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BACKGROUND@#Despite almost two decades of well-funded and comprehensive response efforts by the Chinese Government, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) remains a major problem in China. Yet, few studies have recently examined long-term trends in HIV/AIDS prevalence, incidence, and mortality at the national level. This study aimed to determine the prevalence, incidence, and mortality trends for HIV/AIDS over the past 28 years in China.@*METHODS@#We conducted a descriptive, epidemiological, secondary analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 data. To evaluate trends in prevalence, incidence, and mortality over the study period from 1990 to 2017, we calculated values for annual percentage change (APC) and corresponding 95% confidence intervals (CIs) using joinpoint regression analysis.@*RESULTS@#A significant increase in HIV/AIDS prevalence was observed for 1990 to 2009 (APC: 10.7; 95% CI: 10.4, 11.0; P < 0.001), and then remained stable for 2009 to 2017 (APC: 0.7; 95% CI: -0.3, 1.7; P = 0.1). A significant increase in HIV incidence was also observed for 1990 to 2005 (APC: 13.0; 95% CI: 12.6, 13.4; P < 0.001), and then a significant decrease was detected for 2005 to 2017 (APC: -6.5; 95% CI: -7.0, -6.1; P < 0.001). A significant increase in AIDS-related mortality rate was detected for 1990 to 2004 (APC: 10.3; 95% CI: 9.3, 11.3; P < 0.001), followed by a period of stability for 2004 to 2013 (APC: 1.3; 95% CI: -0.7, 3.3; P = 0.2), and then another significant increase for 2013 to 2017 (APC: 15.3; 95% CI: 8.7, 22.2; P < 0.001).@*CONCLUSIONS@#Although prevalence has stabilized and incidence has declined, AIDS-related mortality has risen sharply in recent years. These findings suggest more must be done to bring people into treatment earlier, retain them in treatment more effectively, actively seek to reenter them in treatment if they dropout, and improve the quality of treatment and care regimens.
Subject(s)
Humans , Acquired Immunodeficiency Syndrome/epidemiology , China/epidemiology , Global Burden of Disease , HIV , HIV Infections/epidemiology , Incidence , PrevalenceABSTRACT
Clopidogrel exhibits variable individual pharmacokinetic, and clopidogrel resistance may occur in some patients which can’t obtain effective platelet inhibition. To prevent the occurrence of cardiovascular adverse events and improve the clinical curative effect, the article explicated and analyzed relevant guidelines and the latest research of clopidogrel detailedly, summarized an individual dose recommendation in pharmacogenomics for the rational use of clopidogrel.
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Objective:The aim of this paper is to explore the influence of physician's occupational risk cogni-tion on defensive medical behavior. Methods:Semi-structured interview was applied for data collection from in-serv-ice doctors. A grounded theory was used to analyze and develop the relationship between physicians'occupational risk cognition and defensive medical behavior. Results:This study shows that the cognition of various occupational risks may lead to a series of psychological effects on doctors,such as mental stress,anxiety and depression,professional i-dentity decrease,fear of adventure and innovation,job enthusiasm decrease and probability of malpractice increase. Adverse defensive medical behaviors, such as ordering more tests, treatments and consultations, selective treatment of patients,shirking responsibility through informed consent, and favorable defensive medical behaviors, such as to improve service attitude,being more cautious during work and to improve professional skills,should be in response to occupational risks. Conclusions:Physicians'occupational risk cognition is the primary motivation of defensive medical behavior,and the relationship between physicians'occupational risk cognition and defensive medical behavior may al-so be mutually causal and effect.
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<p><b>OBJECTIVE</b>To determine the potential urinary biomarkers of metabolic syndrome (MS) with early renal injury and establish diagnostic models by magnetic bead-based separation and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS).</p><p><b>METHODS</b>Participants were selected from the epidemiologic study on MS and renal involvement among residents in Pinggu district, Beijing. Eight-hour overnight urine samples were fractionated by means of magnetic bead-based weak cation exchange chromatography and subsequently analyzed with MALDI-TOF-MS. Wilcoxon test and random forests were used to screen differential protein peaks of MS patients with early renal injury, then combined with genetic algorithm and support vector machine, respectively, to establish diagnostic models.</p><p><b>RESULTS</b>Totally 54 cases of MS without renal injury and 46 cases of MS with early renal injury were enrolled. Totally twenty protein peaks were up-regulated in the urine of MS patients with early renal injury by Wilcoxon test (P < 0.05); random forests algorithm revealed twelve protein peaks up-regulated in the urine of MS patients with early renal injury (importance value of mean decrease in accuracy > 0.005). Genetic algorithm based model showed 82.6% sensitivity, 84.3% specificity, and 83.5% accuracy by a 10-fold cross-validation in identifying MS patients with early renal injury; correspondingly, the support vector machine based model reported 89.2% sensitivity, 81.1% specificity and 85.5% accuracy. Four protein peaks were included in two diagnostic models with mass-to-charge ratios of 2756.98, 3019.11, 9077.04, and 10 054.26.</p><p><b>CONCLUSIONS</b>The urinary proteome patterns of MS with early renal injury were successfully established with magnetic bead-based separation and MALDI-TOF-MS technology. A series of urinary differential expressing protein peaks were identified with bioinformatics tools. Diagnostic models combining cluster of protein peaks are capable of differentiating MS patients with early renal injury from those without renal injury. The different urine protein excretion patterns revealed in this study provide urinary candidate biomarkers of MS patients with early renal injury for future identification and biological roles investigation.</p>