[Application of two kinds of electrophysiological monitoring techniques for the prediction of facial nerve outcomes after vestibular Schwannoma surgery].

Objective: To investigate the application of transcranial facial nerve motor evoked potential (FNMEP) and direct nerve electrical stimulation (DNES) for the prediction of facial nerve function after vestibular schwannoma surgery. Methods: The clinical data of 106 patients who underwent vestibular schwannoma surgery under electrophysiological monitoring of facial nerve between 2017 and 2021 were retrospectively examined, and there were 57 males and 49 females, with a mean age of (51±11) years. Neuroelectrophysiological monitoring was performed in all patients during the operation. After the tumor was removed, FNMEP and DNES were used for electrophysiological evaluation of facial nerve function. The amplitude ratios of FNMEP to baseline (M1) and the brainstem segment to the internal auditory canal segment of DNES (M2) were recorded after the tumor was removed, respectively. The correlation between these two ratios and facial nerve function at 1 day, 1 month and 3 months after the operation were compared. According to the House-Brackmann (HB) scale, Grade Ⅰ-Ⅱ refers to good facial nerve function, and grade Ⅲ-Ⅵ refers to moderate and severe facial nerve dysfunction. Non-parameter Spearman correlation coefficient was used to evaluate the correlation between M1 and M2 and facial nerve function at 1 day, 1 month and 3 months after operation, and the receiver operating characteristic (ROC) curves were plotted to verify the diagnostic efficacy of M1 and M2 for predicting the prognosis of postoperative facial nerve function. Results: Among 106 patients, 102 cases (96.3%) underwent total tumor resection, 4 patients (3.7%) underwent subtotal resection, 104 patients (98.1%) had anatomical preservation of facial nerves, and there were no deaths reported. All patients could evoke reliable FNMEP and 2 patients could not evoke DNES in the brainstem segment of the facial nerve. There were 81 (76.4%), 99 (93.4%) and 103 patients (97.2%) with satisfactory function of facial nerve at 1 day, 1 month and 3 months after surgery, respectively. M1 had large absolute values of Spearman correlation coefficient at 1 day (ρ=|-0.648|) and 1 month (ρ=|-0.552|) after surgery (both P<0.001), while M2 showed a greater absolute value of Spearman correlation coefficient at 3 months (ρ=|-0.395|) than that of M1 (ρ=|-0.378|) (P<0.001). Cut-off value of M1 was 0.58 (sensitivity=0.92, specificity=0.64), and that of M2 was 0.36 (sensitivity=0.64, specificity=1.00). Meanwhile, M1<0.58 or M2<0.36 suggested moderate and severe impairment of facial nerve function. Conclusions: Both FNMEP and DNES during vestibular schwannoma surgery can effectively evaluate the postoperative facial nerve function. FNMEP is better than DNES in predicting the early postoperative facial nerve function, but DNES is better for predicting the long-term postoperative facial nerve function.

[A case of poisoning caused by oral and inhalation of high concentration glutaraldehyde].

Glutaraldehyde is a kind of volatile and irritating aldehyde organic compound, which belongs to high-efficiency disinfectant. It has a strong stimulating effect on the mucous membranes of the eyes, respiratory tract and digestive tract, and skin causing denaturation, liquefaction and necrosis of mucous membrane proteins. This article analyzes the treatment process of a patient with high-concentration glutaraldehyde poisoning by oral and inhalation, and discusses the clinical manifestations and prognosis of high-concentration glutaraldehyde poisoning, so as to provide a basis for clinical treatment.

[Effect of JAZF1 over-expression on high-fat diet-induced non-alcoholic fatty liver disease].

Objective: To investigate the effects of juxtaposed with another zinc finger gene 1 (JAZF1) over-expression on the levels of pro-inflammatory cytokines in high-fat diet (HFD)-induced mouse fatty liver and its associated mechanisms. Methods: Twenty male C57BL/6J (3 weeks old) and 10 male JAZF1 transgenic (JAZF1-Tg) mice were randomly divided into three groups: wide-type with normal diet (NF group,n= 10), wide-type with high-fat diet (HF group,n= 10), and JAZF1-Tg with high-fat diet (HJ group,n= 10). All mice were fed with the corresponding diet for 12 weeks, and their food consumption and body weight were measured periodically. After 12 weeks, fasting blood glucose (FBG), insulin (INS), total cholesterol (TC), triglyceride (TG), free fatty acids (FFA), and alanine aminotransferase (ALT) in the blood and liver tissue from each group were measured. TG concentration in liver tissue was determined using an enzymatic assay, and the mRNA expression of tumor necrosis factor-α(TNF-α), monocyte chemoattractant protein-1 (MCP-1), and interleukin-8 (IL-8) in the liver was measured by RT-PCR. In addition, the expression of p-JNK/JNK, p-p-38 MAPK/p-38 MAPK, p-ERK/ERK, IκBα, andß-actin (reference) in the liver was determined using Western blot.. Results: (1) Body weight, FBG, INS, TC, and ALT were significantly reduced in the HJ group compared with those of the HF group (31.19±0.81 vs 36.07±1.43, 6.94±0.32 vs 8.14±0.36, 31.09±2.12 vs 45.21±3.34, 3.05±0.07 vs 3.81±0.08, 54.75±4.92 vs 68.09±5.15, respectively;P< 0.05). There were no significant differences in TG and FFA between the HJ and HF groups (0.72±0.05 vs 0.81±0.03, 0.81±0.4 vs 0.87±0.03; bothP> 0.05). (2) There was no significant difference in liver TG concentration between the HJ and HF groups (35.49±3.17 vs 38.26±3.59,P> 0.05). (3) Compared with the HF group, the HJ group had significantly reduced mRNA expression of TNF-α, MCP-1, and IL-8 (2.54TNF-αvs 8.64±0.73, 1.19±0.73,vs 3.93±0.18, 5.09±0.48 vs 9.09±0.89; allP< 0.01), significantly reduced protein expression of p-JNK and p-p-38 MAPK (0.92±0.06 vs 1.51±0.01, 1.07±0.04 vs 1.45±0.04; bothP< 0.01), and significantly increased protein expression of IκBα(0.99±0.06 vs 0.79±0.05,P< 0.01) in liver tissue. However, no significant difference was observed in the p-ERK level between the HJ and HF groups (P> 0.05). Conclusion: Upregulation of JAZF1 expression can significantly inhibit the expression of TNF-α, MCP-1, and IL-8 in the liver of mice on HFD. This attenuation may be closely associated with the reduced activation of the JNK, p-38 MAPK, and NF-κB pathways.

[Effects of simvastatin nano-liposomes on osteogenic differentiation of bone marrow stromal cells].

OBJECTIVE: To investigate the effects of liposomal formulation on simvastatin nano-liposomes (SMV-liposome) promoting the osteogenic differentiation of mice bone marrow stromal cells (BMSC) analyzed by the expressions of bone morphogenetic protein 2 (BMP-2) and alkaline phosphatase (ALP). METHODS: Primary BMDC were cultured in vitro using adherence and culture of whole bone marrow method. SMV dosage was set as control group and had two different dosages in this group on the basis of the concentration of SMV. 1 µmol/L and 2 µmol/L SMV concentration were represented by SMV low dosage group (S1) and SMV high dosage group (S2), respectively. Similarly, SMV-liposome dosage was set as experimental group including two different dosages, 1 µmol/L SMV capsuled concentration as SMV-liposome low dosage group (SL1) and 2 µmol/L SMV capsuled concentration as SMV-liposome high dosage group (SL2). Besides, groups with no drug intervention in the experiments were set as blank. BMSC were treated with different concentrations of SMV and SMV-liposome for 48 h, the activity of ALP was measured using p-nitropheny-phosate method, and ALP expression in the BMSC cells was stained by BCIP/NBT alkaline phosphatase color development kit (BCIP/NBT Kit). Furthermore, BMP-2 expression in the BMSC was determined by Western Blot. RESULTS: MTT assay showed, after incubated with different concentrations of SMV and SMV-liposome, the cell viabilities of BMSC were all above 85% and had no significant difference in the groups. Compared with the same dosage of SMV in these groups, control group and experimental group had significantly elevated the specific activity of ALP, the staining of BCIP/NBTKit as well as the protein expression of BMP-2. Besides, the data showed dose-dependent elevation in the control group and experimental group, namely the high dose group had better results than the low dose group. CONCLUSION: Nano-liposomal formulation significantly enhanced SMV effects on the osteogenetic differentiation of BMSC.

[Prevalence and epidemiological characteristics of major chronic diseases in people living with HIV in Taizhou, Zhejiang Province, 1998-2022].

Objective: To understand the prevalence of major chronic diseases of diabetes, cardiovascular disease and malignant tumor in people living with HIV in Taizhou. Methods: The data were collected from China Information System for Disease Control and Prevention and Taizhou Chronic Disease Information Management System. A total of 5 126 people living HIV under follow-up in Taizhou from 1998 to 2022 were included in the analysis. Software SAS 9.4 was used for χ2 test, trend analysis and logistic regression analysis. Results: In the 5 126 people living with HIV, the reported prevalence rates of diabetes,cardiovascular disease and malignant tumor were 10.28% (527/5 126),3.98% (204/5 126) and 6.01% (308/5 126), respectively. 37.00% (195/527) and 48.58% (256/527), 40.20% (82/204) and 48.53% (99/204), 37.66% (116/308) and 48.38% (149/308) were diagnosed as diabetes, cardiovascular disease and malignant tumor before and after confirmation of HIV infection. From 2013 to 2022, the proportion of HIV infected people diagnosed with diabetes, cardiovascular disease and malignant tumor after confirmation increased (trend χ2=79.98,P<0.001; trend χ2=17.44,P<0.001; trend χ2=32.06,P<0.001). Based on the analysis on the factors for complicated chronic diseases in people living with HIV, it was found that women under 60 years old (aOR=0.66, 95%CI: 0.50-0.86) and those with access to antiviral treatment for >5 years before 2016 (aOR=0.54,95%CI:0.37-0.78) were less likely to develop complicated chronic diseases, and those under 60 years old with initial CD4+T lymphocytes counts <200 cells/µl (aOR=1.32, 95%CI: 1.02-1.70), those aged 40-49 and 50-59 years (aOR=2.88, 95%CI:2.20-3.79; aOR=5.43, 95%CI: 4.10-7.21) as well as those without a record of treatment medication use after 2016 (aOR=1.95,95%CI:1.20-3.16) were more likely to develop complicated chronic diseases. The probability of developing complicated chronic diseases might increase with age in people living with HIV. Conclusions: From 1998 to 2022, there was a certain proportion of complicated chronic diseases among HIV infected individuals in Taizhou, and the proportion of diagnosed cases increased after HIV infection was confirmed. It is necessary to conduct early chronic disease screening, behavior intervention and standardized management in people living with HIV.

[Analysis on death causes of HIV/AIDS patients in Taizhou, Zhejiang Province, 1998-2022].

Objective: To understand the incidence and causes of HIV/AIDS death patients in Taizhou from 1998 to 2022. Methods: The data were collected from the AIDS Integrated Prevention and Control Information System of China Information System for Diseases Control and Prevention and Taizhou Chronic Disease Information Management System. By the end of 2022, a total of 5 126 HIV/AIDS patients living in Taizhou for a long time were included, SAS 9.4 was used for Kruskal-Wallis test, χ2 test and trend analysis. Results: From 1998 to 2022, a total of 796 HIV/AIDS patients died, with a fatality rate of 15.53% (796/5 126), in whom 52.26% (416/796) died within one year after confirmation. The proportion of HIV/AIDS patients who died within one year decreased (trend χ2=5.60, P<0.001). For the constituent of death causes, there were 140 (17.59%) deaths of AIDS, 237 (29.77%) deaths of malignant tumors, 99 (12.44%) deaths of cardiovascular disease, 58 (7.29%) deaths caused by injuries, 160 (20.10%) deaths due to other causes, and 102 (12.81%) deaths due to unknown causes. The constituent ratio of deaths of malignant tumor, cardiovascular disease and other causes increased over time (trend χ2=1.92, P=0.028; trend χ2=2.81, P=0.003; trend χ2=2.07, P=0.020). There were differences in the distribution of death causes in HIV/AIDS cases in terms of age, occupation, marital status, ethnic group, educational level and mode of transmission (all P<0.05). The average age of the death cases due to cardiovascular disease was higher than other death cases, the cases who died from AIDS had shorter survival time and the lower initial CD4+T cells after confirmation compared with all other death cases, and the time interval from confirmation to treatment in HIV/AIDS patients with unknown death causes was longer than those of all other death cases (all P<0.05). Conclusions: The constituent ratio of non-AIDS related deaths in HIV/AIDS patients in Taizhou was relatively high and showed an upward trend during 1998-2022. It is necessary to further strengthen the early screening, prevention and treatment of chronic non infectious diseases.

[Correlation between HIV infection, club drug use and anal canal human papillomavirus infection in men who have sex with men in Taizhou].

Objective: To explore the correlation between club drug use and anal canal human papillomavirus (HPV) infection in HIV-negative and HIV-positive men who have sex with men (MSM) in Taizhou. Methods: A cross-sectional survey was conducted in Taizhou. HIV-negative MSM were recruited by convenient sampling in voluntary counseling and testing clinics of Taizhou prefectural CDC from August 2016 to October 2017, and HIV-positive MSM were recruited through the routine follow-up and management by Taizhou prefectural CDC from August 2016 to June 2019. A face-to-face questionnaire interview was conducted to collect the information about the socio-demographic characteristics, sexual orientation, sexual behavior, club drug use and other information of the participants. Anal canal swabs were collected for HPV genotyping. The correlation between club drug use and the prevalence of HPV infection were evaluated with χ2 test and logistic regression analysis. Results: A total of 69 HIV-negative and 345 HIV-infected MSM were included. The prevalence of any type of anal canal HPV infection in HIV-negative MSM (27.5%, 19/69) was lower than that in HIV-positive MSM (66.4%, 229/345) (χ2=36.114,P<0.001). The prevalence of self-reported club drug use in HIV-negative MSM was higher (17.4%, 12/69) than that in HIV-positive MSM (7.0%, 24/345) (χ2=7.886, P=0.005). For HIV-negative MSM, the prevalence of club drug use was higher in MSM who had homosexual group sex (P=0.036); the prevalence of HPV infection was 50.0% (6/12) in club drug users and 22.8% (13/57) in non-club drug users (χ2=3.674, P=0.055). For HIV-positive MSM, the prevalence of HPV infection was 70.8% (17/24) in club drug users and 66.0% (212/321) in non-club drug users (χ2=0.230, P=0.632). Multivariable logistic regression model showed that HPV infection in MSM was positively correlated with HIV infection (OR=5.42, 95%CI: 2.92-10.06), and the association between HPV infection and club drug use (OR=1.66, 95%CI: 0.75-3.71) was not significant. Conclusions: HIV infection was positively correlated with anal canal HPV infection in MSM in Taizhou. Club drug use was positively correlated with high-risk sexual behaviors, while its association with HPV infection needs further study.

[Characteristics and associated factors of blood lipid trajectories among HIV-infected patients receiving antiretroviral therapy].

Objective: To examine characteristics and risk factors of the blood lipid trajectories among HIV-infected patients treated with antiviral therapy (ART). Methods: Based on the retrospective cohort study design, sociodemographic characteristics and baseline laboratory indicators of HIV-infected patients receiving ART from January 2004 to April 2021 in Taizhou, Zhejiang province. The blood lipid trajectories of the subjects was described and classified using the latent class mixed model (LCMM). Multivariate logistic regression was used to determine the risk factors of blood lipid trajectories. The data were analysized by R 3.5.0. software with lcmm package. Results: Among 2 079 HIV-infected patients, the median age (Q1, Q3) was 31 (43, 55) years, and the majority were being male (78.1%, 1 623/2 079) and married (58.7%, 1 221/2 079). BMI ≥24.0 kg/m2 accounted for 18.9% (393/2 079). Heterosexual transmission accounted for 67.7% (1 407/2 079). Three different blood lipid trajectories were classified: inverted U-shaped (2.3%, 48/2 079), progressive (31.3%, 650/2 079), and general trajectory (U-shaped) (66.4%, 1 381/2 079). The inverted U-shaped and progressive trajectory are identified as dangerous trajectories (33.6%). Multivariate logistic regression analysis indicated that compared with 3TC-TDF-EFV antiviral treatment regimen, baseline TC level <5.2 mmol/L, baseline TG level <1.7 mmol/L, BMI 18.5-23.9 kg/m2, baseline CD4+T lymphocytes (CD4) counts <200 cells/µl, antiviral treatment time <5 years,those who had been using 3TC-AZT-EFV antiviral therapy regimen (aOR=1.99,95%CI:1.44-2.77) and those who switched to LPV/r antiviral therapy regimen (aOR=3.17, 95%CI: 2.00-5.01), baseline TC levels were 5.2-6.1 mmol/L (aOR=2.55, 95%CI: 1.92-3.39) and ≥6.2 mmol/L (aOR=5.89,95%CI:3.76-9.25), and baseline TG levels were 1.7-2.2 mmol/L (aOR=2.00, 95%CI: 1.53-2.62) and ≥2.3 mmol/L (aOR=6.51,95%CI:4.97-8.54), respectively, BMI ≥24.0 kg/m2 (aOR=1.44, 95%CI: 1.11-1.88) were more likely to show the dangerous trajectories. BMI <18.5 kg/m2 (aOR=0.55, 95%CI: 0.35-0.86), baseline CD4 counts level was 200-349 cells/µl (aOR=0.67, 95%CI: 0.52-0.87) and baseline CD4 ≥350 cells/µl (aOR=0.71, 95%CI: 0.54-0.94). The duration of antiviral therapy was 5-9 years (aOR=0.74, 95%CI: 0.56-0.99), and ≥10 years (aOR=0.53, 95%CI: 0.22-0.67) were less likely to show the dangerous trajectories. Conclusions: HIV-infected patients showed a dangerous trajectory of blood lipids after ART, which was significantly associated with the use of specific antiviral drugs such as AZT and LPV/r, treatment duration, baseline CD4, TC, TG levels and BMI. It is recommended to strengthen blood lipid monitoring and targeted intervention measure when HIV infected persons start antiviral treatment.

[Neurocognitive impairment and characteristics of neurocognitive performance among people with HIV on antiretroviral treatment].

Objective: Using two measuring tools to examine the prevalence and correlates of neurocognitive impairment (NCI) as well as characteristics of neurocognitive performance among people with HIV (PWH) on antiretroviral treatment (ART). Methods: A total of 2 250 treated PWH from the Comparative HIV and Aging Research in Taizhou (CHART) were recruited in Taizhou, Zhejiang province. The Chinese version of the Mini-mental State Examination (MMSE) and the International HIV Dementia Scale (IHDS) were used to evaluate their neurocognitive performance. Cluster analysis was conducted on the seven cognitive domains in the scale. Results: Among 2 250 treated PWH, 48.0% (1 080/2 250) were aged 45 to 89, 79.2% (1 782/2 250) were male, and 37.8% (852/2 250) had primary school education or below. The prevalence of neurocognitive impairment judged by MMSE and IHDS among HIV-infected people was 14.3% (321/2 250) and 31.8% (716/2 250), respectively. Aged 60 to 89 (aOR=2.63, 95%CI:1.52-4.56), depressive symptoms (aOR=5.58, 95%CI:4.20-7.40) and treatment with EFV (aOR=2.86, 95%CI:1.89-4.34) were main risk factors of NCI diagnosed by MMSE. Male (aOR=0.71, 95%CI:0.51-1.00), overweight (aOR=0.63, 95%CI:0.44-0.89), and high education level (aOR=0.11, 95%CI:0.05-0.25) were protective factors of NCI diagnosed by MMSE. Aged 60 to 89 (aOR=3.10, 95%CI:2.09-4.59), depressive symptoms (aOR=1.78, 95%CI:1.44-2.20) and treatment with EFV (aOR=1.79, 95%CI:1.41-2.29) were risk factors of NCI diagnosed by IHDS. Male (aOR=0.75, 95%CI:0.58-0.97), underweight (aOR=0.67, 95%CI:0.47-0.96), baseline CD4+ T lymphocyte (CD4) counts ≥350 cells/µl (aOR=0.69, 95%CI:0.53-0.91) and high education level (aOR=0.23, 95%CI:0.14-0.39) were protective factors of NCI diagnosed by IHDS. The neurocognitive performance of HIV-infected people can be divided into four main types. Among four types, age, gender, education level, alcohol drinking, depressive symptoms, waist-to-hip ratio, hypertension, diabetes, baseline CD4 counts and treatment with EFV were different statistically (all P<0.05). Conclusions: There are four main types of neurocognitive performance in treated PWH. The prevalence of NCI is high among this population, underscoring the need for tailored prevention and intervention.

[HIV-1 drug resistance and subtypes in newly reported HIV/AIDS patients before antiretroviral therapy in Taizhou city, 2016-2018].

Objective: To explore the HIV-1 drug resistance and subtypes in newly reported HIV/AIDS patients before antiretroviral therapy (ART) in Taizhou city. Methods: A cross-sectional study of HIV-1 drug resistance was conducted among newly reported HIV/AIDS patients before ART in Taizhou from January 2016 to December 2018. HIV-1 pol gene sequences were obtained by RT-PCR. The sequences were submitted to the Stanford University drug resistance database. The drug resistance mutation and the sensitivity of HIV-1 strains to antiretroviral drugs were determined according to WHO Guidelines on HIV drug resistance surveillance of 2014. Results: A total of 806 HIV-1 pol gene sequences were obtained successfully. The overall HIV-1 drug resistance rate was 2.9% (23/806), 1.9% for non-nucleoside reverse transcriptase inhibitors (NNRTIs), 0.6% for nucleoside reverse transcriptase inhibitors (NRTIs), and 0.0% for protease inhibitors (PIs), respectively. From 2016 to 2018, the HIV-1 drug resistance rate was 1.6%, 1.8%, and 4.8%, respectively. The resistance mutations of NNRTIs and NRTIs were mainly K103 N (0.7%) and M184I/V (0.5%). HIV-1 subtypes were mostly CRF01_AE (42.7%,344/806),CRF07_BC (28.9%,233/806) and CRF08_BC (11.2%,90/806).HIV-1 subtypes among homosexually transmitted infections were mostly CRF01_AE (53.3%, 136/255) and CRF07_BC (32.2%, 82/255), and HIV-1 subtypes among heterosexually transmitted infections were mainly CRF01_AE (37.7%, 203/539), CRF07_BC (27.5%, 148/539) and CRF08_BC (16.1%, 87/539). Conclusion: HIV-1 drug resistance rate among newly reported HIV/AIDS patients before ART remained low in Taizhou during 2016 to 2018, an increasing trend seemed to be notifiable and warrants continuous surveillance of HIV-1 drug resistance.

[Prevalence and correlates of plasma cytomegalovirus viremia among newly reported HIV/AIDS patients in Taizhou city, 2017-2018].

Objective: To study the prevalence and correlates of plasma cytomegalovirus (CMV) viremia among newly reported antiretroviral therapy (ART)-naive HIV/AIDS patients in Taizhou during 2017-2018. Methods: CMV DNA was measured in plasma specimens of newly reported ART-naive HIV/AIDS patients by quantitative PCR. Both univariable and multivariable logistic regression analyses were carried out to evaluate CMV viremia correlations among the individuals. Results: Of 612 HIV/AIDS patients, 480 (78.4%) were male, 125 (20.4%) were over 60 years old, 177 (28.9%) were infected via homosexual transmission, and 430 (70.3%) via heterosexual transmission. The prevalence of CMV viremia among HIV/AIDS patients was 13.4% (82/612). Multivariable logistic regression analysis showed that the risk of CMV viremia in CD4+ lymphocyte cells counts (CD4+) ≤200 cells/µl group was higher than CD4 counts >500 cells/µl (OR=5.10, 95%CI:1.74-14.96, P=0.003); The median CMV DNA level (log10) of 82 viremic patients was 1.57 (P25,P75:1.04,2.13); Viremic patients with CD4 counts ≤200 cells/µl had the highest CMV viral load (P<0.01). Conclusions: Among ART-naive HIV/AIDS patients, the prevalence of CMV viremia was significantly associated with immunodeficiency status. Further research is needed to evaluate the association between CMV viremia and the course of HIV infection.

[Risk analysis of immunological failure of antiretroviral therapy in HIV/AIDS patients in Taizhou prefecture, 2006-2019].

Objective: To analyze the immunological failure of antiretroviral therapy (ART), its association with baseline anemia and related factors in HIV/AIDS patients in Taizhou prefecture, during 2006-2019. Methods: A retrospective cohort study was conducted among HIV/AIDS patients under ART. Cox regression model was used to analyze predictors of immunological failure and logistic regression model was used to analyze factors of baseline anemia. Results: A total of 2 904 HIV/AIDS patients were enrolled with a median time of 28 (P(25)-P(75):12-53) months follow-up of ART, in which 177 cases (6.1%) were identified as immunological failure with a failure rate of 2.17 per 100 person-years. The cumulative incidence rates of immunological failure in the first, third, fifth, and tenth years were 5.49%, 6.94%, 7.30% and 8.82%, respectively. Results of multivariate logistic regression analysis showed that for the risk of baseline anemia, ≥66 years old group had 4.17 times higher risk than 18-25 years old group (95%CI: 1.68-10.33), males had 0.67 times higher risk than females (95%CI: 0.50-0.89), and CD(4)(+)T cell counts (CD(4))<200 cells/µl group had 4.35 times higher risk than CD(4)≥350 cells/µl group (95%CI: 2.81-6.72), baseline white blood cells<4.0×10(9) cells/L group had 1.73 times higher risk than 4.0×10(9) cells/L-9.9×10(9) cells/L group (95%CI: 1.31-2.29), baseline platelet counts <100×10(9) cells/L and >300×10(9) cells/L groups had 2.02 times and 4.45 times higher risk than 100×10(9) cells/L-299×10(9) cells/L group (95%CI: 1.36-3.01, 95%CI: 3.05-6.50), respectively. WHO classified stage Ⅲ/Ⅳ group had 2.15 times higher risk than WHO classified stageⅠ/Ⅱ group (95%CI: 1.61-2.87), while heterosexual transmission group had 2.03 times higher risk than homosexual transmission group (95%CI: 1.42-2.92). Results of multivariate cox proportional risk regression showed that for the risk of immunological failure, baseline anemia group had 1.77 times higher risk than no anemia group (95%CI: 1.20-2.60), WHO classified stage Ⅲ/Ⅳ group had 1.66 times higher risk than WHO classified stage Ⅰ/Ⅱ group (95%CI: 1.10-2.48), and withdrawal of follow up and death groups had 3.18 times and 4.61 times higher risks than treatment group (95%CI: 1.96-5.19, 95%CI: 2.98-7.13), respectively. Conclusions: The immunological effect of ART among HIV/AIDS patients in Taizhou prefecture was affected by multiple factors, including anemia, clinical stage and follow-up status. Enhancing surveillance of baseline anemia and timely correction of anemia in elder group can help improve treatment outcome of HIV/AIDS patients.

Growth differentiation factor 11 relieves acute lung injury in mice by inhibiting inflammation and apoptosis.

OBJECTIVE: Acute lung injury (ALI) is the most common organ damage in sepsis and sepsis-induced ALI is a clinically extremely dangerous disease. Therefore, it is essential to find an effective way to treat ALI. We hope to provide a new target for the treatment of clinical ALI by studying the effect of GDF11 on LPS-induced ALI. MATERIALS AND METHODS: C57BL/6 male mice and lipopolysaccharide (LPS) were used to induce mouse ALI. Recombinant GDF11 protein was used to treat mice to detect the effect of GDF11 on mouse ALI. In addition, BEAS-2B cells were used to further validate the effects of GDF11 on inflammation and apoptosis of alveolar epithelial cells. RESULTS: Recombinant GDF11 protein significantly reduced the expression of inflammatory factors and apoptosis-related pathways in mouse lung tissues. Overexpression of GDF11 in BEAS-2B cells also significantly attenuated the levels of inflammation and apoptosis in the cells. In addition, GDF11 can reduce the activity of TLR2/HMGB1/NF-κB signaling pathway, which is an important mechanism for GDF11 to play a role in lung protection. CONCLUSIONS: GDF11 can exert lung protection effects by inhibiting the TLR2/HMGB1/NF-κB signaling pathway and reduce the level of inflammation and apoptosis of the lung.

[Influencing factors of antiretroviral therapy and its association with immunological effect among HIV/AIDS patients in Taizhou city, 2006-2019].

Objective: To analyze influencing factors of instant antiretroviral therapy (ART) and explore associution between strategies of ART and immunological effects among HIV/AIDS patients in Taizhou city during 2006-2019. Methods: A retrospective cohort study was conducted on HIV/AIDS patients under ART, and a logistic regression model was used to analyze factors of instant ART. The student t-test and chi-square test were used to compare immunological effect of different ART strategies while the Kaplan-Meier method was used to generate a survival curve. Results: A total of 2 971 HIV/AIDS patients were enrolled with 1 786 cases (60.1%) having instant ART strategy. The proportion of instant ART were 77.8% (1 170/1 504) during 2016 to 2019. The treatment success rate of the instant ART group (87.4%, 1 561/1 786) were higher than the delayed ART group (84.4%, 1 000/1 185). The results of multivariate logistic regression model indicated that male (aOR=1.28, 95%CI: 1.03-1.59), married (aOR=1.71, 95%CI: 1.33-2.19) and baseline CD(4)(+)T lymphocyte cells (CD(4)) counts ≤200 cells/µl (aOR=1.60, 95%CI: 1.27-2.02) were factors positively related to instant ART while 31-40 years old (aOR=0.63, 95%CI: 0.48-0.84), infected through heterosexual transmission(aOR=0.60, 95%CI: 0.49-0.74) and diagnosed before 2015 (aOR=0.20, 95%CI: 0.17-0.23) were inversely related to instant ART. The increase of the CD(4)/CD(8) ratio was greater, and the cumulative ART success rate was higher each year in the instant ART group than in the delayed ART group (P<0.05). Conclusions: The instant ART strategy has been well implemented in Taizhou city during 2006-2019, and the immunological effect was better in instant ART group. The proportion of instant ART were more than 60.0% among HIV/AIDS patients. Instant ART strategy needs to be strengthened for those who are 31-40 years old, women, unmarried, and infected through heterosexual transmission in an attempt to further increase treatment level and improve treatment effect.

[Prevalence of alcohol use and related factors in HIV positive and HIV negative males].

Objective: To understand the prevalence of alcohol use and related factors in HIV positive and HIV negative males. Methods: Baseline data were from the prospective cohort study of comparative HIV and aging research in Taizhou of Zhejiang province from January to December, 2017. The information about alcohol use in the last month was collected through a face-to-face questionnaire interview. Participants were categorized into non-current drinkers, light/moderate drinkers and heavy drinkers according to the US National Institute on Alcoholism and Alcohol Abuse (NIAAA) standard. Results: A total of 1 367 HIV positive males and 2 418 HIV negative males were included. Current alcohol use rate (35.2%, 481/1 367) and heavy alcohol use rate (5.0%, 24/481) were significantly lower in HIV positive males than in HIV negative males (48.0%, 1 161/2 418; 23.5%, 273/1 161), but the proportion of drinking wine and yellow rice wine were significantly higher (21.8%, 105/481; 9.1%, 44/481) in HIV positive males than in HIV negative males (13.5%, 157/1 161; 5.8%, 67/1 161). The multivariate multinomial logistic regression analysis results showed that larger waist circumference, current smoking and regular physical exercise were associated with heavy alcohol use behavior in HIV positive males, and age ≥30 years, current smoking, regular physical exercise, higher score of depressive symptoms, heterosexual transmission route and baseline CD(4)(+)T cells counts of 200-499 cells/µl were significantly associated with mild/moderate alcohol use behavior in HIV positive males. Conclusions: The alcohol use rate was significantly lower in HIV positive males than in HIV negative males in Taizhou. It is important to strengthen intervention on alcohol drinking behavior and chronic disease risk factors, such as larger waist circumference, smoking and so on.

[Characteristics of sleep disorder in HIV positive and HIV negative individuals: a cluster analysis].

Objective: To understand the characteristics of sleep disorder in HIV positive and negative individuals, and compare the distributions and epidemiologic characteristic of different subtypes of sleep disorder between two groups. Methods: Baseline data were from the prospective cohort study of comparative HIV and aging research in Taizhou of Zhejiang province from January to December, 2017. A total of 459 HIV positive patients and 798 HIV negative controls with sleep disorders (Pittsburg Sleep Quality Index >5 or at least one question with answers of "most nights" or "every night" for Jenkins Sleep Scale) were included in the analysis. Cluster analysis was conducted to identify the different subtypes of sleep disorder based on 15 sleep-related questions. Results: A total of 1 257 participants were divided into three groups (clusters), i.e. difficulty falling asleep and sleep keeping group (cluster 1), the mild symptoms group (cluster 2), and restless night and daytime dysfunction group (cluster 3), accounting for 19.4% (89/459), 63.8% (293/459) and 16.8% (77/459) in HIV positive group and 13.8% (110/798), 60.5% (483/798) and 25.7% (205/798) in HIV negative group (χ(2)=16.62, P<0.001). In HIV positive group, the patients in cluster 1 and 3 were older and had higher frailty score, the patients in cluster 1 had highest level of depression, and the more patients in cluster 3 had low body weight or overweight (χ(2)=13.29, P=0.039; χ(2)=23.33, P<0.001; χ(2)=25.71, P<0.001; χ(2)=15.37, P=0.004). In HIV-negative group, similar findings were found for age, depressive symptoms and frailty score. In addition, the proportion of those who were illiteracy or with primary school education level was significantly high in cluster 1, and the proportion of abnormal waist-to-hip ratio was significantly higher in cluster 1 and 3 (χ(2)=30.59, P<0.001; χ(2)=11.61, P=0.003). Conclusions: The proportion of every subtype of sleep disorder in HIV positive individuals were different to those in HIV negative individuals. Mental and physical health status were the main factors affecting the prevalence of sleep disorder. It is necessary to conduct targeted interventions to improve sleep quality.

[Association between mitochondrial haplogroups and neurocognitive disorder in HIV positive individuals].

Objective: To investigate the distribution of mitochondrial haplogroups and their correlation with neurocognitive disorder (NCD) in HIV positive individuals. Methods: Baseline data were from the prospective cohort study of comparative HIV and aging research in Taizhou of Zhejiang province from January to December, 2017. A cross-sectional survey was performed in 448 HIV positive individuals. Sanger method was used for the sequencing and genotyping of whole mitochondrial genome of HIV positive individuals. NCD prevalence in the HIV positive individuals was assessed by Mini-mental State Examination (MMSE) in questionnaire interviews. Multivariable logistic regression analysis was performed to assess the associations between mtDNA haplogroups and NCD. Results: In this sample, mitochondrial haplogroups D (19.6%, 88/448), B (19.4%, 87/448) and F(17.0%, 76/448) were the most predominant haplogroups. The overall prevalence rate of NCD was 20.3% (91/448), and was high in haplogroups A (23.1%, 9/39), D (21.6%, 19/88), F (26.3%, 20/76) and M7 groups (26.1%, 12/46), respectively. In multivariable logistic regression analysis after adjusting confounding factors, such as age and gender, compared with haplogroup A, there were no differences in the prevalence rate of NCD among HIV positive individuals with haplogroup B, D, F, M7, M8, N9, and others. Conclusion: The study explored primarily correlation between mitochondrial haplogroups and NCD among HIV positive individuals and suggested that there is no significant association between mitochondrial haplogroups and NCD, but further longitudinal investigation with large sample size of HIV positive population is needed to confirm this finding.

[Investigation of group sex in men who have sex with men in Taizhou, Zhejiang province, 2013-2015].

Objective: To understand the prevalence of group sex in men who have sex with men (MSM) and related factors in Taizhou, Zhejiang province. Methods: From March 2013 to September 2015, a cross-sectional survey was conducted among MSM recruited from gay bars or bath houses in Taizhou by using questionnaire to collect the information about their sexual behavior and HIV test. Results: A total of 1 435 MSM were recruited, 179 of them (12.5%) were HIV infected, 231 (16.1%) reported group sex during the past year. Compared with MSM without group sex, more MSM with group sex had more than ten male sexual partners (53.7% vs. 19.0%, χ(2)=125.527, P<0.01), had both male and female sexual partners (86.6% vs. 68.2%, χ(2)=31.935, P<0.01), used no condom at sex with female partners during the past year (28.1% vs. 19.8%, χ(2)=6.540, P<0.05). After adjusted for educational level and occupation, group sex was associated with age[≥50 years old vs. ≤24 years old, adjusted odds ratio (aOR)=2.25, P=0.027], marriage with female (divorced or widowedvs. unmarried, aOR=0.29, P=0.001), census registering (local resident vs. non-local resident, aOR=1.56, P=0.023), number of male seuxal partners (≥21 vs. 2-5, aOR=8.06, P<0.001; 11-20 vs. 2-5, aOR=3.25, P<0.001) and number of female seuxal partners (≥6 vs. 0, aOR=2.63, P=0.005; 2-5 vs. 0, aOR=2.58, P=0.001; 1 vs. 0, aOR=2.01, P=0.010). Conclusion: The prevalence of group sex in MSM was high in Taizhou, and their poor condom use and complex sex behaviors would result in higher HIV infection rate and risk of transmission.

Prescribing Pattern of Antidepressants in Children and Adolescents: Findings from the Research on Asia Psychotropic Prescription Pattern.

OBJECTIVE: Pharmacotherapy of depression in children and adolescents is complex. In the absence of research into the efficacy and safety of antidepressants in this group of patients, their off-label prescription is common. This paper aimed to illustrate the prescription pattern of antidepressants in children and adolescents from major psychiatric centres in Asia. METHODS: The Research on Asia Psychotropic Prescription Pattern on Antidepressants worked collaboratively in 2013 to study the prescription pattern of antidepressants in Asia using a unified research protocol and questionnaire. Forty psychiatric centres from 10 Asian countries / regions participated and 2321 antidepressant prescriptions were analysed. RESULTS: A total of 4.7% antidepressant prescriptions were for children and adolescents. Fluoxetine, sertraline, and escitalopram were the most common antidepressants prescribed for children and adolescents. Almost one-third (30.3%) of prescriptions were for diagnoses other than depressive and anxiety disorders. There was less antidepressant polypharmacy and concomitant use of benzodiazepine, but more concomitant use of antipsychotics in children and adolescents compared with adults. CONCLUSION: Off-label use of antidepressants in children and adolescents was reported by 40 Asian psychiatric institutions that participated in the study. In-service education and regulatory mechanisms should be reinforced to ensure efficacy and safety of antidepressants in children and adolescents.

Antidepressant Prescription Pattern in the Presence of Medical Co-morbidity: REAP-AD 2013 Study.

OBJECTIVE: To evaluate the prescription pattern of antidepressants in patients with medical co-morbidity from major psychiatric centres in Asia. METHODS: The Research on Asian Psychotropic Prescription Pattern for Antidepressants (REAP-AD 2013) collected data from 42 psychiatric centres in 10 Asian countries and regions. Antidepressant prescriptions of 2320 patients with various psychiatric disorders were evaluated. Of these, 370 patients who had specified medical co-morbidities formed the study cohort. RESULTS: Escitalopram (20%) and mirtazapine (20%) were the most commonly prescribed antidepressants in patients with medical co-morbidity followed by sertraline (16%), trazodone (15%), and paroxetine (12%). Overall, more than half (52%; 247/476) of prescriptions comprised selective serotonin reuptake inhibitors. Slightly less than two-thirds (63%; n = 233) of patients received at least 1 selective serotonin reuptake inhibitor. In addition, 79% of patients were prescribed only 1 antidepressant. The mean number of antidepressants used per patient was 1.25 (standard deviation, 0.56). There were subtle differences in the most preferred antidepressant across medical illnesses such as diabetes mellitus, liver dysfunction, acid peptic disease, and cerebrovascular disease. Differences were also seen in prescription patterns across different countries. CONCLUSION: Although selective serotonin reuptake inhibitors formed the bulk of antidepressant prescriptions in the presence of medical co-morbidity, mirtazapine was also commonly used in the presence of medical co-morbidities. Specified medical morbidities do influence the selection of antidepressants.