The safety and efficacy of delayed surgery by simulating clinical progression of observable papillary thyroid microcarcinoma: a retrospective analysis of 524 patients from a single medical center.

Objective: When active surveillance (AS) is developed in the patients with low-risk papillary thyroid microcarcinoma (PTMC), a medical center needs to ensure the delayed operation that is caused by PTMC clinical progression to have the same prognosis as that of immediate operation. The objective of this study was to investigate the efficacy of delayed surgery by simulating clinical progression (tumor size enlargement and appearance of lymph node metastasis) of PTMCs with AS in a single medical center. Methods: We retrospectively analyzed the response to therapy in 317 papillary thyroid carcinoma patients treated with total thyroidectomy and post-operative radioactive iodine ablation. They were classified into three groups according to tumor size (group A ≤0.5 cm; group B >0.5 cm and ≤1 cm; group C >1 cm and ≤1.5 cm) or two groups according to the presence (cN1) or absence (cN0) of the clinical lymph node (LN) metastasis. Groups C and cN1 were regarded as simulated clinical progression of observational PTMC and the operation for them was assumed to be "delayed surgery". However, Groups A, B and cN0 were regarded as no clinical progression and the operation for them was considered as immediate surgery. Results: There were no significantly differences in excellent response to therapy and recurrence-free survival not only among the group A, B and C, but also between the group cN0 and cN1. In other words, these insignificant differences were found between immediate and simulated "delayed" surgeries. Conclusion: For the PTMC patients suitable for AS, the oncological outcomes were also excellent even if surgery was delayed until after the presence of clinical progression, according to our clinical simulation. Furthermore, we consider that it was feasible for medical centers to assess the ability to implement AS for PTMC patients by retrospectively analyzing their own previous clinical data using the described simulation.

Related Risk Factors of Early Childhood Caries in Zhejiang Province, China During the COVID-19 Pandemic.

Objectives: This work aims to examining the latest early childhood caries situation in children aged 3 and 5 and its related risk factors in Zhejiang Province during the COVID-19 pandemic. Method: There are 3,537 children and their main caregivers participate in this study. We used chi square test or U-test to analyze whether there were differences in the prevalence of dental caries under different variables. The risk factors on ECC were determined by multivariate logistic analysis. Results: The ECC rate of children in this study was 57.51%. The mean decayed missing filled teeth (dmft) scores were 3.01. The result of multivariate logistic analysis showed higher ECC prevalence was found in children as age increasing, with lower district economic level, with high frequency of confectionary consumption, having oral medical treatment behavior and bad evaluation of children's oral health by parents. Conclusion: In general, the prevalence rate of ECC in this study was lower than five years ago, but still higher than those developed countries. And it was associated with age, district economic level, frequency of confectionary consumption, oral medical treatment behavior and evaluation of children's oral health by parents.

The Clinical Significance of Detecting Blood Supply to the Inferior Parathyroid Gland Based on the "Layer of Thymus-Blood Vessel-Inferior Parathyroid Gland" Concept.

Objective: How to preserve the inferior parathyroid gland (IPTG) in situ during central neck dissection (CND) is the major concern of thyroid surgeons. The "layer of thymus-blood vessel-IPTG" (TBP layer) concept showed to be effective in preserving IPTG. The objective of this study was to identify the origin and course of blood supply to IPTG (IPBS) within the TBP layer and to take key points of operation during CND. Design: This is a retrospective control study. Participants. Patients who underwent thyroidectomy plus CND using the TBP layer concept and conventional technique between 2017 and 2019 were enrolled. Measurements. The origin and course of IPBS in relation to recurrent laryngeal nerve (RLN) and thymus and prevalence of hypoparathyroidism were detected. Results: A total of 71.3% of IPTGs (251 of 352) were supplied by ITA branches, defined as type A. Type A was further divided into Types A1 (branches of ITA, coursing laterally to the RLN (53.1%, 187 of 352)) and A2 (branches of ITA, traversing medially to the RLN (18.2%, 64 of 352)). Type A2 was more common on the right side than on the left side (P < 0.001). Fifty-five (15.6%) IPTG feeding vessels originated from the thymus or mediastinum. Nineteen (5.4%) IPTGs were supplied by branches of the superior thyroid artery. The incidence of transient hypoparathyroidism decreased from 45.7% to 3.6% (P < 0.001), in the TBP layer group compared with the conventional technique group. Conclusion: The origin and course of IPBS follow a definite pattern. This mapping and precautions help surgeons optimize intraoperative manipulations for better preservation of IPBS during CND.

Spatial analysis and risk factors of suicide among people living with HIV/AIDS who committed suicide.

Poor mental health may confer worse health outcomes among people living with HIV/AIDS (PLWH). Suicidal behaviors are symptoms of a depressive episode. The goal was to explore characteristics for spatial distribution and risk factors for suicide among PLWH. This study was conducted in Mainland China with the annual newly reported data of PLWH from 2013 to 2018. We compared the spatial distribution differences between the HIV epidemic and suicide mortality and analyzed the global and local spatial analysis of suicide. Further, we explored the possible risk factors of suicide in PLWH by multivariate regression and a decision tree model. High suicide mortality regions in PLWH in China were inconsistent with that of the high prevalence of PLWH, which showed that there was distribution discordance between the HIV epidemic and suicide mortality. Multivariate regression showed that the possible risk factors of PLWH who committed suicide were younger age, with Han nationality, single, having a higher educational level, and homosexual infection route. The decision tree model showed that age was the primary factor. In conclusion, there was a discordance between HIV prevalence and suicide mortality; lower HIV prevalence regions might have higher mortality due to suicide. Concern is merited amongst PLWH with poor mental health.

Facile preparation of BiOBr/cellulose composites by in situ synthesis and its enhanced photocatalytic activity under visible-light.

BiOBr/regenerated cellulose composites photocatalysts were easily prepared by in situ synthesis method with the utilization of pulp board as the cellulose source in TEMPO (2, 2, 6, 6-tetramethylpiperidine-1-oxyl radical)-Mediated Oxidation. The physicochemical characteristic of the BiOBr/cellulose composites are systematically indicated by SEM, XRD, FT-IR, TG, BET, XPS, UV-vis, TOC, HPLC and EIS. The results indicated that the BiOBr nanoparticles were incorporated into cellulose surface, and there was a strong interaction between the hydroxyl groups of regenerated cellulose (RC) and the BiOBr through hydrogen bonding interactions. Under visible light irradiation, the composites showed remarkable photocatalytic activity for degradation of Rhodamine B (C0 = 25 mg L-1) with degradation percentage of 99% within only 50 min irradiation and 88.6% after four recycles. This study promotes that the BiOBr/cellulose composites can act as a new and green portable photocatalyst in the field of wastewater treatment.

Mortality among People Living with HIV and AIDS in China: Implications for Enhancing Linkage.

To assess the patterns and predictors of AIDS-related mortality and identify its correlates among adult people living with HIV/AIDS (PLWHA) in China, a retrospective record-based cohort study was conducted among 18 years or older PLWHA, who had at least one follow up reported to the national database between January-1989 and June-2012. Cumulative Incidence Function was used to calculate AIDS-related mortality rate. Gray's test was used to determine the variation in cumulative incidence across strata. The Fine and Gray model was used to measure the burden of cumulative incidence of AIDS-related mortality and strength of its association with potential correlates. Among 375,629 patients, 107,634 died during study period, of which 54,759 (50.87%) deaths were AIDS-related. Cumulative mortality rates of AIDS-related death at one, two, five, 10 and 15 years post-diagnosis were 5.7%, 8.2%, 14.3%, 22.9% and 30.9%, respectively. Among PLWHA, male gender, ethnic minority and having AIDS were associated with significantly higher mortality. Further, homosexual transmission, being on ART and increasing CD4-testing frequency were associated with lower mortality. To reduce mortality among PLWHA, efficient interventions targeting males, ethnic minority, heterosexually infected and AIDS patients should be combined with immunologic monitoring, enhancement of coverage of HIV-testing and ART.

[Meta-analysis of HIV infection incidence and risk factors among men who have sex with men in China].

OBJECTIVE: To understand the incidence of HIV infection among men who have sex with men (MSM) in China. METHODS: Meta-analysis was performed to systematically and quantitatively review all the original research papers and reports published during 2010-2015 on the incidence of HIV infection among MSM in China. Pooled incidence, pooled hazard ratios, publication bias, heterogeneity and sensitivity analysis for those studies were calculated or analyzed by using Stata 12.0 software. RESULTS: A total of 24 studies were analyzed. Pooled incidence of HIV infection among MSM in China was 5.0/100 person year; Based on HIV case report, severe epidemic areas had higher HIV incidence than other areas (4.9/100 person year vs. 3.4/100 person year). Low education level (HR = 1.61, 95% CI: 1.21-2.15), syphilis prevalence (HR = 3.22, 95% CI: 2.21-4.70), unprotected anal sex (HR = 2.92, 95% CI: 1.51-5.63), minority ethnic group (HR = 4.01, 95% CI: 1.96-8.21), commercial sex (HR = 4.11, 95% CI: 1.47-11.46) and multiple sexual partners (HR = 2.31, 95% CI: 1.60-3.34) were the risk factors for HIV incidence. CONCLUSION: Pooled incidence of HIV infection among MSM was 5.0% in China. Low education level, syphilis prevalence, unprotected anal sex, minority ethnic group, commercial sex and multiple sexual partners were the risk factors for HIV infection.

[Compliance of antiviral therapy and influencing factors in people living with HIV/AIDS in Nanjing].

OBJECTIVE: To understand the compliance of highly active anti-retroviral therapy (HAART) and influencing factors in people living with HIV/AIDS (PLWHA) in Nanjing. METHODS: PLWHA receiving HAART in No. 2 Hospital of Nanjing during May-June 2014 were recruited in this study. Self-administrated questionnaire was used to collect the data about HAART compliance and socio-demographic characteristics of PLWHA surveyed. Descriptive and multivariate statistical analysis were conducted to examine the effects of the factors on self-reported HAART adherence. RESULTS: A total of 276 PLWHA were surveyed, According to the evaluation criterion of Center for Adherence Support Evaluation (CASE), 252 cases showed good compliance (91.3%). logistic regression analysis revealed that smoking, progress of the disease and side effects, reminding of taking drug and age were correlated with self-reported HAART adherence. CONCLUSION: It is suggested to strengthen the education about antiviral therapy compliance in PLWHA with mild infection and those who are smokers and young, suffer from side effects, have no reminding methods for taking drug.

[Study on economic burden caused by antiretroviral treatment for people living with HIV/AIDS and influencing factors in Nanjing].

OBJECTIVE: To understand the economic burden caused by antiretroviral treatment for people living with HIV/AIDS and influencing factors in Nanjing. METHODS: People living with HIV/AIDS were divided into two groups, HIV infected patients and AIDS patients. The data about their direct medical expenditure, direct non-medical expenditure and indirect economic loss in the past year were collected. Univariate and multivariate analysis were conducted to identify the potential influencing factors. RESULTS: The median of direct medical expenditure and total costs for 133 HIV infected patients were 1,200 yuan RMB and 1,972 yuan RMB respectively. The median of direct medical expenditure and total costs for 145 AIDS patients were 1 060 yuan RMB and 2 826 yuan RMB respectively. The differences in direct medical expenditure and total costs between HIV infected patients and AIDS patients showed no statistical significance. The results from univariate analysis indicated that the sample source influenced total costs significantly. Multivariate analysis showed that onset time and CD level were negatively correlated with direct medical expenditure. The patients infected through heterosexual contact had more direct medical expenditure than those infected through homosexual contact. The patients receiving HIV test in hospitals had more direct medical expenditure than those receiving volunteer counseling and testing. CONCLUSION: Further efforts should be made to expand HIV testing and treatment coverage in order to detect HIV infections as early as possible. Early antiretroviral treatment should be given to HIV infected patients to maintain their immunity and reduce their medical expenditure.

[Drop out of antiretroviral therapy in people living with AIDS/HIV and related factors in Nanjing and Yuncheng].

OBJECTIVE: To understand the incidence of drop out of antiretroviral therapy (ART) in people living with AIDS/HIV and related factors in Nanjing, Jiangsu province, and Yuncheng, Shanxi province. METHODS: Retrospective cohort analysis was conducted. The cumulative incidence curves of drop out of ART, mortality and drug withdrawal were drawn with Kaplan-Meier method. The related factors were identified with Cox proportional hazards regression model. RESULTS: A total of 1 006 patients were included in Yuncheng, the median length of ART follow-up was 49.59 months (QR: 20.02-92.84), and 976 patients were included in Nanjing, the median length of ART follow-up was 19.93 months (QR: 11.48-34.07). The cumulative incidence of drop out of ART at 3 months, 6 months, 1 year, 2 years, 4 years, 8 years after ART was 8.19%, 9.23%, 11.08%, 13.75%, 17.74%, 27.66% in Yuncheng, and 3.01%, 5.17%, 7.47%, 10.97%, 17.45%, 28.72% in Nanjing respectively. Age, marital status, infection route, baseline CD4 cell count, the clinical stage classified by WHO at the end of the observation were correlated with the drop out of ART. CONCLUSION: In order to reduce the drop out of ART among people living with AIDS/HIV, it is necessary to conduct effective interventions targeting the patients with young age, the patients who divorced/widowed, the patients who were intravenous drug users, the patients with higher CD4 cell count at the beginning of ART and clinical stage III or IV at the end of the follow-up and increase the coverage of HIV test.

[Prevalence and associated risk factors of diabetes among ethnic Han residents in Guizhou].

OBJECTIVE: To understand the fast plasma glucose (FPG) level and the epidemiologic characteristics of diabetes in ethnic Han residents of Guizhou province. METHODS: The survey was conducted among the ethnic Han residents aged 20-80 years, who were selected through multi stage cluster sampling in Guizhou. Basic laboratory test, physical examination were performed for each subject. RESULTS: A total of 2 967 subjects were surveyed. The average FPG level was 5.21 mmol/L for urban residents and 5.03 mmol/L for rural residents, (P<0.001) and the average FPG level was higher in males than in females (5.23 mmol/L vs. 5.09 mmol/L, P=0.003). The FPG level increased with age (P<0.001). In urban residents, the standardized prevalence of diabetes was 6.01% (crude prevalence: 7.45%), higher in males than in females (P<0.001) and increased with age. In rural residents, the standardized prevalence of diabetes was 3.47% (crude prevalence: 3.77%) and increased with age, but there was no sex specific difference in diabetes prevalence. The awareness rate of self diabetes status was 56.59%, the treatment rate was 84.47% and the plasma glucose control rate was 41.38%. Multiple logistic regression analysis indicated that risk factors for diabetes included being male, older than 40 years, family history of diabetes, frequent physical exercise, hypertension, high triglycerid level. CONCLUSION: The prevalence of diabetes was high in ethnic Han residents in Guizhou, the differences in diabetes prevalence between urban area and rural area was statistical significant. More than half of the patients' FPG level had not been under control after treatment. The awareness rate of self diabetes status, the treatment rate and the control rate of diabetes should be improved.

Purification and characterization of nattokinase from Bacillus subtilis natto B-12.

Bacillus subtilis natto B-12 was isolated from natto, a traditional fermented soybean food in Japan. A fibrinolytic enzyme (B-12 nattokinase) was purified from the supernatant of B. subtilis natto B-12 culture broth and showed strong fibrinolytic activity. The enzyme was homogenously purified to 56.1-fold, with a recovery of 43.2% of the initial activity. B-12 nattokinase was demonstrated to be homogeneous by SDS-PAGE and was identified as a monomer of 29000 +/- 300 Da in its native state by SDS-PAGE and size exclusion methods. The optimal pH value and temperature were 8.0 and 40 degrees C, respectively. Purified nattokinase showed high thermostability at temperatures from 30 to 50 degrees C and alkaline stability within the range of pH 6.0-9.0. The enzyme activity was activated by Zn(2+) and obviously inhibited by Fe(3+) and Al(3+). This study provides some important information for the effect factors of fibrinolytic activity, the purification methods, and characterization of nattokinase from B. subtilis natto B-12, which enriches the theoretical information of nattokinase for the research and development of nattokinase as a functional additive of food.