Large-Area Integrated Triboelectric Sensor Array for Wireless Static and Dynamic Pressure Detection and Mapping.

Large-area flexible pressure sensors are of paramount importance for various future applications, such as electronic skin, human-machine interfacing, and health-monitoring devices. Here, a self-powered and large-area integrated triboelectric sensor array (ITSA) based on coupling a triboelectric sensor array and an array chip of CD4066 through a traditional connection is reported. Enabled by a simple and cost-effective fabrication process, the size of the ITSA can be scaled up to 38 × 38 cm2 . In addition, unlike previously proposed triboelectric sensors arrays, which can only react to the dynamic interaction, this ITSA is able to detect static and dynamic pressure. Moreover, through integrating the ITSA with a signal processing circuit, a complete wireless sensing system is present. Diverse applications of the system are demonstrated in detail, including detecting pressure, identifying position, tracking trajectory, and recognizing the profile of external contact objects. Thus, the ITSA in this work opens a new route in the direction of large-area, self-powered, and wireless triboelectric sensing systems.

Isolation of benzolactones, Ganodumones A-F from Ganoderma lucidum and their antibacterial activities.

Six previously undescribed benzolactone constituents, ganodumones A-F (1-6), a new type of Ganoderma meroterpenoids (GMs) fused with 1,2,3,4,5-pentasubstituted phenyl and 1',2'-dioxy-3'-methyl-pentyl chain were isolated from the fruiting bodies of Ganoderma lucidum. Their structures were determined by spectroscopic analysis, X-ray crystal diffraction, and ECD computational methods. Meanwhile, bioactive evaluation showed that compounds 3 and 5 have antibacterial activities against Microsporum gypseum with MIC90 56.86 ± 3.98 and 18.48 ± 0.47 µg/mL, respectively.

Structurally diverse lanostane triterpenoids from medicinal and edible mushroom Ganoderma resinaceum Boud.

Ganoderma resinaceum is a multi-purpose herbal medicine that is homologous to functional food that has long been used for enhancing health and treating chronic hepatopathy in Traditional Chinese Medicine. In a search program to discover the key bioactive composition of G. resinaceum, sixteen new lanostane-type triterpenoids (1-16), and twenty known analogues (17-36) were isolated from the fruiting bodies of G. resinaceum. Spectroscopic analyses and X-ray crystallography were used to determine the new structures. Furthermore, the spectroscopic properties of 15ß-hydroxy-4,4,14α- trimethyl-3,7,11,20-tetraoxo-5α-pregn-8-ene (15) and 15α-hydroxy-4,4,14α-trimethyl- 3,7,11,20-tetraoxo-5α-pregn-8-ene (34) indicated a potential structural misassignment of their analogues, lucidone E and lucidone H, reported previously. To probe this hypothesis, ROESY experiments and single-crystal X-ray diffraction analysis were conducted. These results undoubtedly reassigned the structure of lucidone E and lucidone H. Biological evaluation of the selected compounds disclosed that compounds 3, 4, 7/21, 11, 12, 13/14, 17, 18, 24/25, 27, 30, 31, and 35 had significant hepatoprotective activities, due to their remarkable in vitro inhibitory activities against the increase of ALT and AST levels in HepG2 cells induced by H2O2.

Prenatal diagnosis of anomalous origin of one pulmonary artery branch by two-dimensional echocardiography: summary of 12 cases.

OBJECTIVES: To improve the prenatal diagnosis for anomalous origin of pulmonary artery branches by comparing and analyzing different types of fetal echocardiography features. METHODS: Between June 2012 and December 2018, fetal echocardiographic features were analyzed retrospectively from fetuses with a prenatal diagnosis of anomalous origin of pulmonary artery branch. The main points of identification were summarized. RESULTS: A total of 12 fetuses were diagnosed, including anomalous origin of a pulmonary artery branch from the innominate artery and six cases with unilateral absence of pulmonary artery. The shared characteristic sonographic finding was the lack of confluence at the bifurcation of the main pulmonary artery. The differences between the two conditions are highlighted by the origin of the anomalous vessel. In fetuses with anomalous origin of one pulmonary artery branch, the affected pulmonary artery arose from the posterior wall of the ascending aorta as noted on three vessels and trachea view as well as the long axis of the left ventricular outflow tract. This is in contrast to fetuses with unilateral absence of pulmonary artery, where the origin of affected pulmonary artery arises from the base of the innominate artery via the ipsilateral patent arterial duct as evident on the three vessels and trachea view and the coronal view of innominate (brachiocephalic) artery. CONCLUSION: (1) The main similarity is an absence of a confluence at the bifurcation of the main pulmonary artery. (2) The main distinguishing feature is the origin of the anomalous vessel from either the subclavian or directly from the aorta.

Nanofiber-Reinforced Silver Nanowires Network as a Robust, Ultrathin, and Conformable Epidermal Electrode for Ambulatory Monitoring of Physiological Signals.

Extremely soft and thin electrodes with high skin conformability have potential applications in wearable devices for personal healthcare. Here, a submicrometer thick, highly robust, and conformable nanonetwork epidermal electrode (NEE) is reported. Electrospinning of polyamide nanofibers and electrospraying of silver nanowires are simultaneously performed to form a homogeneously convoluted network in a nonwoven way. For a 125 nm thick NEE, a low sheet resistance of ≈4 Ω sq-1 with an optical transmittance of ≈82% is achieved. Due to the nanofiber-based scaffold that undertakes most of the stress during deformation, the electric resistance of the NEE shows very little variation; less than 1.2% after 50 000 bending cycles. The NEE can form a fully conformal contact to human skin without additional adhesives, and the NEE shows a contact impedance that is over 50% lower than what is found in commercial gel electrodes. Due to conformal contact even under deformation, the NEE proves to be a stable, robust, and comfortable approach for measuring electrocardiogram signals, especially when a subject is in motion. These features make the NEE promising for use in the ambulatory measurement of physiological signals for healthcare applications.

Prenatal Diagnosis of Aortopulmonary Window by 2-Dimensional Echocardiography: Summary of 8 Cases.

Aortopulmonary window (APW) is a rare congenital heart anomaly. A total of 8 cases with APW confirmed by echocardiography and surgery were retrospectively reviewed and the echocardiographic features analyzed. Among the 8 APW cases, 5 were type II and 3 were type III, the latter of which includes 2 cases complicated with Berry syndrome. Prenatal echocardiography can provide accurate information for the diagnosis of fetal APW. The prognosis depends on the timing of surgery and the nature of the associated cardiac anomalies.

Ganolearic Acid A, a Hexanorlanostane Triterpenoid with a 3/5/6/5-Fused Tetracyclic Skeleton from Ganoderma cochlear.

Ganolearic acid A (1), a 3,4- seco-hexanortriterpenoid featuring a rare 3/5/6/5 tetracyclic system, was obtained in trace amounts from Ganoderma cochlear by a LC-UV/MS-guided method. Meanwhile, a new 3,4- seco-nortriterpenoid, fornicatin M (2), as well as its biogenetic precursor, fornicatin D (3), was isolated. The stereochemical structure of 1 was completely established by 1D, 2D NMR, IR, and HRMS spectra, as well as 13C NMR and electronic circular dichroism calculations. The plausible biogenetic pathway of 1 and 2 was proposed. Furthermore, their anti-inflammatory activities were evaluated.

Structural Elucidation and Biomimetic Synthesis of (±)-Cochlactone A with Anti-Inflammatory Activity.

A pair of new natural meroterpenoids, (±)-cochlactone A (1) possessing a bicyclo[4.4.0]decane ring system with a γ-lactone fragment, was isolated from Ganoderma cochlear. To further confirm their absolute configurations, a high-yielding, one-step biomimetic synthesis of (±)-cochlactone A (1) from ganomycin C (3) was conducted. In addition, a new compound, (±)-cochlactone B (2), featuring a bicyclo[3.3.1]decane fragment fused to a γ-lactone moiety was synthesized. Their structures were determined using spectroscopic data, X-ray diffraction crystallography, and electronic circular dichroism (ECD) analyses. Furthermore, a plausible reaction mechanism for the formation of 1 and 2 was proposed. Compounds (+)-2 and (±)-2 showed inhibitory effects against Staphylococcus aureus with MIC50 values of 41.1 ± 0.1 and 64.0 ± 2.6 µg/mL, respectively. Meanwhile, (±)-1, (-)-1, (+)-2, and (±)-2 displayed significant anti-inflammatory activities (IC50: 5.9 ± 0.1, 6.1 ± 0.2, 12.1 ± 0.4, and 18.7 ± 1.9 µM, respectively).

[Advances of sequencing and assembling technologies for complex genomes].

Complex genomes are noted to be extremely difficult to sequence or assemble by using ordinary methods. Complex genomes are typically characterized as being highly repetitive, highly heterozygous, extremely GC biased, or naturally contaminated, i.e., contaminations which cannot be removed before sequencing. To solve these problems with sequencing and assembling complex genomes, three major techniques include: (1) DNA extraction experiments, (2) Sequencing technologies and platforms, and (3) Algorithms and strategies for assembling. In this review, we summarize these state-of-the-art technologies and strategies used in these directions. We also review the representative projects of complex genome sequencing and address the development of these technologies and strategies for solving the challenges when sequencing or assembling complex genomes.

Pepluane and Paraliane Diterpenoids from Euphorbia peplus with Potential Anti-inflammatory Activity.

Twelve new diterpenoids based on two rare skeletal types, namely, paralianones A-D (1-4) and pepluanols A-H (5-12), along with five known compounds, were isolated from an acetone extract of Euphorbia peplus. Their structures were proposed based on 1D and 2D NMR spectroscopic data analysis. These diterpenoids were evaluated for potential anti-inflammatory activity in a lipopolysaccharide-stimulated mouse macrophage cellular model. Compounds 3, 4, 11, 13, and 16 displayed moderate inhibitory effects on NO inhibition, with IC50 values ranging from 29.9 to 38.3 µM.

Osteoinductive potential of a novel biphasic calcium phosphate bone graft in comparison with autographs, xenografts, and DFDBA.

OBJECTIVES: Since the original description of osteoinduction in the early 20th century, the study and development of innovative biomaterials has emerged. Recently, novel synthetic bone grafts have been reported with potential to form ectopic bone in vivo. However, their full characterization in comparison with other leading bone grafts has not been investigated. The aim of this study was to determine the osteoinductive potential of bone grafts by comparing autogenous bone grafts, demineralized freeze-dried bone allografts (DFDBA), a commonly utilized natural bone mineral (NBM) from bovine origin (Bio-Oss), and a newly developed biphasic calcium phosphate (BCP). MATERIALS AND METHODS: Grafts were compared in vitro for their ability to stimulate bone marrow stromal cell (BMSC) migration, proliferation, and differentiation as assessed by quantitative real-time PCR for genes coding for bone markers including Runx2, collagen I, and osteocalcin. Furthermore, bone grafts were implanted in the calf muscle of 12 beagle dogs to determine their potential to form ectopic bone in vivo. RESULTS: The in vitro results demonstrate that both autografts and DFDBA show potential for cell recruitment, whereas only autografts and BCP demonstrated the ability to differentiate BMSCs toward the osteoblast lineage. The in vivo ectopic bone model demonstrated that while NBM particles were not osteoinductive and autogenous bone grafts were resorbed quickly in vivo, ectopic bone formation was reported in DFDBA and in synthetic BCP grafts. CONCLUSION: The modifications in nanotopography and chemical composition of the newly developed BCP bone grafts significantly promoted ectopic bone formation confirming their osteoinductive potential. In conclusion, the results from this study provide evidence that synthetic bone grafts not only serve as a three-dimensional scaffold but are also able to promote osteoinduction.

Enamel matrix derivative improves gingival fibroblast cell behavior cultured on titanium surfaces.

OBJECTIVE: Although an extensive amount of research has demonstrated the positive effects of an enamel matrix derivative (EMD) on soft tissue wound healing around intrabony defects, little information is available describing its effect on peri-implant soft tissues, an area that has recently gained tremendous awareness due to the increasing prevalence of peri-implantitis. The aim of the present study was to assess the role of EMD when gingival fibroblasts were cultured on titanium surface with different surface topographies. METHODS: Human primary gingival fibroblasts were cultured on pickled (PT) and sand-blasted with large grit followed by acid etching (SLA) surfaces and assessed for cell adhesion at 2, 4, and 8 h, cell morphology at 2, 4, 8, and 24 h as well as cell proliferation at 1, 3, and 5 days post-seeding. Furthermore, genes encoding collagen 1a1, vascular endothelial growth factor-A (VEGF-A), and fibronectin were assessed by real-time PCR. Human gingival fibroblasts were also quantified for their ability to synthesize a collagen matrix on the various titanium surfaces with and without EMD by immunofluorescence staining. RESULTS: The results from the present study demonstrate that EMD significantly increased cell spreading at 2, 4, 8, and 24 h on PT surfaces and 4, 8, and 24 h on SLA surfaces. Furthermore, proliferation at 5 days on PT surfaces and 3 and 5 days on SLA surfaces was also increased for groups containing EMD. Real-time PCR results demonstrated that the culture of gingival fibroblasts with EMD significantly increased extracellular matrix synthesis of collagen 1 as well as improved mRNA levels of VEGF-A and fibronectin. Collagen1 immuno-fluorescent staining revealed a significantly higher area of staining for cells seeded on PT + EMD at 7 and 14 days and 14 days for SLA + EMD when compared to control samples. CONCLUSION: The results from the present study favor the use of EMD for colonization of gingival fibroblasts on titanium surfaces by increasing cell growth, spreading, and synthesis of an extracellular matrix. The improvements were primarily irrespective of surface topography. Future animal and human studies are necessary to fully characterize the beneficial effects of incorporating EMD during soft tissue regeneration of implant protocols. CLINICAL RELEVANCE: The use of EMD may speed up the quality of soft tissue integration around dental implants by facilitating gingival cell attachment, proliferation, and matrix synthesis of collagen 1.

In vitro characterization of an osteoinductive biphasic calcium phosphate in combination with recombinant BMP2.

BACKGROUND: The repair of alveolar bone defects with growth factors and bone grafting materials has played a pivotal role in modern dentistry. Recombinant human bone morphogenetic protein-2 (rhBMP2), an osteoinductive growth factor capable of cell recruitment and differentiation towards the osteoblast lineage, has been utilized in combination with various biomaterials to further enhance new bone formation. Recently, a group of novel biphasic calcium phosphate (BCP) bone grafting materials have been demonstrated to possess osteoinductive properties by demonstrating signs of ectopic bone formation. The aim of the present study was to study the effects of rhBMP2 in combination with osteoinductive BCP bone grafts on osteoblast cell behaviour. METHODS: MC3T3-E1 pre-osteoblasts were seeded on 1) control tissue culture plastic, 2) 10 mg of BCP alone, 3) 100 ng rhBMP2, and 4) 100 ng rhBMP2+ 10 mg of BCP and analyzed for cell recruitment via a Transwell chamber, proliferation via an MTS assay and differentiation as assessed by alkaline phosphatase (ALP) activity, alizarin red staining and real-time PCR for osteoblast differentiation markers including Runx2, collagen1, ALP, and osteocalcin (OCN). RESULTS: rhBMP2 was able to significantly upregulate cell recruitment whereas the addition of BCP as well as BCP alone had no additional ability to improve osteoblast recruitment. Both BCP and rhBMP2 were able to significantly increase cell proliferation at 3 and 5 days post seeding and cell number was further enhanced when rhBMP2 was combined with BCP. In addition, the combination of rhBMP2 with BCP significantly improved ALP activity at 7 and 14 days post seeding, alizarin red staining at 14 days, and mRNA levels of Runx2, ALP and osteocalcin when compared to cells seeded with rhBMP2 alone or BCP alone. CONCLUSIONS: The results from the present study demonstrate that 1) the osteoinductive potential of BCP bone particles is equally as osteopromotive as rhBMP2 on in vitro osteoblast differentiation and 2) BCP particles in combination with rhBMP2 is able to further increase the osteopromotive differentiation of osteoblasts in vitro when compared to either rhBMP2 alone or BCP alone. Future animal testing is further required to investigate this combination approach on new bone formation.

Death domain associated protein (Daxx), a multi-functional protein.

Death domain associated protein (Daxx), a multi-functional protein, plays an important role in transcriptional regulation, cell apoptosis, carcinogenesis, anti-virus infection and so on. However, its regulatory mechanisms for both cell survival and apoptosis remain largely obscure. Our review of recent studies shows that Daxx has many interesting functional dualities and can provide a reference for further research on Daxx.

Characterization of a shorter recombinant polypeptide chain of bone morphogenetic protein 2 on osteoblast behaviour.

BACKGROUND: Recombinant bone morphogenetic protein two (rhBMP2) has been utilised for a variety of clinical applications in orthopaedic surgery and dental procedures. Despite its widespread use, concerns have been raised regarding its short half-life and transient bioactivity in vivo. Recent investigation aimed at developing rhBMP2 synthesized from a shorter polypeptide chain (108 amino acids) has been undertaken. METHODS: The osteopromotive properties of BMP2 were investigated on cell behaviour. Five concentrations of rhBMP2_108 including 10, 50, 100, 200 and 500 ng/ml were compared to a commercially available rhBMP2 (100 ng/ml). Each of the working concentrations of rhBMP2_108 were investigated on MC3T3-E1 osteoblasts for their ability to induce osteoblast recruitment, proliferation and differentiation as assessed by alkaline phosphatase (ALP) staining, alizarin red staining, and real-time PCR for genes encoding ALP, osteocalcin (OCN), collagen-1 (COL-1) and Runx2. RESULTS: The results demonstrate that all concentrations of rhBMP2_108 significantly improved cell recruitment and proliferation of osteoblasts at 5 days post seeding. Furthermore, rhBMP2_108 had the most pronounced effects on osteoblast differentiation. It was found that rhBMP2_108 had over a four fold significant increase in ALP activity at seven and 14 days post-seeding and the concentrations ranging from 50 to 200 ng/ml demonstrated the most pronounced effects. Analysis of real-time PCR for genes encoding ALP, OCN, COL-1 and Runx2 further confirmed dose-dependant increases at 14 days post-seeding. Furthermore, alizarin red staining demonstrated a concentration dependant increase in staining at 14 days. CONCLUSION: The results from the present study demonstrate that this shorter polypeptide chain of rhBMP2_108 is equally as bioactive as commercially available rhBMP2 for the recruitment of progenitor cells by facilitating their differentiation towards the osteoblast lineage. Future in vivo study are necessary to investigate its bioactivity.

Awareness and knowledge about human papillomavirus among high school students in China.

OBJECTIVE: To investigate awareness and knowledge of human papillomavirus (HPV) infection among high school students and to provide a basis for health education on HPV infection for high school students in China. STUDY DESIGN: A questionnaire on HPV awareness and knowledge was administered to 900 high school students in Xiangtan City of Hunan Province in China by layer cluster sampling. A total of 848 anonymous valid questionnaires were received from volunteers who completed the questionnaire correctly. RESULTS: Only 10.1% had heard of HPV, and of those only 18.6% knew that HPV could lead to cervical cancer. Single factor analysis indicated that home address, age, grade, academic achievement, sex history, gender, father's education level and mother's education level were impact factors for HPV knowledge of high school students. Multiple regression analysis showed 4 independent risk factors associated with HPV knowledge: academic achievement, sex history, gender, and mother's education level. The limited knowledge came primarily from television and radio broadcasts (59.3%), the Internet (57.0%), parents (25.6%), medical workers (20.9%), and teachers (18.6%). CONCLUSION: High school students lack HPV knowledge, which is affected by multiple factors. Targeted health education of all sorts must be provided. Both schools and families are responsible for reinforcing HPV education provided to high school students.

National income accounting attributes and economic welfare. Evidence from Pakistan.

Economic welfare is essential in the modern economy since it directly reflects the standard of living, distribution of resources, and general social satisfaction, which influences individual and social well-being. This study aims to explore the relationship between national income accounting different attributes and the economic welfare in Pakistan. However, this study used data from 1950 to 2022, and data was downloaded from the World Bank data portal. Regression analysis is used to investigate the relationship between them and is very effective in measuring the relationship between endogenous and exogenous variables. Moreover, generalized methods of movement (GMM) are used as the robustness of the regression. Our results show that foreign direct investment outflow, Gross domestic product growth rate, GDP per capita, higher Interest, market capitalization, and population growth have a significant negative on the unemployment rate, indicating the rise in these factors leads to a decrease in the employment rate in Pakistan. Trade and savings have a significant positive impact on the unemployment rate, indicating the rise in these factors leads to an increase in the unemployment rate for various reasons. Moreover, all the factors of national income accounting have a significant positive relationship with life expectancy, indicating that an increase in these factors leads to an increase in economic welfare and life expectancy due to better health facilities, many resources, and correct economic policies. However, foreign direct investment, inflation rate, lending interest rate, and population growth have significant positive effects on age dependency, indicating these factors increase the age dependency. Moreover, GDP growth and GDP per capita negatively impact age dependency. Similarly, all the national income accounting factors have a significant negative relationship with legal rights that leads to decreased legal rights. Moreover, due to better health facilities and health planning, there is a negative significant relationship between national income accounting attributes and motility rate among children. Our study advocated the implications for the policymakers and the government to make policies for the welfare and increase the social factors.

Classification of pain expression images in elderly with hip fractures based on improved ResNet50 network.

The aim of this study is designed an improved ResNet 50 network to achieve automatic classification model for pain expressions by elderly patients with hip fractures. This study built a dataset by combining the advantages of deep learning in image recognition, using a hybrid of the Multi-Task Cascaded Convolutional Neural Networks (MTCNN). Based on ResNet50 network framework utilized transfer learning to implement model function. This study performed the hyperparameters by Bayesian optimization in the learning process. This study calculated intraclass correlation between visual analog scale scores provided by clinicians independently and those provided by pain expression evaluation assistant(PEEA). The automatic pain expression recognition model in elderly patients with hip fractures, which constructed using the algorithm. The accuracy achieved 99.6% on the training set, 98.7% on the validation set, and 98.2% on the test set. The substantial kappa coefficient of 0.683 confirmed the efficacy of PEEA in clinic. This study demonstrates that the improved ResNet50 network can be used to construct an automatic pain expression recognition model for elderly patients with hip fractures, which has higher accuracy.

Overexpression of Helicobacter pylori VacA N-terminal fragment induces proinflammatory cytokine expression and apoptosis in human monocytic cell line through activation of NF-κB.

Vacuolating cytotoxin (VacA) is an important virulence factor in the pathogenesis of Helicobacter pylori-related diseases. The aim of this study was to investigate the function of the amino-terminal 476 residue fragment (p52) of VacA and the possible molecular mechanisms responsible for its induction of proinflammatory cytokines secretion and apoptosis. Human acute monocytic leukemia cell line THP-1 was used as an in vitro model to study proinflammatory cytokines secretion and apoptosis induced by transfection of a recombinant plasmid encoding the amino-terminal 476 residue fragment (p52) of VacA. The results showed that VacA p52 overexpression induced the production of tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1ß), nitric oxide, and reactive oxygen species in THP-1 cells in a time-dependent manner. VacA p52 overexpression also promoted THP-1 cells apoptosis. In addition, VacA p52 triggered the activation of nuclear factor kappa B (NF-κB), indicating a possible mechanism for its induction of proinflammatory cytokines secretion and cell apoptosis. Our study demonstrated that the induction of cytokines secretion and apoptosis by VacA p52 in THP-1 cells could be mediated through activation of nuclear factor kappa B.

Prevalence of coinfection in children with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis.

BACKGROUND: The pathology of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) has not been elucidated. The progression of the disease could be influenced by coinfection with other pathogens. This study investigates the prevalence of cytomegalovirus (CMV), hepatitis B and C, bacteria, mycoplasma, fungi, and tuberculosis among EBV-HLH children. DESIGN AND METHODS: Clinical and laboratory records of EBV-HLH patients at Beijing Children's Hospital between June 2007 and June 2010 were retrospectively reviewed. RESULTS: Forty-seven children diagnosed with EBV-HLH were included. The average age at diagnosis was 4 years 1 months ± 3 years 9 months (mean ± SD). CMV-Ab-IgM was positive in 6.7% (3 of 45), bacteria culture was positive in 14.3% (6 of 42), fungi culture was positive in 10.7% (3 of 28) patients. Hepatitis B virus surface antigen, hepatitis C virus antibody, purified protein derivative, and myoplasma antibody-IgM were negative in these patients. Two patients were coinfected by 2 pathogens: fungi and bacteria (n = 1), CMV and bacteria (n = 1). Four patients died in hospital, among them 2 patients had bacteria culture positive results. Only a fraction of the EBV-HLH patients had genetic defects in PRF1, UNC13D, and XIAP. CONCLUSIONS: The overall coinfection ratio with EBV-HLH was 21.3% in our series (10 of 47), 50% of in hospital deaths (2 of 4) were attributable to sepsis. More attention should pay on coinfections in EBV-HLH patients, especially bacterial coinfection.