[Analysis of loss to follow-up status and influencing factors of children born to pregnant women with HIV infection in China in 2019].

Objective: To understand the loss to follow-up of children born to pregnant women with HIV infection (HIV-exposed children) and analyze its influencing factors in China in 2019. Methods: The data were collected from the follow-up records of pregnant women with HIV infection and their children reported by the national "Management Information System for the Prevention of HIV, syphilis and Hepatitis B Mother-to-Child Transmission" in 2019. HIV-exposed children were defined as those who were not followed up after birth or who were not followed up at 18 months of age and who were not followed up at 21 months of age. The univariate and multivariate influencing factors of loss to follow-up of children born to HIV-infected pregnant women were analyzed by χ2 test and logistic regression model. SPSS 25.0 software was used for statistical analysis. Results: The number of HIV-infected pregnant women was 5 039, the number of live-born children was 5 035, the number of loss to follow-up children within 18 months of age was 283, and the loss to follow-up rate children was 5.62%(283/5 035). The results of multivariate logistic regression analysis showed that the rate of loss to follow-up of exposed children born to pregnant women who worked as farmers (animal husbandry and fishery) (aOR=0.34, 95%CI: 0.22-0.53), unmarried (aOR=0.47, 95%CI: 0.24-0.93), first marriage (aOR=0.38, 95%CI: 0.22-0.67), remarriage (aOR=0.36, 95%CI: 0.20-0.67) and cohabiting (aOR=0.47, 95%CI: 0.23-0.97), and knew they had HIV infection before this pregnancy (aOR=0.53, 95%CI: 0.40-0.70) was lower. Han nationality (aOR=1.52, 95%CI: 1.09-2.13), primary school (aOR=2.06, 95%CI: 1.10-3.89) and junior middle school (aOR=1.81, 95%CI: 1.03-3.17) educational level, non-use of antiviral drugs (aOR=6.21, 95%CI: 4.32-8.93) and delivery in township (street) level midwifery institutions (aOR=5.72, 95%CI: 1.61-20.27) had higher rates of loss to follow-up among infants born to HIV-infected pregnant women. Conclusions: HIV-exposed children still have a specific rate of loss to follow-up in China in 2019. In order to further reduce the rate of loss to follow-up, it is of great significance to improve the detection rate of HIV before pregnancy and the rate of antiviral drugs used in pregnant women with HIV infection, which is of great significance for the effective implementation of comprehensive intervention measures of prevention of mother-to-child transmission of HIV.

[Epidemiological analysis of the current prevalence of hepatitis B virus infection among pregnant and postpartum women in China from 2021 to 2023].

Objective: To analyze hepatitis B serologic tests and the current prevalence of hepatitis B virus (HBV) infection among pregnant and postpartum women in China from 2021 to 2023. Methods: Data on managing the prevention of mother-to-child transmission of HIV, syphilis, and hepatitis were retrieved from the National Information System. A positive serum HBsAg test was used to define HBV infection. The χ(2) test was used to compare the coverage rate of the hepatitis B serologic test across different years, in early-stage pregnancy, and the current HBV infection in pregnant and postpartum women. A two-sided P value of <0.05 was considered a statistically significant difference. Results: The coverage rate for hepatitis B serological detection in pregnant (including intrapartum) and postpartum women and early-stage pregnancy rose from 99.68% (10 463 059/10 496 883) and 82.96% (8 707 765/10 496 883) to 99.94% (8 678 777/8 684 387, P < 0.001) and 88.87% (7 717 857/8 684 387, P < 0.001) in China between 2021 and 2023. The current prevalence rate of HBV infection decreased from 4.98% (521 479/10 463 059) in 2021 to 4.56% (396 148/8 678 777) in 2023 among pregnant and postpartum women (P < 0.001). The current prevalence rate of HBV infection ranged from 1.53% to 10.39% among pregnant and postpartum women in various provinces of China in 2023. Conclusion: The coverage rate for hepatitis B serologic tests in China increased significantly between 2021 and 2023 in pregnant and postpartum women. Therefore, the current prevalence rate of HBV infection has decreased significantly in pregnant and postpartum women, but a regional difference still exists.

[Incidence and related factors of antiviral drug resistance in HIV-infected pregnant and postpartum women in some areas of three western provinces of China from 2017 to 2019].

Objective: To analyze the incidence and related factors of drug resistance in HIV-infected pregnant and postpartum women in some areas of three western provinces of China from 2017 to 2019. Methods: From April 2017 to April 2019, face-to-face questionnaires and blood sample testing were conducted in all health care institutions providing maternal and perinatal care and midwifery-assisted services in 7 prevention of mother-to-child transmissi project areas in Xinjiang, Yunnan and Guangxi provinces/autonomous regions. Information was collected during the perinatal period and viral load, CD4+T lymphocytes and drug resistance genes were detected at the same time. The multivariate logistic regression model was used to analyze the relationship between different factors and drug resistance in HIV-infected pregnant and postpartum women. Results: A total of 655 HIV-infected pregnant and postpartum women were included in this study. The incidence of drug resistance was 3.4% (22/655), all of whom were cross-drug resistant. The rate of low, moderate and high drug resistance was 2.1% (14/655), 1.2% (8/655) and 0.8% (5/655), respectively. The drug resistance rate in the people who had previously used antiviral drugs was 1.9% (8/418), and the drug resistance rate in the people who had not used drugs was 5.9% (14/237). The NNRTI drug resistance accounted for 2.8% (18/655) and the NRTI drug resistance rate was 2.5% (16/655). The multivariate logistic regression model showed that the risk of HIV resistance was lower in pregnant women who had previously used antiviral drugs (OR=0.32, 95%CI: 0.11-0.76). Conclusion: Strengthening the management of antiviral drug use and focusing on pregnant and postpartum women who have not previously used antiviral drugs can help reduce the occurrence of drug-resistant mutations. Personalized antiviral therapy should be considered to achieve viral inhibition effects in clinical practice.

[Experience of the selection and maintainence for donor lung: 62 cases attached].

Objective: To summarize the experience of selection and maintainence for the lungs from donation. Methods: From January 2015 to June 2016, 62 cases had been evaluated by Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University. All the clinic data had been collected to evaluate the donor lungs, including the basic information, physical examination, results of radiology and laboratory, the bronchoscope, etc. All the satisfactory donors had been harvested and transplanted to the receipient and then follow up. Results: Forty cases of donor lung had been harvested from 62 cases. There were 31 male and 9 female cases with average age of 28.7 years. There were 34 cases form donation after brain death and 6 cases from donation after circulatory death. In addition, 8 cases which were considered to be the marginal donors became satisfied after the donor maintanence. The microbe in all 40 cases had been detected and the bacterial infection rate was 82.5% (33/40). The microbe below could be detected in the bronchial stump or lung tissue, including Klebsiella Pneumonia, Baumanii, Staphylococcus Aureus, Enterococcus Faecium, etc. In the end, 22 bilateral lung transplantations, 17 single lung transplantations, 1 heart-lung transplantation had been implemented successfully and the survival rate in the perioperative period was 90.0%. Conclusions: The utilization ratio of donation can be increased and the waste of medical resource in unacceptable donor can be reduced by the sufficient donor selection and maintanence. The participation of multi-department is needed in the process of donor selection and maintanence.

A single nucleotide polymorphism in GABAA receptor isoforms is potentially responsible for isoflurane sensitivity in mice.

GABAA receptors are chloride channels in the brain that are activated by binding with g-aminobutyric acid (GABA). The cDNA sequences of GABAA receptor subunits from two strains of mice with different sensitivities to isoflurane were compared to identify nucleotide mutations. Included 80 mice from two strains with different sensitivities to isoflurane on C57BL/6 background. Forty mice were from an isoflurane-sensitive strain (S group) and 40 mice were from a resistant strain (R group). RNA was extracted from brains of the mice, and cDNA were reverse transcribed using AMV reverse transcriptase. The amplified products were processed, sequenced, and analyzed for differences between the two strains. Chi-square analysis was performed to compare differences in nucleotide mutation frequencies between the two strains. No differences were identified in the α1-6, ß2, ß3, or γ1-3 nucleotide sequences and no single nucleotide polymorphisms were found in the comparison with the GenBank sequence for the GABAA receptor subunit. A single nucleotide polymorphism (SNP) at the nucleotide position 462 (C/G) in the ß1 sequence was found. This SNP was observed in 5 mice from the sensitive strain and in 36 mice from the resistant strain. The Fischer exact test (P < 0.01) was used to compare two strains of mice for SNP in the cDNA sequence of the ß1 subunit. Additional studies are required to understand whether the GABAA receptor is a specific target of inhaled anesthetic action or whether the identified SNP affects the action of the volatile anesthetic.

[Recent progress of study on single nucleotide polymorphisms].

Single nucleotide polymorphisms (SNPs) is a new genetic marker system following RFLP and microsatellite polymorphism. It has been shown to have the characteristics of high-density, inheritance stability and facilitation in analysis automation. SNPs can be detected by electrophoresis, endonuclease-cleavage, PCR and sequencing, and can be used extensively in gene mapping, disease-correlativity analysis, population genetics and drug research.

[Inhibition of ERK1/2 activity and c-fos mRNA after coronary artery balloon injury by intracoronary radiation in swine].

The effect of intracoronary radiation on extracellular signal regulated kinase 1/2 (ERK1/2) activity and c-fos mRNA after coronary artery balloon injury was investigated in swine. Twenty three swines were randomly divided into a radiation group and a control group after coronary balloon over stretch. The dilated segments in the radiation group were exposed to a dose of 20 Gy by a catheter based radiation system. The animals were sacrificed at 3 (6 swines from each group) and 30 days (6 swines from radiation group and 5 from control group) after the operation. The injured segments were processed to examine c-fos gene expression by reverse transcription polymerase chain reaction (RT PCR) and to measure the activity of ERK1/2 biochemically. Intracoronary radiation decreased significantly the ERK1/2 activity and gene expression of c-fos in the radiation treated animals 3 days after coronary balloon injury (20.5%,P<0.01; 47.7%,P<0.05), but neither ERK1/2 activity nor c-fos gene expression was significantly affected by endovascular radiation in animals 30 days after balloon injury. Therefore, both ERK1/2 and c-fos may be involved in inhibiting restenosis.

[Surgical treatment of atherosclerotic occlusion of lower extremities].

27 patients with atherosclerotic occlusion of lower extremities were admitted from January 1988 to December 1992. Those patients underwent various kinds of bypass operations, with an effective rate of 86.8%. Some factors influencing the operative effect are discussed.

Blood pressure and life style in the People's Republic of China: three samples in the INTERSALT Study.

In INTERSALT, the International Cooperative Study on Electrolytes and Blood Pressure, three centres located in the People's Republic of China (PRC) had distinctive patterns of BP and of life style variables that, in INTERSALT overall, were found to relate to BP. The PRC centres had low body mass index (BMI) and alcohol consumption but high urinary sodium and sodium/potassium ratio (Na/K). Compared with 45 other INTERSALT centres, average BMI was 22.7 vs. 25.4 and alcohol consumption was 32% vs. 61%, with heavy drinking 3% vs. 14%. However, Na/K in the PRC was 6.7 vs. 3.2 in the other centres. This combination of factors may underlie the BP pattern observed. While mean BP in the PRC was lower than in the 45 centres (-7.0 mmHg SBP, -5.6 mmHg for DBP), this was counterbalanced by other findings. Upward slope of systolic pressure with age was 45% greater for the PRC than the other centres and 24% greater for diastolic pressure. As a result, although percentage hypertensive for ages 20-49 years for the PRC was half that in the 45 centres (6% vs. 12%), by age 50-59 years the prevalence was 31% in the PRC and 38% in the other centres. Hypertension prevalence in Tianjin, with highest Na/K in INTERSALT (7.6) was 40% for ages 50-59 years. While sample size in individual centres does not provide power to demonstrate aetiological relationships, these findings permit formulation of the following hypothesis: although lower body mass and lower alcohol intake may counteract to some degree impact of high salt intake, such intake over decades eventually takes its toll on BP.

[Experiences in improving prognosis of acute necrotizing pancreatitis].

Seventy-eight cases of acute necrotizing pancreatitis were analysed. Mortality varied with: timing of operation (14.3% after 5 days vs. 37.9% within 5 days), procedure (16.7% after necrosectomy vs. 44.4% after partial pancreatectomy) and nutritional support (15.0% with nutritional support vs. 50.0% without). Univariate (Chi-square test) and multivariate analyses (Logistic regression analysis showed correlation between each variable (timing of operation, procedure and nutritional support) and survival. It is felt that delayed necrosectomy with intraabdominal lavage, and early nutritional support may help to improve prognosis of this disease.

Normal gestation after 5 years on home parenteral nutrition.

A case of normal gestation after 5 years on HPN is reported. The patient had her entire jejunum and ileum and right colon resected because of gangrene and has subsisted normally on HPN ever since. From the second trimester on, her HPN formula was supplemented to meet the requirement for growth and development of the foetus. Anaemia, hypoalbuminaemia, low plasma zinc levels and jaundice became manifest in the final trimester. These responded readily to readjustment of her HPN formula. A normal baby weighing 2020 g was delivered by Caesarean section at 36 weeks. Long-term HPN, final trimester abnormalities and HPN formula adjustments are discussed.

The all-in-one nutrient solution in parenteral nutrition.

Dextrose, lipid emulsion, amino-acids, electrolytes, vitamins and trace elements were mixed in a well defined order to prepare 10 different total nutrient admixture solutions. The pH and osmolality of these solutions did not change significantly during 14 days of storage at 4 degrees C. Mean diameters of lipid particles on different occasions for the different solutions varied from 0.31 +/- 0.10 mum to 0.48 +/- 19 mum with 95% of particles less than 0.6 mum. Particles greater than 6 mum were not observed. Cultures were all negative. 243 patients received 5101 infusions of the admixture fluids. Patients on treatment for more than 1 week showed improved nitrogen balance. Serum transferrin and albumin were increased when treatment was ongoing for more than 2 weeks. No adverse reactions or abnormal laboratory findings were observed. One patient, with only duodenum and a part the colon left, has been maintained in good health for more than 55 months using this kind of nutritional support.

Defibrase, a purified fibrinolytic protease from snake venom in acute myocardial infarction.

To investigate the thrombolytic effects of defibrase in AMI, 157 pts with AMI were studied. Of the 157 pts, 87 were assigned to defibrase thrombolysis and 70 to the conventional therapy plus heparin (control). Coronary arteriography was performed in 36 pts of the defibrase group and 26 of the control group. Pretreatment coronary arteriography was performed in 10 pts and total occlusion of infarct-related artery (IRA) was demonstrated in 7. Thirty to 45 min after either intracoronary or intravenous defibrase thrombolysis, recanalization occurred in 4 of the 7 pts. The perfusion and stenosis was improved in 2 of the 3 pts with patent IRA. Of the 10 pts who underwent emergency coronary arteriography after the onset of i.v. defibrase thrombolysis, 6 were shown to have patent IRAs. Of the 16 pts who underwent coronary arteriography two weeks after the i.v. defibrase thrombolysis, 13 were shown to have patent IRAs. In contrast, only 11 of the 26 pts in the control group had patent IRAs two weeks after admission to the hospital. Of the 36 angiographic cases of the defibrase group, 15 underwent follow-up coronary arteriography, only 1 pt showed reocclusion. In comparison to the control group, the pts in the defibrase group had earlier CPK peaking, higher percentage of pts with LVEF > 0.5, a lower mortality and complication rate. Major spontaneous bleeding complications were rarely seen with defibrase. The results indicate that defibrase is an effective thrombolytic agent with a reasonable recanalization rate, low reocclusion rate and a low rate of bleeding complications.

[The prehospital emergency cardiac care in patients with acute myocardial infarction].

In order to evaluate the current status of prehospital care of acute myocardial infarction (AMI) in this city, the clinical manifestations and the emergency cardiac care in prehospital phase in 210 patients were reviewed in the period from 1987 to 1988. Before admission to CCU, 45.7% of the patients had complications of severe cardiac arrhythmias or hemodynamic disturbances and 14.8% had cardiac arrests. The mortality during the first 4 weeks was 25.2%. Among 53 patients who died, 50.9% occurred before admission and 37.7% within 1 hour. One hundred and ten patients (52.4%) had prehospital care and, 4 of them provided by the City Emergency Center and others by the local clinics near by. The median time from the cardiac attack to the first medical care, hospital arrival and CCU admission was 2, 3.6 and 6.3 hours respectively. The management on the scene was not efficient and effective in many patients. The rate of successful resuscitation in patients who had cardiac arrest out of hospital was only 7.7%. We are impressed that the mortality of patients with AMI is mainly in the early stage after appearance of symptoms. The initiation of emergency cardiac care is very necessary. The current status of prehospital cardiac care needs to be improved immediately, some suggestions are made for this purpose.

Ketanserin in the treatment of hypertension: a multicentre dose-finding study in China.

The effect of ketanserin at 5 mg, 10 mg and 20 mg twice daily for 3 months was studied in Chinese patients with hypertension. Both 10 mg and 20 mg doses twice daily effectively reduced systolic and diastolic pressures, while 5 mg twice daily was not effective. The 20 mg regimen was more effective than 10 mg in reducing diastolic, but not systolic pressures. Blood pressure reduction was progressive up to 1 month of treatment but not thereafter. Neither first-dose hypotension nor postural hypotension were seen. There were no effects on body weight or heart rate. A nominally significant 6 msec increase in QTc was seen with 10 mg, but not with 5 or 20 mg twice daily; this could be a chance finding. The side-effect burden was light, and decreased with time.

Serum lipid and apolipoprotein levels in a Tibetan population sample.

Serum lipid and apolipoprotein levels were measured in a Tibetan population sample. In both men and women serum cholesterol levels were markedly lower than in Western populations. In men HDL-cholesterol levels were higher compared to both Oriental and Western populations while in women the values were markedly higher than in other Oriental populations and similar to Western populations. Highly significant positive relationships were found between serum lipid levels and corresponding apolipoprotein levels. In men but not in women serum cholesterol was markedly higher in office workers than in factory workers.

[Hemodynamic study of a single oral dose of enalapril in patients with heart failure].

Clinical and hemodynamic studies were carried out for the purpose of evaluating the effects of enalapril in the treatment of chronic heart failure. Enalapril 10-20 mg was given once to 10 patients with moderate to severe congestive heart failure (coronary 6, hypertensive heart disease 2 and idiopathic congestive cardiomyopathy). Hemodynamic studies were done on the first day after drug administration and the same dose was maintained for 2 weeks. The results showed a decrease of mean BP of 18.29% (P less than 0.01), CVP 40.4% mPAP 23.9%, PCWP 41.2%, SVR 39.9% and PVR 41.3% respectively (P less than 0.001). Cardiac index increased 44.16% (P less than 0.001). The therapeutic action lasted more than 24 hours after a single dose. No further drop of BP was found weeks later, 6 patients in NYHA class III and 2 in class IV improved to class II. No severe side effects were found. The results showed that enalapril is well tolerated after a single dose and its therapeutic action lasts 2 weeks with improvement both in hemodynamics and subjective symptoms.

[Cyclic AMP levels in the plasma and ischemic myocardium and free fatty-acid levels in the serum following coronary artery ligation in dogs: relation to ventricular fibrillation].

This study was designed to shed light on the biochemical causes of serious ventricular arrhythmias in the early stage of acute myocardial infarction (AMI). Fourteen mongrel dogs were divided into 2 groups. One group was subjected to coronary ligation by placing silk sutures around the LAD coronary artery about 1.5 cm from its origin. All the dogs of this group were found to have ventricular tachycardia and fibrillation, starting approximately 18 min. After ligation, associated with regional accumulation of myocardial cAMP in the ischaemic zone. The increase of cAMP started about 10-15 min. before the onset of the arrhythmia. In contrast, the control group had only sutures placed without ligation and was not found to have change in myocardial cAMP within 35 min and arrhythmias at the same time. Both plasma cAMP and serum FFA were studied, but no significant changes were found. It is concluded that myocardial cAMP may play an important role in the genesis of ventricular arrhythmias in the acute ischaemic heart and it may be one of the arrhythmogenic factors to evoke ventricular arrhythmias.