[Thoracoscopic laparoscopy-assisted Ivor-Lewis resection of esophagogastric junction cancer].

Objective: To investigate the outcome of patients with esophagogastric junction cancer undergoing thoracoscopic laparoscopy-assisted Ivor-Lewis resection. Methods: Eighty-four patients who were diagnosed with esophagogastric junction cancer and underwent Ivor-Lewis resection assisted by thoracoscopic laparoscopy at the National Cancer Center from October 2019 to April 2022 were collected. The neoadjuvant treatment mode, surgical safety and clinicopathological characteristics were analyzed. Results: Siewert type Ⅱ (92.8%) and adenocarcinoma (95.2%) were predominant in the cases. A total of 2 774 lymph nodes were dissected in 84 patients. The average number was 33 per case, and the median was 31. Lymph node metastasis was found in 45 patients, and the lymph node metastasis rate was 53.6% (45/84). The total number of lymph node metastasis was 294, and the degree of lymph node metastasis was 10.6%(294/2 774). Among them, abdominal lymph nodes (100%, 45/45) were more likely to metastasize than thoracic lymph nodes (13.3%, 6/45). Sixty-eight patients received neoadjuvant therapy before surgery, and nine patients achieved pathological complete remission (pCR) (13.2%, 9/68). Eighty-three patients had negative surgical margins and underwent R0 resection (98.8%, 83/84). One patient, the intraoperative frozen pathology suggested resection margin was negative, while vascular tumor thrombus was seen on the postoperative pathological margin, R1 resection was performed (1.2%, 1/84). The average operation time of the 84 patients was 234.5 (199.3, 275.0) minutes, and the intraoperative blood loss was 90 (80, 100) ml. One case of intraoperative blood transfusion, one case of postoperative transfer to ICU ward, two cases of postoperative anastomotic leakage, one case of pleural effusion requiring catheter drainage, one case of small intestinal hernia with 12mm poke hole, no postoperative intestinal obstruction, chyle leakage and other complications were observed. The number of deaths within 30 days after surgery was 0. Number of lymph nodes dissection, operation duration, and intraoperative blood loss were not related to whether neoadjuvant therapy was performed (P>0.05). Preoperative neoadjuvant chemotherapy combined with radiotherapy or immunotherapy was not related to whether postoperative pathology achieved pCR (P>0.05). Conclusion: Laparoscopic-assisted Ivor-Lewis surgery for esophagogastric junction cancer has a low incidence of intraoperative and postoperative complications, high safety, wide range of lymph node dissection, and sufficient margin length, which is worthy of clinical promotion.

[Application of synthetic MRI in predicting isocitrate dehydrogenase 1 genotypes in gliomas].

This study analyzed the clinical and imaging data of 81 glioma patients who underwent brain synthetic MRI and diffusion weighted imaging (DWI) examination in the General Hospital of Ningxia Medical University from August 2020 to September 2021 to explore the value of synthetic MRI relaxation quantitative value in predicting the genotype of isocitrate dehydrogenase 1 (IDH1) in gliomas. There were 44 males and 37 females, those patients with an aged 50.0 (36.5, 59.0) years. The tumor pre-T1, pre-T2, pre-PD, post-T1 and ADC values were obtained by outlining the region of interest (ROI). Univariate analysis was used to compare the differences of parameter values between groups, and the receiver operating characteristic was used to evaluate the diagnostic efficacy of each parameter value in predicting glioma IDH1 genotype. The results showed that the pre-T1 and pre-PD values [M (Q1, Q3)] of IDH1m glioma were lower than those of IDH1w glioma [1 462.75 (1 306.41, 1 567.75) ms vs 1 532.83 (1 434.67, 1 617.67) ms, 84.18 (82.28, 86.41) pu vs 85.85 (84.65, 86.90) pu] (all P<0.05). The post-T1 and ADC values of IDH1m glioma were higher than those of IDH1w glioma [1 054.50 (631.92, 1 262.63) ms vs 669.67 (535.17, 823.33) ms, 1.20 (0.86, 1.35) ×10-3 mm2/s vs 0.80 (0.76, 0.93) ×10-3 mm2/s] (all P<0.05). The AUC of the combined model (pre-T1+pre-PD+post-T1+ADC+Age) is 0.828 (95%CI:0.729-0.903). Synthetic MRI relaxation quantitative values are helpful to distinguish IDH1 genotypes in glioma. The diagnostic efficacy of the multi-parameter combined model based on pre-T1, pre-PD, post-T1, ADC, and age is better than that of the single parameter, and it can be used as an effective strategy to improve the differential diagnosis ability of gliomas molecular markers.

[Surgical treatment for esophageal cancer during the outbreak of COVID-19].

Since December 2019, unexplained pneumonia has appeared in Wuhan City, Hubei Province, and a new type of coronavirus infection was confirmed as COVID-19. COVID-19 spread rapidly nationwide and abroad. The COVID-19 has brought huge impacts to all the people and walks of life, especially to the medical and health systems. It has also brought great challenges to the treatment of patients with cancer. Esophageal cancer is a common malignant tumor in China and most of the patients are in the middle and advanced stage when diagnosed, with immunosuppressive and poor prognosis. The selection of surgical procedures and perioperative managements of esophageal cancer require all thoracic surgeons work together to figure out a reasonable system of surgical treatment and emergency response.

[Clinical differences between primary nasopharyngeal NK/T-cell lymphoma and primary nasal cavity NK/T-cell lymphoma with nasopharynx extension].

Objective: To investigate the clinical and prognostic differences between primary nasopharyngeal natural killer (NK)/T-cell lymphoma (NP NKTCL) and extranodal NK/T-cell lymphoma of the nasal cavity with nasopharynx extension (N-NP NKTCL). Methods: A total of 89 patients with NP NKTCL and 113 patients with N-NP NKTCL from January 2000 to June 2015 were retrospectively analyzed. Clinical and pathological features, treatment responses and prognosis were compared between the two groups. Results: NP NKTCL patients showed similar clinicopathological features with those with N-NP NKTCL, except that the former had a relative low proportion of elevated lactate dehydrogenase (LDH) levels (28.1% vs. 41.6%; P=0.001). Both of two groups presented with high proportion of cervical lymph node involvement (55.1% and 42.5%; P=0.076). The 5-year overall survival (OS) rates in these two groups were 63.2% and 54.6%, respectively, whereas 5-year progress-free survival (PFS) rates were 50.7% and 45.6%, respectively. For the patients with stage Ⅰ and Ⅱ, the 5-year OS and PFS rates in these two groups were 68.8% and 55.7% as well as 55.6% and 47.2%, respectively. These were no statistically significant differences between two groups (all P>0.05). The complete response (CR) rate after initial chemotherapy in NP NKTCL group was 43.8%, which was significant higher than that of 19.6% in N-NP NKTCL group (P=0.006). Additionally, the CR rate after primary radiotherapy was 63.4% and 62.7%, respectively (P=0.629). The NP NKTCL patients with stage Ⅰ and Ⅱ who accepted radiotherapy with or without chemotherapy had similar survival times with chemotherapy alone, showing the 5-year OS rates of 70.5% and 33.3% (P=0.238), as well as the 5-year PFS rates of 56.7% and 33.3%, respectively (P=0.431). Similar results were found in N-NP NKTCL group, the 5-year OS rates for patients with radiotherapy with or without chemotherapy and chemotherapy alone were 57.4% and 33.3% (P=0.246), while the 5-year PFS rates were 49.3% and 16.7% (P=0.177), respectively. Besides, the relapse pattern of NP NKTCL and N-NP NKTCL groups was also similar, mainly involving the distant extra-nodal organs followed by lymph nodes. Conclusion: The patients with N-NP NKTCL and NP NKTCL showed similar clinical and prognostic features, however, the initial response to chemotherapy was different.

Molecular characterizations of DNA methyltransferase 3 and its roles in temperature tolerance in the whitefly, Bemisia tabaci Mediterranean.

The Bemisia tabaci Mediterranean (MED) cryptic species is an invasive pest, distributed worldwide, with high ecological adaptability and thermotolerance. DNA methylation (a reversible chromatin modification) is one possible change that may occur within an organism subjected to environmental stress. To assess the effects of temperature stress on DNA methyltransferase 3 (Dnmt3) in MED, we cloned and sequenced BtDnmt3 and identified its functions in response to high and low temperatures. The full-length cDNA of BtDnmt3 was 3913 bp, with an open reading frame of 1962 bp, encoding a 73.89 kDa protein. In situ hybridization showed that BtDnmt3 was expressed mainly in the posterior region. BtDnmt3 messenger RNA expression levels were significantly down-regulated after exposure to heat shock and significantly up-regulated after exposure to cold shock. Furthermore, after feeding on double-stranded RNA specific for BtDnmt3, both heat resistance and cold resistance were significantly decreased, suggesting that BtDnmt3 is associated with thermal stress response and indicating a differential response to high- and low-temperature stress in MED. Together, these results highlight a potential role for DNA methylation in thermal resistance, which is a process important to successful invasion and colonization of an alien species in various environments.

[Screening of the SETX gene in sporadic amyotrophic lateral sclerosis patients of Chinese origin].

Objective: To investigate all coding regions of amyotrophic lateral sclerosis (ALS)-related gene Senataxin (SETX) in sporadic amyotrophic lateral sclerosis patients of Chinese origin. Methods: From January 2010 to December 2014, the peripheral venous blood samples and clinical data were collected from 311 patients with sporadic amyotrophic lateral sclerosis (SALS) and 311 healthy controls who were of Chinese ancestry from the Department of Neurology, Chinese PLA General Hospital.Genomic DNA was extracted from peripheral venous blood of all participants using standard methods. The coding regions of SETX were amplified by polymerase chain reaction (PCR) and screened for mutations using next-generation sequencing technology. The online software SIFT and PolyPhen-2 were used to analyze the conservation of an altered amino acid and predict the potential pathogenicity of identified mutations. The SPSS 22.0 software was used to analyze the clinical feature of all participants. Results: Tenkinds of rare and one novel nonsynonymous mutations were identified and were absent in 311 controls. Twelve (3.86%) patients carried one SETX gene mutation. Five (1.61%) out of above-mentioned 12 patients carried highly pathogenic mutations including p. Pro1868Leu (c.5603G>A), p. Pro1331Leu (c.3992G>A), p. Glu756Val (c.2267T>A), p. Leu564Val (c.1690A>C), and p. Asn144Ser (c.431T>C). Patients carried SETX mutations were not different from other patients in onset age. Conclusion: Mutations in SETX are likely to be a pathogenesis for Chinese sporadic amyotrophic lateral sclerosis.

Prevalence of pathogenicity island ETT2 in Escherichia coli isolated from piglets with diarrhea in northeast of China.

Our aim was to investigate the prevalence of the pathogenicity island ETT2 and to examine the relationship between the ETT2 locus and other virulence factors in Escherichia coli (E. coli) isolated from piglets with diarrhea. A total of 354 E. coli strains isolated from scouring piglets were tested using PCR for the presence of the ETT2 locus. The E. coli strains were also analyzed for enterotoxins, fimbriae, non-fimbrial adhesin, Shiga toxins, pathogenicity islands, α-haemolysin (hlyA), afa8 gene cluster and autotransporter protease (sepA) genes. The results showed that 215 (60.7%) of the isolates possessed the ETT2 island. In 215 ETT2-positive E. coli strains, the virulence genes found were EAST1 (27.0%), irp2 (18.6%), paa (15.4%), STb (7.9%), LT (6.5%), ler (4.7%), hlyA (3.7%), AIDA-I (3.7%), K88 (3.7%), eae (3.3%), STa (2.8%), afaD (1.4%), afaE (1.4%), K99 (0.9%) and sepA (0.47%), respectively, and the isolates could be assigned into 25 different virulence factor patterns. In 139 ETT2-negative E. coli strains, the virulence genes detected were EAST1 (38.9%), paa (14.4%), STb (11.5%), AIDA-I (10.1%), irp2 (7.9%), sepA (2.16%), LT (0.7%), STa (0.7%), eae (0.7%), ler (0.7%), hlyA (0.7%) and K88 (0.7%), respectively, and the isolates could be classified into 13 different virulence factor patterns. Moreover, the occurrence of LT gene of ETT2-positive E. coli strains was far more than that of ETT2-negative E. coli strains.

[Analysis of a Chinese Charcot-Marie-Tooth disease type 2D pedigree].

Objective: To achieve definite diagnosis in a clinically diagnosed Charcot-Marie-Tooth disease (CMT) pedigree and broaden the mutational diversity of CMT-related mutations in Chinese Han population. Methods: Patients clinically diagnosed with CMT were recruited from Department of Neurology, Chinese PLA General Hospital between December, 2012 to June, 2016. Clinical examination, laboratory tests, nerve conduction studies, and molecular and bioinformatics analyses were performed on a clinically diagnosed CMT pedigree. Results: In the pedigree, a GARS mutation (c.794C>T, p. S265F) was identified and CMT2D was diagnosed. Conclusion: The newly identified GARS mutation has broaden the mutational diversity of CMT2D in Chinese Han population.

[Characteristics of repetitive nerve stimulation in 53 cases of amyotrophic lateral sclerosis].

Objective: To investigate the feature of repetitive nerve stimulation (RNS) in patients with amyotrophic lateral sclerosis (ALS) and correlation between RNS and clinical features and electromyography (EMG) findings of the corresponding muscle. Methods: Needle EMG and RNS were performed in 53 patients with ALS, who were recruited into Department of Neurology of Chinese PLA general hospital during April to December in 2016. Decrement of the compond muscle action potential (CMAP) in response to RNS of different nerves and stimulus frequencies was compared. The effects of gender, age of onset, disease duration, region of onset, ALS functional rating scale-revised (ALSFRS-R) and rate of disease progression (ΔFS) on the decrement were analyzed. Results: 49.1% of patients with ALS had decremental responses to low frequency RNS (LF-RNS) in accessory nerve, which was lower in ulnar nerve (4.3%) and common peroneal nerve (2.6%). Decremental responses of accessory nerve at 3 Hz were observed in 49.1% of patients with ALS, more frequent than 30.2% at 1 Hz. None of the patients had increased responses to high frequency RNS. Patients with upper-limb-onset, longer disease duration and lower ALSFRS-R tended to have more frequent decrement of CMAP in response to RNS. The decrement with LF-RNS of accessory nerve was in concert with neurogenic damage of sternocleidomastoid muscle with needle EMG (r=0.365, P=0.007). There were 3 patients who had decremental responses to LF-RNS in accessory nerve without clinical involvement and neurogenic damage of sternocleidomastoid muscle. Conclusions: There is significant decrement of CMAP in response to LF-RNS of accessory nerve in patients with ALS, which may reveal neuromuscular junction (NMJ) impairment. It may indicated a dying-back pattern of disease progression which derived from motor neuron terminal or NMJ to neuronal soma that some patients with ALS have decremental responses in RNS without clinical involvement and neurogenic damage of sternocleidomastoid muscle.

Emulating Anyonic Fractional Statistical Behavior in a Superconducting Quantum Circuit.

Anyons are exotic quasiparticles obeying fractional statistics, whose behavior can be emulated in artificially designed spin systems. Here we present an experimental emulation of creating anyonic excitations in a superconducting circuit that consists of four qubits, achieved by dynamically generating the ground and excited states of the toric code model, i.e., four-qubit Greenberger-Horne-Zeilinger states. The anyonic braiding is implemented via single-qubit rotations: a phase shift of π related to braiding, the hallmark of Abelian 1/2 anyons, has been observed through a Ramsey-type interference measurement.

Analysis of KIT mutations and c-KIT expression in Chinese Uyghur and Han patients with melanoma.

BACKGROUND: The KIT gene plays an important role in the pathogenesis of malignant melanoma (MM). In recent years, activating mutations in KIT have been recognized as oncogenic. A number of therapies have been established, which provide significant clinical benefits for patients with MM with KIT mutations. Thus, detection of KIT mutations can have profound therapeutic implications. AIM: To investigate KIT gene expression in MMs in Chinese Uyghur and Han patients with mutations in KIT, and to identify the clinical features associated with KIT mutations and c-KIT expression. METHODS: In total, 105 MMs (56 from Uyghur and 49 from Han patients) were selected from patients in the Uyghur Autonomous region. Formalin-fixed, paraffin wax-embedded tumour sections were analysed for c-KIT expression using immunohistochemistry. Exons 11 and 13 of KIT were analysed for the presence of mutations using PCR amplification and DNA sequencing. RESULTS: Of the 105 MMs, 13 (10 Han and 3 Uyghur) were found to have mutations in KIT. Thus, the frequency of KIT mutations in Han patients was significantly higher than that in Uyghur patients (P = 0.02). We detected c-KIT expression in 71.4% and 42.9% of the tumour tissue samples collected from the Uyghur and Han patients, respectively. CONCLUSION: In the Xinjiang Uyghur Autonomous Region in China, chronic sun-induced damage MM is the most prevalent MM among Chinese Uyghur patients, whereas acral and mucosal MMs are the most prevalent in Uyghur patients. Mutations in the KIT gene do not correlate with c-KIT expression.

Prevalence of Bilateral Involvement in Patients with Discoid Lateral Meniscus : a Systematic Literature Review.

We assessed the prevalence of bilateral discoid lateral meniscus (BDLM), as well as its subtypes, among patients with symptomatic DLM. Medline, Cochrane, EMBASE, and Google Scholar were searched until September 18, 2015. All studies evaluating patients with BDLM who underwent MRI, macroscopic observation, and/or arthroscopy for the diagnosis of discoid meniscus/menisci were included. Eight clinical studies with a total of 583 DLM patients examined including 103 cadavers. There was a male predominance and average age of BDLM patients ranged from 10.4 to 39.9 years. The reported prevalence was higher in East Asian countries (72.7 to 97%) than rest of the world (6.8 to 90%). Homotypes were much more common than heterotype, and ranged from 82.9 to 91.7% of all BDLM patients. The actual prevalence of BDLM is likely higher. The findings provide a glimpse of the wide spread this disorder potentially has in East Asia.

[Clinical outcome of intramyocardial dissecting hematoma after acute myocardial infarction].

Objective: To observe the clinical outcome of intramyocardial dissecting hematoma (IDH) after acute myocardial infarction (MI). Methods: The clinical characteristics and outcomes of nine patients with IDH after acute MI in Beijing Anzhen Hospital from 2010 to 2014 were retrospectively assessed, and all the patients were followed up. Results: The mean age of nine IDH patients (7 males, 2 females) was (61±5) years. One patient was diagnosed as right ventricular IDH and died before surgery because of deteriorated cardiac and renal failure. Eight patients were diagnosed as left ventricular IDH, among whom 1 patient died of perioperative bleeding. The other 7 patients survived, among whom 5 cases were treated medically and 2 cases accepted surgical treatment. After 2-6 years of follow-up, the survived patients had no other complications. Conclusion: IDH after acute MI was a rare clinical event with a high mortality, and improvement of recognition of this rare condition may reduce its mortality, especially the right ventricular IDH.

Inhibition effect produced by dominant negative mutant fusion protein PreS2-TLM-ScFv-HBcDN on HBV replication in vitro.

A mammalian expression vector comprised of the PreS2-TLM (translocation motif), a single-chain variable fragment (ScFv) that binds to hepatitis B surface antigen (HBsAg) and the EGFP gene was constructed. A stably transformed cell line that could express and secrete the fusion protein (PreS2-TLM-ScFv-EGFP) was established. HBsAg-positive HepG2.2.15 cells and HepG2 and HeLa cells were incubated with the supernatant of the transformed cell line cultures for evaluating the cellular permeability of PreS2-TLM-ScFv-EGFP. The location of the fusion protein PreS2-TLM-ScFv-EGFP in HepG2.2.15 cells was observed with immunofluorescence staining. EGFP was next replaced by a dominant negative mutant of the hepatitis B virus core gene (HBcDN) for producing fusion protein PreS2-TLM-ScFv-HBcDN, which was detected by western blot. The supernatant containing fusion protein PreS2-TLM-ScFv-HBcDN was added to the cultures of HepG2.2.15 cells, and the packaged hepatitis B virus (HBV) pregenomic RNA expression levels in the cells were measured using qRT-PCR. The results of the in vitro study indicated that the packaged HBV pregenomic RNA expression levels in HepG2.2.15 cells significantly decreased when these cells were exposed to the supernatant at the dose of 25% for 24, 48 and 72 h, or at the dose of 12.5% for 72 h.

Predictors of survival in Chinese patients with lupus nephritis.

The current study was to determine the predictors of survival in 491 Chinese patients with lupus nephritis (LN). All patients were evaluated and consecutively followed up from 2003 to 2010. The female: male ratio was 9.5:1, with a median age of 31.1 ± 12 years. Forty-nine (10.0%) patients were lost to follow-up and 47 (10.3%) patients died. The overall cumulative probability of survival at 5, 10, 15 and 20 years by Kaplan-Meier analysis was 88%, 77%, 53% and 45%, respectively. The log-rank test showed that the probability of survival was significantly decreased in the late-onset patients (≥50 years) (P = 0.036), patients with hypoproteinaemia (≤35 g/l) (P = 0.014), patients with increased creatinine (≥1.5 mg/dl) (P = 0.002) and patients with massive proteinuria (≥3.5 g/24 h) (P = 0.009). However, the probability of survival was significantly higher in patients treated with hydroxychloroquine (HCQ) (P = 0.003) than those not treated with it. Based on a multivariate model, increased creatinine (hazard ratio (HR) = 2.041; P = 0.017) and proteinuria ≥3.5 g/24hours (HR=1.716; P = 0.016) were independent risk factors. Glucocorticoid (HR = 0.457; P = 0.01) and HCQ (HR=0.197; P = 0.026) were independent protective factors. Our findings suggest that renal dysfunction and massive proteinuria are independent risk factors for mortality. HCQ could improve the survival of patients with LN.

Analysis of prognosis-related factors in patients with invasive cervical adenocarcinoma.

OBJECTIVE: To explore the prognostic related factors in patients with cervical adenocarcinoma. METHODS: Clinical and pathological data were retrospectively analyzed in 144 patients with cervical adenocarcinoma between 1995 and 2004. RESULTS: Five-year survival rates were 80.1%, 59.7%, 6.3 % and 0.0%, respectively, in patients with Stage I, II, III and IV cervical adenocarcinoma, and the overall 5-year survival rate was 59.0%. Univariate analysis indicated poor prognosis in non-exophytic tumor, tumor diameter > 4 cm, advanced clinical stage, mucinous adenocarcinoma and clear cell carcinoma, or poorly differentiated tumor. The prognosis was related to lymph node metastasis and deep myometrial invasion. Multivariate analysis indicated that besides clinical stage, myometrial invasion and lymph node metastasis, tumor shape was also an independent prognostic related factor. CONCLUSION: The prognosis is associated with tumor shape besides pre-confirmed clinical stage, myometrial invasion and lymph node metastasis. Ovarian preservation in young women remains to be further explored.

Preliminary evaluation on the use of homing pigeons as a biomonitor in urban areas.

This study evaluates the usefulness of homing pigeons as a biomonitor of polycyclic aromatic hydrocarbons (PAHs) in urban environments. The mean concentrations of total PAHs in liver and lung tissues were greater in pigeons from Beijing compared to pigeons from Chengdu, however, this difference was only statistically significant for PAH concentrations in liver tissue (P < 0.05). Similarly, the severity of anthracosis or pneumoconiosis in lung tissue and hepatitis in liver tissue was greater in pigeons from Beijing compared to pigeons from Chengdu. Low molecular weight PAHs dominated the contribution of individual PAHs in both tissues. Significant differences (P < 0.05) were observed for most low and moderate molecular weights PAHs in liver and for some low and high molecular weights PAHs in lung between the two cites. The profile patterns of individual PAHs were similar between lung tissue of pigeons and between local ambient airs in summer for both cities, whereas the profile patterns between liver tissue and pigeon food were less similar. These data suggest that homing pigeons may be of value as a biomonitor of environmental pollution in urban areas.

[Perinatal outcomes on mortality and influencing factors among HIV-infected mothers in Sichuan province].

Objective: To explore the influencing factors on perinatal mortality of pregnant women with HIV infection to reduce the mother-to-child transmission in Sichuan province. Methods: In this study, 4 786 perinatal infants of the HIV-infected pregnant women were included. Related data on perinatal epidemiology was reported by all the 183 medical and health care institutions where the HIV prevention of mother-to-child transmission program was initiated in 2005-2016. Univariate χ(2) test and multivariate logistic regression methods were used to analyze the perinatal mortality outcomes and influencing factors. Results: The overall perinatal mortality rate was 25.7‰ (123/4 786) among HIV-infected pregnant women, with annual downwarding trend (trend χ(2)=32.220, P=0.000). Perinatal mortality rate appeared the highest (χ(2)=4.130, P=0.042), with more fetal deaths and stillbirths and less early neonatal death within 7 days in Liangshan county (χ(2)=29.626, P=0.000). Results from the multivariate logistic regression analysis showed that fewer pregnant numbers would contribute to the, lower perinatal mortality rate (1-2 pregnancies OR=0.417, 95%CI: 0.184-0.943; 3-4 pregnancies OR=0.447, 95%CI: 0.223-0.895). Perinatal deaths were more likely to be prevented if LPV/r protease inhibitor-based triple antiviral therapy was provided (OR=0.530, 95%CI: 0.285- 0.986) or delivery was taken place in the hospital (hospital of municipal-level and above OR=0.222, 95%CI:0.098-0.499; county-level hospital OR=0.282, 95%CI: 0.166-0.480; township-level hospital OR=0.134, 95%CI: 0.031-0.586) among HIV-infected pregnant women. However, premature delivery or neonatal asphyxia would increase the risk of perinatal mortality (premature delivery OR=8.285, 95%CI: 5.073-13.533; neonatal asphyxia OR=9.624, 95%CI: 4.625-20.028). Conclusions: The perinatal mortality rate of HIV-infected pregnant women appeared significantly higher than that in the province or the whole country. Strategies involving LPV/r-based triple antiviral therapy, promotion of hospital delivery, reducing the incidence rates of premature deliveries and neonatal asphyxia, should be strengthened.

Relationship between inflammatory factors and arrhythmia and heart rate variability in OSAS patients.

OBJECTIVE: Obstructive Sleep Apnea Syndrome (OSAS) is a disorder characterized by recurrent upper airway obstruction, apnea, and hypopnea, associated with decreased oxygen saturation and disturbed sleep structure during sleep. It was found that OSAS was associated with a variety of arrhythmia and conduction disorders, but the relationship between multiple types of arrhythmia and the severity of OSAS, and its possible mechanism remain unclear. The purpose of this study was to observe the main types of arrhythmia and the condition of heart rate variability (HRV) in patients with OSAS, to detect the levels of multiple inflammatory factors in serum of OSAS patients, and to observe the correlation between polysomnographic parameters or inflammatory factors, and arrhythmia or HRV, as well as its possible mechanisms. PATIENTS AND METHODS: 141 patients with suspected OSAS were collected in the Second Affiliated Hospital of Soochow University and Xinghua People's Hospital from February 2016 to February 2018. According to the sleep apnea hypopnea index (AHI), they were divided into control group (AHI <5, n = 34), mild-moderate OSAS group (5≤ AHI <30, n = 48), and severe OSAS group (AHI ≥30, n = 59). Clinical data such as gender and age were collected. All patients completed polysomnography (PSG), 24-hour Holter monitoring and blood routine, biochemical indexes and serum hs-CRP, TNF-α, IL-6, and IL-1ß testing. The indicators in the three groups were compared, and the correlation between PSG parameters, HRV and inflammatory biomarkers was investigated. RESULTS: Compared with control group, there were significant differences in age, sex ratio, BMI, uric acid, TC, and TG in the mild-moderate OSAS group (p<0.05), and in age, sex ratio, BMI, red blood cell count, hemoglobin, hematocrit, uric acid, FBS, TC, TG, LDL, and HDL in severe OSAS group (p<0.05). There were significant differences in gender ratio, BMI, red blood cell count, hemoglobin, hematocrit, uric acid, FBS, TC, TG, LDL, and HDL between mild-moderate OSAS group and severe OSAS group (p<0.05). Heart rate variability (HRV) parameters include SDNN, SDNN index, RMSSD, PNN50, LF, HF, and LF/HF. SDNN, PNN50, and HF in severe OSAS group and mild-moderate OSAS group were significantly lower than those in control group (p<0.05). LF/HF was significantly higher than that of control group (p<0.05). There was a significant difference in PNN50, HF, and LF/HF between severe OSAS group and mild-moderate OSAS group (p<0.05). In terms of inflammation, serum hs-CRP was significantly higher in mild-moderate OSAS group and severe OSAS group than that in control group (p<0.05). Serum IL-1ß was significantly higher in mild-moderate OSAS group than that in severe OSAS group (p<0.05). There was no significant difference in other indicators (p>0.05). There was a significant positive correlation between hs-CRP and oxygen reduction index (ODI) (r=0.209, p=0.013) and a significant negative correlation with PNN50 (r=-0.188, p=0.025). There is no significant correlation between other indicators. CONCLUSIONS: Systemic inflammatory reactions existed in patients with OSAS. With the increase of OSAS, inflammation was aggravated, especially serum hs-CRP. Hs-CRP was significantly and negatively correlated with PNN50 and positively correlated with ODI. The results suggested that the inflammatory response was involved in the occurrence of heart rate variability in OSAS patients.