days from the last negative result of SARS-CoV-2 RNA test or 10 days from hospital discharge. RP patients were prone to be older, having mild/moderate conditions, unilateral lung involvement and fatigue, chills, stuffy or runny nose, with high lymphocyte count. Multivariate logistic analysis and COX regression analysis demonstrated that age, lymphocyte count, urea nitrogen, stuffy or runny nose as well as lung involvement were independently associated with RP RNA test (P<0.05). CONCLUSIONS: Older patients accompanied with stuffy or runny nose, low urea nitrogen as well as unilateral lung involvement were more likely to develop RP RNA test result after hospital discharge. Therefore, we strongly suggest using broncho-alveolar lavage fluid for RNA detection, extending quarantine time, and conducting continual follow-up medical examination for those discharged patients.

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Macao, a special administrative region (SAR) of the People's Republic of China, is located in southern China and shares the border with mainland China. It is the most densely populated region in the world, with a population of 667400 and a total land area of 32.9 square kilometers in 2019. Since the first case diagnosed on January 22, 2020, there was a total of 45 laboratory-confirmed coronavirus disease 2019 (COVID-19) cases in Macao, of which 43 patients (96%) were imported cases. To date, all patients had been discharged successfully from Centro Hospitalar Conde de São Januário, a designated hospital to manage all COVID-19 patients in Macao. Eventually, no patient died, and no local community outbreak was noted. This opinion review describes the underlying factors that could have contributed to the successful experience in Macao SAR, China, which include the following: (1) Early implementation of containment measures; (2) Large-scale quarantine using hotel rooms to reduce the risk of a local outbreak; and (3) Multidisciplinary co-operation and transparency of information to the public. Although the successful experience in Macao SAR, China, may not be generalized to other regions, it should not be unreasonable to be well prepared with sufficient logistic support to conduct timely containment and early detection of episodic cases to prevent the backsliding of COVID-19 outbreak.

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BACKGROUND: Human papillomavirus (HPV) tests and genotyping have been used in clinical risk assessment. The purpose of this study was to analyze the performance of 2 common HPV testing platforms in detecting high-grade cervical lesions (high-grade squamous intraepithelial lesion [HSIL] or worse [≥HSIL]). METHODS: Between January 1 and December 31, 2015, 2041 Papanicolaou (Pap) tests with biopsy confirmation were analyzed along with HPV tests performed on Cobas or Aptima platforms. A biopsy diagnosis of grade 2 cervical intraepithelial neoplasia was confirmed with p16/Ki-67 immunohistochemistry. RESULTS: In total, 1866 and 175 Pap cases were tested on Cobas and Aptima platforms, respectively. Both platforms were highly sensitive (97% for both) for biopsy-confirmed ≥HSIL. Cobas HPV testing had higher positive rates for the diagnosis of benign lesions (84% vs 51%) and low-grade squamous intraepithelial lesions (89% vs 63%) on biopsy compared with Aptima. Aptima testing had significantly higher specificity for ≥HSIL than Cobas (41% vs 13%; P < .0001). Overall, performance of the Aptima platform was superior to that of the Cobas platform in detecting biopsy-confirmed ≥HSIL, resulting from its significantly higher positive predictive value (25% vs 16%; P < .03) and overall accuracy (50% vs 26%; P < .0001). CONCLUSIONS: Although both the Cobas and Aptima platforms offer highly sensitive tests for high-grade cervical lesions, Aptima HPV testing demonstrated significantly higher specificity and positive predictive value than Cobas testing for biopsy-confirmed ≥HSIL. The considerable difference may be related to the significant increase in E6/E7 expression after HPV DNA integration. The significantly higher specificity and overall accuracy of Aptima testing for ≥HSIL, resulting in the identification of high-risk populations that require immediate treatment and close follow-up, may prove useful in clinical risk stratification. Cancer Cytopathol 2017;125:652-7. © 2017 American Cancer Society.

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BACKGROUND: Recombinant immunoblot assay (RIBA) or RNA test is considered to be a supplemental test for confirming a HCV infection. A correlation has been reported between the signal-to-cutoff (S/CO) ratios of a third generation HCV enzyme-linked immunosorbent assay (ELISA) and a confirmed HCV infection. This study examined the results of an evaluation of domestic anti-HCV EIA and immunoblot kit (RIBA) in Korean donors. METHODS: A total of 375,576 donor samples were tested for anti-HCV using the LG third generation HCV ELISA (LG HCD 3.0 TMB, LGphD, Korea) and HCV RNA by NAT (Biomerieux/Roche RT-PCR, 24 pool). The anti-HCV repeat reactive samples were further tested by third generation RIBA (LG HCD Confirm, LGphD, Korea). A positive result by either the nucleic acid amplification test (NAT) or RIBA was interpreted as a confirmed HCV infection. RESULTS: There were 506 out of the 375,576 donor samples (0.13%) that were anti-HCV repeat reactive (RR) by routine screening ELISA. The confirmed HCV prevalence in the donors was 0.01% (RIBA 42/375,570, RNA 36/375,570). 443 samples from the 506 repeat reactive samples in ELISA (87.6%) showed a S/CO ratio 3.6 (mean 4.40+/-0.80), compared with the negative group (mean 1.54+/-0.64). CONCLUSION: There was a good correlation between a high S/CO ratios and a confirmed HCV infection. In addition, samples showing a low S/CO ratio with an ID (Indeterminate) or negative RIBA result suggest a high probability of nonspecific reactivity in ELISA.

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OBJECTIVE: Our purpose was to estimate the prevalence of hepatitis C virus seropositivity and define the risk factors for HCV infection in a group of pregnant women and the effect of HCV infection to mother and baby at the time of delivery. METHODS: From March 1997 to February 1998, 5655 women who delivered over 20 gestational weeks at our hospital were screened for HCV-Antibody(RIA), and the samples of most of HCV-Ab positive cases were analyzed for HCV-RNA by polymerase chain reaction(PCR). We also studied the risk factors for HCV infection, the effect of HCV infection to mothers and neonates at delivery. RESULTS: Of 5655 mothers 25 (0.44%) were HCV-Ab positive, and 20 of HCV-Ab positive mothers were analyzed for HCV-RNA by PCR. Of 20 HCV-Ab positive mothers 12 cases (60%) were HCV-RNA positive. Risk factors significantly more prevalent among HCV-seropositive patients were : a history of habitual intraveneous drug use, a history of smoking, alcohol drinking during pregnancy, having liver cirrhorsis. The proportions who had received a blood transfusion, had a history or ongoing syphilis or were positive for hepatitis B virus surface antigen were not significantly different between seropositive and seronegative women. Liver function test at delivery was abnormal in 4 cases(16%) of HCV-Ab positive group. And the number of abnomal liver function test cases in HCV-Ab negative group were 47(0.83%). This had statistical difference. In neonates at delivery, all 20 neonates of 20 ones having HCV-Ab positive mother were HCV-Ab positive. But only 2 cases of 20 babies were HCV-RNA positive. CONCLUSION: Mothers who have risk factors such as injecting drug use, smoking, alchohol drinking and liver cirrhorsis, should undergo HCV-Ab testing and quantitative HCV-RNA testing by PCR. More advanced studies about vertical transmission of HCV infection are needed.

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