Treatment of maternal syphilis for preventing congenital syphilis: an observational study of adherence to treatment recommendation in Suzhou, China, 2019-2021.

BACKGROUND: China is one of the countries that set the goal to eliminate mother-to-child transmission (EMTCT) of syphilis by a target date. Active screening for syphilis among pregnant women, followed by effective treatment of maternal syphilis, is critical for achieving the goal. The China health authority issued national implementation protocols to guide EMTCT practice in health facilities. METHODS: Within a cohort of infants born to mothers infected with syphilis, we obtained the data of regimens used for treatment of maternal syphilis from the National Information System of Prevention of Mother-to-Child Transmission of HIV, Syphilis and Hepatitis B, and analysed the physician's treatment behaviour and its associated factors in a public hospital in Suzhou of China. RESULTS: A total of 450 pregnant women who were positive for treponemal or non-treponemal antibody, or had previous infection with syphilis were included into the study for analysis. Of them, 260 (57.8%) were positive for both treponemal and non-treponemal antibodies (syphilis seropositivity), and 353 (78.4%) were treated for syphilis according to the protocol in which 123 (34.8%) were treated with two courses. Non-adherence to treatment recommended by the protocol for maternal syphilis was significantly associated with antenatal visits in the third trimester (AOR 6.65, 95% CI 2.20-20.07, P =0.001), being positive only for a treponemal test (AOR 5.34, 95% CI 3.07-9.29, P <0.001) or having a syphilis infection before the pregnancy (AOR 2.05, 95% CI 1.14-3.69, P =0.017), whereas the uptake of treatment for two treatment courses was associated with attending antenatal care in 2020 or before (AOR 3.49, 95% CI 1.89-6.42, P <0.001), being positive for treponemal and non-treponemal tests (AOR 5.28, 95% CI 2.78-10.06, P <0.001) or having non-treponemal antibody titre of ≥1:8 (AOR 3.71, 95% CI 1.77-7.78, P =0.001). CONCLUSIONS: Implementation of the current recommendation to offer a universal treatment for syphilis among all pregnant women who are shown to be positive for a treponemal test alone is challenging in some clinical settings in China.

Oral Manifestations of Early Syphilis in Adults: A Systematic Review of Case Reports and Series.

ABSTRACT: Rapid emergence of syphilis and oral sexual behaviors has focused attention on oral syphilis, and published reports of cases with oral syphilis have increased in the recent decades. We performed a systematic literature review by searching articles from PubMed, EMBSE, and Google Scholar, looking for case reports or series that would potentially have the clinical characteristics and outcomes for each individual case with oral syphilis. A total of 145 cases with the infection, from 95 studies, were identified to include in our review. Two main clinical phenotypes (ulcerative lesions and mucous patches) appeared to be of particular relevance to oral manifestations. A solitary ulcer was mostly manifested as the lesion of primary syphilis (91.7%) preferentially located on the upper lip, tongue, palate, and buccal mucosa. The most affected anatomical site in the patients with single location involved was the tongue (37.5%), followed by the lips (29.5%), palates (19.3%), and buccal mucosa (6.8%). It is concluded that oral syphilis has its predominant clinical phenotypes although it can manifest in diverse manners.

Risk Factors for Congenital Syphilis Transmitted from Mother to Infant - Suzhou, China, 2011-2014.

Mother-to-child transmission of syphilis remains a major global public health issue, and elimination of congenital syphilis is one of the millennium development goals of the World Health Organization (1). In 2012, an estimated 930,000 maternal syphilis infections caused 350,000 adverse pregnancy outcomes, including 143,000 early fetal deaths and stillbirths, 62,000 neonatal deaths, 44,000 preterm or low-weight births, and 102,000 infected infants worldwide (2). In China, the number of congenital syphilis cases reported annually increased from 468 in 2000 to 10,032 in 2013; the corresponding national congenital syphilis incidence rate increased nearly 26-fold, from 2.6 cases per 100,000 live births in 2000 to 69.9 in 2013 (3,4). To examine risk factors for mother-to-child transmission of syphilis, a cohort of pregnant women with a new syphilis diagnosis and their live-born infants was recruited during July 2011-July 2014 in Suzhou, in eastern China. Multivariable logistic regression results demonstrated that gestational age >36 weeks at the time of maternal syphilis diagnosis, higher maternal titers of rapid plasma reagin (RPR) and higher Treponema pallidum particle agglutination assay (TPPA) titers are risk factors for congenital syphilis. Among women with syphilis diagnosed at >36 weeks' gestational age, three quarters were migrant women. Recommendations for strengthening community and provider education about mother-to-child transmission of syphilis, early diagnosis and timely treatment of syphilis in pregnancy, and improving and providing access to prenatal care and screening migrant pregnant women with temporary residence status might reduce the incidence of congenital syphilis in China.

Ceftriaxone compared with penicillin G for the treatment of neurosyphilis: study protocol for a multicenter randomized controlled trial.

BACKGROUND: Neurosyphilis may cause irreversible neurological sequelae. First-line treatment consists of penicillin G, with ceftriaxone being an alternative treatment in patients allergic to penicillin. The lack of clinical data comparing the efficacy of these two drugs indicated the need for comparative clinical trials to improve national treatment guidelines in China. METHODS/DESIGN: In this multicenter randomized controlled clinical trial, 290 patients newly diagnosed with neurosyphilis will be randomized 1:1 to treatment with aqueous crystalline penicillin G (ACPG) or ceftriaxone. Patients will be treated with standard regimens of ACPG or ceftriaxone according to Chinese National Guidelines and will be followed up for 12 months. All clinical parameters will be assessed at baseline and at follow-up 3, 6, 9, and 12 months later. The primary outcomes will include cerebrospinal fluid (CSF) white blood cell (WBC) count, serological efficacy, and clinical efficacy. The secondary outcomes will include CSF protein concentrations, Mini-Mental State Examination (MMSE) scores, imaging results, recurrence, and time to recovery from neurosyphilis. Adverse events will be monitored and recorded during the trial. DISCUSSION: This trial will provide clinical data to determine whether ceftriaxone is non inferior to ACPG in treating neurosyphilis and will provide evidence for the improvement of treatment guidelines. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100047164. Registered on 9 June 2021 and updated on 23 November 2021.

Case report: Visual acuity loss as a warning sign of ocular syphilis: A retrospective analysis of 17 cases.

Objectives: To define the clinical features of ocular syphilis and analyze the cerebrospinal fluid (CSF) of ocular syphilis patients to determine the co-occurrence of neurosyphilis. Methods: This was a retrospective study of 17 patients (23 eyes) with ocular syphilis admitted to the Fifth People's Hospital, Suzhou, China from September 2017 to December 2021. Clinical manifestations, laboratory tests, treatment, and clinical outcomes were analyzed, and a review was conducted. Results: Eight males (12 eyes) and nine females (11 eyes) were enrolled. Mean patient age was 49.06 ± 3.47 years. The total manifestation time for ocular symptoms ranged from 10 days to 6 years. The cohort was comprised of three cases of early syphilis, four cases of late syphilis, and ten cases of unknown stage. The primary complaints were decreased visual acuity in 15 cases (21 eyes), ptosis in 1 case (1 eye), and loss of light perception in 1 case (1 eye). Cases were diagnosed as chorioretinitis in 7 cases (8 eyes), optic nerve retinitis in 4 cases (6 eyes), optic neuritis in 4 cases (7 eyes), and oculomotor nerve palsy in 1 case (1 eye), syphilitic stromal keratitis in 1 case (1 eye). Serum HIV antibody was positive in one case(Nos.2). All patients had reactive serum Treponema Pallidum Particle Agglutination (TPPA) and Toluidine Red Unheated Serum Test (TRUST). All patients underwent CSF examination. CSF white blood cell count was ≥5 × 106/L in 13 cases, CSF protein was >500 mg/L in 6 cases, TPPA was reactive in 15 cases, and TRUST was reactive in 5 cases. Eleven cases were also diagnosed with neurosyphilis. Patients were treated with either penicillin G sodium or ceftriaxone sodium. At time of discharge, 12 patients reported improved visual acuity. Abnormal serum or CSF examination improved in ten patients during the 6-12 month follow-up. Conclusion: Visual acuity loss is a warning indicator of ocular syphilis. Ocular syphilis primarily manifests as posterior uveitis, involving the choroid, retina, and optic nerve, and often co-occurs with neurosyphilis. Effective treatment should be administered immediately to avoid irreversible visual impairment and other serious adverse outcomes.

Diagnosis of subclinical extramammary Paget's disease with a combination of noninvasive photodynamic diagnosis and reflectance confocal microscopy.

Extramammary Paget's disease is a rare skin malignancy, and its diagnosis requires invasive biopsy and histopathological examination. Surgery is the standard treatment for extramammary Paget's disease patients; however, as incision boundaries and the depth of tumor cell infiltration are often unclear, the postoperative recurrence rate is high. We present a case in which we used photodynamic diagnosis in combination with reflectance confocal microscopy before surgery to detect an extramammary Paget's disease lesion that was located 3 cm away from the classical lesion. This secondary lesion exhibited a subclinical presentation, and it was eventually confirmed as an extramammary Paget's disease lesion by pathological examination. During detection using our technique, we delineated the boundaries of the extramammary Paget's disease lesion as a guide for surgical excision. The findings of our case demonstrate that photodynamic diagnosis combined with reflectance confocal microscopy can be used for the noninvasive diagnosis of subclinical extramammary Paget's disease and may be used to guide strategies for planning treatment and preventing relapse.

Utility of photodynamic diagnosis plus reflectance confocal microscopy in detecting the margins of extramammary Paget disease.

BACKGROUND: Due to the clinically poorly delineated unclear margin of extramammary Paget disease, the recurrence rate after surgical resection is high. AIMS: To compare photodynamic diagnosis and photodynamic plus reflectance confocal microscopy diagnosis in determining the tumor margins in patients with extramammary Paget disease. METHODS: Thirty-six patients with histopathologically confirmed primary extramammary Paget disease between January 2017 to June 2018 were included in the study. The skin lesion margins were preoperatively observed by the naked eye and with photodynamic diagnosis and photodynamic diagnosis plus reflectance confocal microscopy and they were compared to the postoperative histopathological examination results. RESULTS: Among the 130 sections taken from 36 patients, 83 sections (63.8%, 83/130) had tumor margins beyond the macroscopic line with a distance of 3.5 ± 3.1mm and a median of 2.7mm. Forty-six sections (35.4%, 46/130) exceeded the photodynamic diagnosis marker line with a distance of 2.1 ± 1.7mm and a median of 1.5mm. Twenty seven sections (20.8%, 27/130) were obtained beyond the photodynamic diagnosis plus reflectance confocal microscopy marker line with a distance of 1.4 ± 1.2mm and a median of 0.9mm. LIMITATIONS: Photodynamic diagnosis and reflectance confocal microscopy detection can be used to observe only the superficial margin of the tumor and not the deep part. Moreover, reflectance confocal microscopy was not used alone as a control. CONCLUSION: In terms of determining the extramammary Paget disease margin invasively, photodynamic diagnosis and photodynamic diagnosis plus reflectance confocal microscopy were found superior to observations made with the naked eye, while photodynamic diagnosis plus reflectance confocal microscopy was superior to photodynamic diagnosis alone.

Identification of protein-protein interactions of the occlusion-derived virus-associated proteins of Helicoverpa armigera nucleopolyhedrovirus.

The purpose of this study was to identify protein-protein interactions among the components of the occlusion-derived virus (ODV) of Helicoverpa armigera nucleopolyhedrovirus (HearNPV), a group II alphabaculovirus in the family Baculoviridae. To achieve this, 39 selected genes of potential ODV structural proteins were cloned and expressed in the Gal4 yeast two-hybrid (Y2H) system. The direct-cross Y2H assays identified 22 interactions comprising 13 binary interactions [HA9-ODV-EC43, ODV-E56-38K, ODV-E56-PIF3, LEF3-helicase, LEF3-alkaline nuclease (AN), GP41-38K, GP41-HA90, 38K-PIF3, 38K-PIF2, VP80-HA100, ODV-E66-PIF3, ODV-E66-PIF2 and PIF3-PIF2] and nine self-associations (IE1, HA44, LEF3, HA66, GP41, CG30, 38K, PIF3 and P24). Five of these interactions - LEF3-helicase and LEF3-AN, and the self-associations of IE1, LEF3 and 38K - have been reported previously in Autographa californica multiple nucleopolyhedrovirus. As HA44 and HA100 were two newly identified ODV proteins of group II viruses, their interactions were further confirmed. The self-association of HA44 was verified with a His pull-down assay and the interaction of VP80-HA100 was confirmed by a co-immunoprecipitation assay. A summary of the protein-protein interactions of baculoviruses reported so far, comprising 68 interactions with 45 viral proteins and five host proteins, is presented, which will facilitate our understanding of the molecular mechanisms of baculovirus infection.

The hypoglycemic effects of Camellia assamica var. kucha extract.

Kucha (Camellia assamica var. kucha) is an endemic tea that grows in cloudy and foggy highlands in southwest China. Its hypoglycemic effects were studied here. The postprandial blood glucose levels in mice after sucrose and soluble starch loading were significantly reduced by Kucha administration. The glycosidase inhibitory activities were effective both in vitro and in vivo. It is concluded that the hypoglycemic effects of Kucha might be due to inhibition of disaccharidases activities.

[Value of soluble triggering receptor expression on myeloid cells-1 level of alveolar fluid in early diagnosis of ventilator-associated pneumonia: a Meta-analysis].

OBJECTIVE: Serum soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) is a useful biomarker of bacterial infection. However, the diagnostic value of sTREM-1 of alveolar fluid in pulmonary infection is still unclear. This article aimed to explore the value of sTREM-1 of alveolar fluid in the early diagnosis of ventilator-associated pneumonia (VAP) by systematic review of relevant literatures. METHODS: CNKI, Wanfang, VIP, PubMed/Medline and Embase databases were retrieved. Articles on diagnosis of VAP by sTREM-1 before June 30, 2019 were collected. QUADAS-2 scale provided by Cochrane Collaboration Network was used to evaluate the quality of diagnostic experiments. RevMan 5.3 and Stata 13.0 software were used to complete Meta-analysis. The levels of sTREM-1 between VAP and non-VAP patients were analyzed by Meta-analysis, and then diagnostic test Meta-analysis was conducted. Heterogeneity, sensitivity and publication bias were analyzed. RESULTS: A total of 24 articles were enrolled. QUADAS-2 scale indicated that the selected literature had low bias and high clinical adaptability. (1) In Meta-analysis of sTREM-1 level in alveolar fluid, 20 articles were selected and found to have high heterogeneity (I2 = 94.4%, P = 0.000). The random effects models were used for Meta-analysis. It was indicated that the sTREM-1 level in alveolar fluid of VAP group was significantly higher than that of non-VAP group with significant difference [standardized mean difference (SMD) was 1.47, 95% confidence interval (95%CI) was 1.00-1.95, Z = 6.14, P = 0.000]. By subgroup analysis and Meta-regression analysis, no source of heterogeneity was found. Sensitivity analysis suggested that the results of this Meta-analysis were robust and credible, and Begg funnel plot analysis showed that there was no significant publication bias (Z = 1.46, P = 0.143). (2) A total of 18 articles were included in the Meta-analysis of diagnostic experiments. Deek funnel plot showed publication bias (P = 0.012). The combined sensitivity was 0.87 (95%CI was 0.81-0.91), specificity was 0.80 (95%CI was 0.73-0.86), and diagnostic odds ratio (DOR) was 26 (95%CI was 13-50). Subgroup analysis of three different sources of alveolar fluid (bronchoalveolar lavage fluid, endotracheal aspiration fluid and exhaled ventilator condensate) showed that STREM-1 had a certain value in early diagnosis of VAP. The I2 of combined DOR was 35.4%, and I2 of sensitivity was 79.46%, I2 of specificity was 77.61%, suggesting heterogeneity in the selected literature. Subgroup analysis found that nationality, subject design, sample source, sample size and diagnostic "gold criteria" were related to heterogeneity, but not age. The area under synthetic receiver operating characteristic (SROC) curve (AUC) was 0.90 (95%CI was 0.87-0.92). CONCLUSIONS: The detection of sTREM-1 level in alveolar fluid can be used for the early diagnosis of VAP with high sensitivity and specificity. If combined with other biomarkers, it may have more diagnostic value.

A case of hidroacanthoma simplex.

We report a case of hidroacanthoma simplex with giant lesion that was found on the left lumbar part which was treated with surgical excision.

[Cough-relieving, analgesic and antibiotic effects of durian shell extracts: a study in mice].

OBJECTIVE: To investigate the cough-relieving, analgesic and antibiotic effects of durian shell extract (DSE) in relieving cough and its analgesic and antibiotic effects. METHODS: The effect of DSE in relieving cough was assessed in mice challenged with ammonia and SO(2) to induce coughing. The analgesic and antibiotic effects of DSE in mice were evaluated by hot plate test and twisting reaction induced by acetic acid, and by minimal inhibitory concentration (MIC) and disc-agar diffusion tests, respectively. RESULTS: Compared with the control group, the mice treated with 300 and 900 mg/kg DSE showed significantly prolonged latency with decreased number of coughing induced by ammonia and SO(2), and the effect was dose-dependent. DSE markedly prolonged the latency and decreased the twisting number of the mice induced by acetic acid without affecting the pain threshold in hot plate test. DSE produced no significant inhibitory effects against Staphylococcus aureus, Staphylococcus epidermidis, or E. coli, and showed a week inhibition against Bacillus aeruginosus. CONCLUSION: DSE shows obvious effect in relieving cough and produces better analgesic effect against chemical factor-induced pain than against physical agent-induced pain sensation. DSE has a moderate inhibitory effect against Bacillus aeruginosus.