The effect of dexmedetomidine in coracoid approach brachial plexus block under dual stimulation.

BACKGROUND: Coracoid approach brachial plexus block (CABPB) is safe and effective for clinical anesthesia and analgesia. Dual stimulation can enhance the block effect of CABPB when using nerve stimulator. Dexmedetomidine is a highly selective α-adrenoceptor agonist and it can prolong the duration of anesthesia when it is added into local anesthetics. The aim of this study was to assess the effects of dexmedetomidine on the duration of anesthesia and the effective postoperative analgesia time when it was mixed with ropivacaine for CABPB under dual stimulation. METHODS: A total of 60 patients were randomly assigned into 2 groups (groups D and C), 30 patients in each group. CABPB were guided by nerve stimulator under dual stimulation. Each patient received 40 mL of 0.375% ropivacaine (group C), or 40 mL of 0.375% ropivacaine mixed with 1 µg/kg dexmedetomidine (group D). The duration of anesthesia, the effective postoperative analgesia time, sensory and motor block onset time, visual analog scale (VAS), and the cumulative dose of rescue tramadol were recorded. RESULTS: Twenty-eight patients in each group were analyzed. The duration of anesthesia was longer in group D as compared with group C (759 vs 634 minutes, P < .05) and the effective postoperative analgesia time was longer in group D as compared with group C (986 vs 789 minutes, P < .05) too. The onset time of sensory and motor blocks were not significantly different between the 2 groups (P > .05). The VAS was similar in the 2 groups at 6 and 12 hours after block (P > .05), but it was lower in group D at 24 hours after block as compared to group C (P < .05). The cumulative dose of rescue tramadol during the first 48 hours postoperative period was significantly lower in group D as compared to group C (P < .05). No significant changes were observed in vital signs in either group. CONCLUSION: The addition of 1 µg/kg dexmedetomidine to ropivacaine extends the duration of anesthesia and the effective postoperative analgesia time for CABPB under dual stimulation. The VAS at 24 hours after block and the demand for rescue tramadol during the first 48 hours postoperative period are lower as well without side effects in the study group.(Registered in ClinicalTrials.gov id. NCT02961361).

Heterosexual transmission of HIV and related risk factors among serodiscordant couples in Henan province, China.

BACKGROUND: HIV transmission between discordant couples has become an important source of new infections in China. To describe the seroconversion rate among serodiscordant couples and to identify salient behavioral and clinical risk factors including ART that affect heterosexual HIV transmission risk among couples in rural China. METHODS: Longitudinal follow-up of an open cohort of HIV serodiscordant couples took place between 2007 and 2011 in Zhumadian, a city in southern Henan province in China, where blood plasma selling in 1990s led to a regional HIV epidemic. Annual follow-up included separate face-to-face interviews of husbands and wives, and HIV antibody testing for non-index partners. Cox proportional-hazard modeling was used to assess the relationship between HIV seroconversion and covariates of interest. RESULTS: By the end of 2011, 4499 HIV serodiscordant couples had been enrolled in at least two follow-up interviews; 100 non-index partners seroconverted during the entire observation period for an incidence rate of 0.82 per 100 person-years (95% CI: 0.66-0.99). The incidence rates by the end of 2008, 2009, and 2010 were 2.14, 1.51, and 0.90 per 100 personyears respectively. Always using condoms in the past year of sex, gender of the index partner, frequency of sex, and ART exposure were all significant predictors of HIV seroconversion in the negative spouse. ART was highly protective against seroconversion whether the index partner was actively receiving treatment at the last follow-up (RR = 0.05, 95% CI, 0.01-0.16) or if the index partner had ever received ART (RR = 0.01, 95% CI, 0.00, 0.12). The risk of seroconversion in the nonindex spouse also decreased the longer the duration of the index partner's exposure to ART. CONCLUSIONS: ART exposure and always using condom were highly protective against HIV seroconversion in the negative spouse. HIV incidence in serodiscordant couples has been decreasing over time, associated with ART treatment time within 7 years in the index partner. Gender of the index spouse and frequency of sex were also important predictors. Treatment as part of a combination prevention package may be a feasible method of HIV control in this population.

[Sero-conversion of HIV sero-negative partners among discordant couples in a city of Henan province].

OBJECTIVE: To understand the overall HIV sero-conversion rate and its trend and risk factors of uninfected partners in sero-discordant couples. METHODS: A total of 3088 uninfected partners, whose HIV positive partners infected via former plasma donation or blood transfusion from July, 2006 to December 2010, were chosen as a fix cohort. They were tested for HIV antibodies twice a year using ELISA by local CDC from July, 2006 to December, 2010. Data regarding demographic, sexual behavior information of uninfected partners and infection, serologic characteristics of positive partners were retrospectively surveyed and collected to analyze possible risky factors. RESULTS: A total of 132 in 3088 uninfected partners were sero-converted, with a sero-conversion rate of 1.17/100 person years (95%CI: 0.99/100 person years -1.39/100 person years). Sero-conversion rate reached the peak (0.82%) in the following interval of January and June in 2008 and have a bottom conversion rate (0.13%) in the same month interval in 2010. Conversion rate outcome showed a downward trend in following(χ(2)trend = 8.907, P < 0.05). In the survey, 56.6% (1513/2673) uninfected partners were males, 56.2% (1501/2673) were with lower education level. Among uninfected partners, as reported by themselves, having sex in recently 6 months accounted for a proportion of 81.4% (2176/2673), sex frequency of less than 4 times per month accounted for 45.7% (1169/2558) and consistent using of condom accounted for 94.5% (2418/2558). The proportion of the index partners' most recently CD4 cell count less than 200 cells per µl was 17.4% (437/2505). Results from multivariate of Cox regression showed that male negative partners (RR = 1.58, 95%CI: 1.02 - 2.43), negative partners with lower education level(RR = 2.77, 95%CI: 1.68 - 4.57), having sexual activity in latest one year(RR = 4.39, 95%CI: 1.53 - 12.56) and CD4 count less than 200 cells per µl (RR = 2.36, 95%CI: 1.42 - 3.93) were associated with increased risk of HIV sero-conversion, while intercourse frequency less than 4 times per month(RR = 0.18, 95%CI: 0.10 - 0.32), consistent using of condom(RR = 0.07, 95%CI: 0.05 - 0.12) decreased the risk of conversion. CONCLUSION: In this city, the conversion rate of negative partners whose positive partner infected via former plasma donation or blood transfusion is relatively low and behave a downward trend. Serologic surveillance, education and intervention based on couple are needed to be enhanced.

[HIV sero-conversion rate and risk factors among HIV discordant couples in Zhumadian city, Henan province].

OBJECTIVE: To analyze the sero-conversion rate and risk factors among HIV discordant couples in Zhumadian. METHODS: Sero-discordant couples had been followed up during 2006 - 2011. Information were collected from the National Comprehensive HIV/AIDS Information Management System and the HIV discordant couples Follow-up Management Information System including demographic characteristics of sero-negative spouses, the characteristics of infection and antiretroviral therapy information of index spouses, marital sexual behavior and social support etc., on a biannual basis. Blood specimens of sero-negative spouses were also collected and tested. Cox proportional-hazard model was used to analyze the related risk factors on HIV sero-conversion. RESULTS: Among 4813 sero-discordant couples, 127 HIV sero-conversion spouses were identified, with a total sero-conversion rate as 0.63 per 100 person-years. The one-year sero-conversion rate in 2006 - 2011 ranged from 0.29 to 1.28 per 100 person-years. Factors that associated with increased risk of HIV sero-conversion were: sero-negative spouses with lower education level (RR = 1.50, 95%CI: 1.02 - 2.21, P = 0.04), index spouses not received ART (RR = 3.16, 95%CI: 2.20 - 4.56, P < 0.01) and last recorded CD4(+) cell counts as < 200 cells per µl (RR = 2.11, 95%CI: 1.40 - 3.19, P < 0.01), marital sexual contacts in the past 6 months with frequency of ≥ 4 times per month (RR = 4.27, 95%CI: 2.89 - 6.30, P < 0.01) but never used condoms (RR = 6.40, 95%CI: 3.67 - 11.17, P < 0.01), couples had not received any financial support and care assistance in the past 6 months (RR = 4.75, 95%CI: 2.34 - 9.64, P < 0.01). CONCLUSION: During 2006 - 2011, the sero-conversion rate among sero-negative spouses in Zhumadian had been stabilized and the rate was lower than it was in the last years. The increase of ART acceptance and its adherence and social support should be improved and focused on the follow-up management towards the serodiscordant couples.

[Aging affects early stage direction selectivity of MT cells in rhesus monkeys].

The middle temporal area (MT/V5) plays an important role in motion processing. Neurons in this area have a strongly selective response to the moving direction of objects and as such, the selectivity of MT neurons was proposed to be a neural mechanism for the perception of motion. Our previous studies have found degradation in direction selectivity of MT neurons in old monkeys, but this direction selectivity was calculated during the whole response time and the results were not able to uncover the mechanism of motion perception over a time course. Furthermore, experiments have found that direction selectivity was enhanced by attention at a later stage. Therefore, the response should be excluded in experiments with anesthesia. To further characterize the neural mechanism over a time course, we investigated the age-related changes of direction selectivity in the early stage by comparing the proportions of direction selective MT cells in old and young macaque monkeys using in vivo single-cell recording techniques. Our results show that the proportion of early-stage-direction-selective cells is lower in old monkeys than in young monkeys, and that the early stage direction bias (esDB) of old MT cells decreased relative to young MT cells. Furthermore, the proportion of MT cells having strong early stage direction selectivity in old monkeys was decreased. Accordingly, the functional degradation in the early stage of MT cells may mediate perceptual declines of old primates in visual motion tasks.

[Study on the natural history of HIV among former commercial plasma donors caused by contaminated plasma donation in central China].

OBJECTIVE: To investigate the natural history of HIV infection caused by contaminated plasma donation among former commercial plasma donors in China. METHODS: Ambispective cohort study among HIV/AIDS cases and suspected AIDS deaths was conducted from January 1, 1995 to March 31, 2008 in 7 administrative villages in Shangcai county of Henan province. Information regarding diagnostic criteria, deaths and anti-retrovirus treatment was collected. Incubation and survival time were calculated using Kaplan-Meier and life-tables method. Sensitive analysis on the time of outcome was conducted. RESULTS: A total number of 2569 cases of HIV infection including 483 suspected AIDS deaths were involved in a cohort. 200 patients with rapid progress (7.8%) and 337 long-term but non-progressive patients (13.1%) were identified. Results from the sensitive analysis showed that the median incubation period from HIV infection to AIDS was between 8.5 and 8.9 years, with incidence as 11.7 - 12.0 cases/100 person-years and the median survival time for HIV progression to death was from 8.8 to 10.7 years, with the death rate as 6.9 - 8.3 cases/100 person-years. The median survival time for AIDS patient was from 1.2 to 2.0 years, with death rate as 34.9 - 51.5 cases/100 person-years. CONCLUSION: According to sensitive analysis, the incubation period for HIV progression to AIDS, the median survival time for HIV progression to death and the median survival time for AIDS patient to death were 8.8 years, 1.2 years and 9.8 years, respectively.

[Study on the quality of life and its influential factors among HIV positive population.].

OBJECTIVE: To study the quality of life and its influential factors among HIV positive population. METHODS: Quality of life was evaluated among 2608 HIV positive population by WHOQOL (Chinese Version) to calculate the total and four domains' scores of quality of life. Multiple linear regression model was used to analyze the relationship between the factors and the scores of the four domains and the total score of quality of life. RESULTS: Physical, psychological, social, environmental and the total scores of the HIV positive population were 12.96 +/- 1.94, 11.79 +/- 1.19, 13.79 +/- 2.44, 12.40 +/- 1.93 and 51.02 +/- 6.03, respectively. Females had a higher scores than males in the four domains and the total score of quality of life. Through a multiple linear regression model, we found that the influential factors would include gender, age, occupation, family conflict and appetite etc. CONCLUSION: People living with HIV had higher scores in social domain, but lower scores in psychological domain, suggesting that psychological intervention should be strengthened.

[A retrospective cohort study on reduction of AIDS mortality among patients enrolled in national-free antiretroviral treatment programme in two cities in China].

OBJECTIVE: To determine the effect of national free highly active antiretroviral treatment (HAART) on reduction of mortality and relevant risk factors among adult Acquired immunodeficiency syndrome (AIDS) patients. METHODS: A retrospective cohort study was conducted and all AIDS patients diagnosed before Aug. 30th, 2008 in Zhumadian, Henan province, and Fuyang, Anhui province were enrolled in this study, where HAART initiated in early time. The data and information were collected such as AIDS progress, diagnosis, treatment, death and et al. RESULTS: Among 10,394 AIDS patients, the mean age was (41.7 +/- 9.3) year-old, 50.3% (5233/10,394) were male, 85.0% (8808/10,394) were married, 95.1% (9880/10,394) were farmers, and 81.2% (8438/10,394) were former plasma donors (FPDs). The coverage of HAART increased from 5.2% in 2002 to 66.5% in 2008. Conversely, the overall mortality declined from 35.4/100 person-years in 2002 to 5.9/100 person-years in 2008. In a multivariate Cox proportional hazards analysis, the greatest risk factor for mortality was non-HAART, with a hazard ratio (HR) 4.3 (95%CI: 4.0 - 4.7). Among treated patients, compared with higher CD(4)(+) T cell counts (> 200 cells/microl), those initiating therapy with lower CD(4)(+) T cell counts, were at greater risk to death (< 50 cells/microl, HR = 7.9; 50 - 199 cells/microl, HR = 2.8). Number of opportunistic infections (OIs) was risk to mortality (HR = 2.1). In addition, other risk factors included male, age (>or= 50 years old), and other infection way except FPDs (HR were 1.4, 1.6 and 1.8). CONCLUSION: The national free treatment program has significantly reduced the AIDS mortality rate among HIV-infected FPDs through the use of generic antiretroviral drugs in rural clinical settings. The effective reduction of AIDS mortality could be realized through increased coverage of therapy.

[Significance of increased level of serum macrophage colony-stimulating factor in patients with preeclampsia].

OBJECTIVE: To explore the role of macrophage colony-stimulating factor (MCSF) in the pathogenesis of preeclampsia. METHODS: By ELISA method, MCSF concentrations were determined in serum samples obtained from 39 patients with preeclampsia and 40 normal pregnant women as controls. The concentrations of serum MCSF were compared between preeclampsia and normal pregnancy, and between early-onset and late-onset preeclampsia. RESULT: Serum MCSF concentrations were significantly higher in preeclamptic women than those in controls (431.0 kIU compared with 179.1 kIU, P<0.001). There were no significant differences in serum MCSF levels between early-onset and late-onset preeclampsia (P>0.05). Serum MCSF was not correlated with maternal age, gestational age, and placenta weight (P>0.05 for all). CONCLUSION: Increased level of serum MCSF is an important indicator of preeclampsia and it may play a role in the pathogenesis of the disease.