Objective To compare the rates of regimen modification between patients with different initial antiretroviral therapy, and to investigate risk factors associated with drug toxicity-related regimen modification.Methods A two-years retrospective cohort study was conducted in 14 060 patients who initiated antiretroviral treatment with Zidovudine (AZT)/Tenofovir disoproxil (TDF)+Lamivudine (3TC)+Efavirenz (EFV) since 2012.There were 5 126 patients initiated TDF+3TC+EFV therapy (TDF group) and 8 934 patients initiated AZT+3TC+EFV therapy (AZT group).Chi-square test was used to compare the rate of first-line regimen modification and the rate of toxicity-related regimen modification between two groups.Cox proportional hazard model was used to investigate the risk factors associated with regimen modification.Results A total of 14 060 acquired immunodeficiency syndrome patients were observed for a median period of 1.85 person-years.There were 2 795 patients who changed their initial antiretroviral regimen and the rate of initial regimen modification was 19.9%.Two hundred patients who changed their initial regimen due to pregnancy were excluded.There were 2 070 patients in AZT group who changed their initial regimen with a rate of 23.5%.Among them, 1 652 patients changed their regimen due to drug toxicity and the rate was 18.8%.There were 525 patients in TDF group who changed their initial regimen with a rate of 10.4% and the rate of toxicity-related regimen modification was 6.2%.The differences between two groups were statistical significance (χ2=366.68 and 416.89, respectively, both P<0.01).The risk of regimen modification in AZT group were significantly higher than that in TDF group (aHR=2.89, 95%CI: 2.57-3.24).The risk of toxicity-related regimen modification in AZT group was also significantly higher than that in TDF group (aHR=3.85, 95%CI: 3.34-4.45).Conclusions Patients initiated antiretroviral treatment with AZT+3TC+EFV are more likely to change their initial regimen than those who initiated treatment with TDF+3TC+EFV.Female, age >45 years old, BMI<18.5 kg/cm2 and baseline CD4+ T cell count<200/mL were risk factors associated with regimen modification.

Objective The aim of the study was to investigate the related factor of postoperative provisional paraly?sis of parasagittal meningioma in the eloquent area. Methods A retrospective review was conducted on ninety-six pa?tients with parasagittal meningioma in the eloquent area treated by surgery from May 2005 to December 2015. Accord?ing to the diagnostic criteria for postoperative provisional paralysis, patients were divided into postoperative provisional paralysis group(n=31)and non- postoperative provisional paralysis group(n=65). Univariate and multivariate logistic regression methods were used to analyze the data including age, size of tumor,preoperative epilepsy, preoperative periph?eral edema, complete the occlusion of superior sagittal sinus(SSS) by tumor, incision of SSS during surgery, drainage vein damage during surgery. Results Univariate analysis showed that there were significant differences(P<0.05)between these two groups in age(χ2=14.943,P=0.000), preoperative peripheral edema(χ2=4.435,P=0.049), the complete occlu?sion of SSS by tumor(χ2=5.248,P=0.028), incision of SSS during surgery(χ2=5.773,P=0.026), drainage vein damage during surgery(χ2=11.441,P=0.002). Multivariate analysis showed that the factors related to postoperative provisional paralysis were age(OR=8.709,P=0.028), drainage vein damage during surgery(OR=16.242,P=0.012)and complete oc?clusion of SSS by tumor(OR=0.053,P=0.025). Conclusion Age and the drainage vein damage during surgery are the risk factors of postoperative provisional paralysis and complete occlusion of SSS by tumor is the protective factor for the oc? currence of postoperative provisional paralysis.

Objective To investigate the prevalence of malnutrition in human immunodeficiency virus ( HIV )‐infected children in China , and to explore and analyze the factors associated with malnutrition .Methods A cross‐sectional study was conducted by the antiretroviral treatment database of children .HIV‐infected children aged between 0 - 15 years old who initiated antiretroviral treatment were collected between January 1st , 2010 and December 31st , 2014 . Z‐score of height and weight were calculated by WHO Anthro (plus) software .Univariate and multivariate Logistic model analyses were performed to determine the factors associated with acute /chronic/mixed malnutrition .Results Baseline data of the 3 138 HIV‐infected children showed that 1 645 patients (52 .42% ) had malnutrition before antiretroviral treatment ,with acute ,chronic and mixed malnutrition of 8 .76% (275) ,39 .77% (1 248) and 3 .89% (122) ,respectively according to the type of malnutrition .Multivariate analysis showed that baseline CD4 + cell count < 200 cells/μL was the risk factor associated with acute malnutrition (aOR =2 .27 ,95% CI :1 .68 - 3 .06) ;rural settings (aOR = 1 .30 ,95% CI :1 .11 - 1 .53) ,baseline CD4 + cell count < 200 cells/μL (aOR = 1 .98 ,95% CI :1 .65 - 2 .38) ,baseline CD4 + cell count between 200 to 350 cells/μL (aOR = 1 .38 ,95% CI :1 .13 - 1 .69) and having AIDS‐related diseases (aOR = 1 .34 ,95%CI :1 .13 - 1 .59) were risk factors associated with chronic malnutrition ;and age of 11 - 15 years (aOR =2 .38 ,95% CI :1 .46 - 3 .88) ,baseline CD4 + cell count < 200 cells/μL (aOR = 4 .99 ,95% CI :3 .04 -8 .21) and having AIDS‐related diseases (aOR = 2 .45 ,95% CI :1 .65 - 3 .66) were risk factors associated with mixed malnutrition .Conclusions The prevalence of malnutrition in untreated HIV‐infected children remains high .All three types of malnutrition are associated with immunodeficiency .Early diagnosis and early treatment should be improved in HIV‐infected children through antiviral therapy to reduce the destruction of HIV to immune system .At the same time ,intensified monitoring of the nutritional status and nourishing undernourished children should be strengthened to reduce the prevalence of malnutrition .

Objective To investigate the clinical value of serum soluble Axl receptor tyrosine ki-nase(sAxlTK)in evaluating short-term prognosis in patients with acute decompensated heart failure(ADHF).Methods A total of 238 elderly ADHF patients admitted to Bozhou People's Hospital from January 1,2018 to October 1,2021 were recruited and divided into poor prognosis group(45 patients)and good prognosis group(193 patients)according to the occurrence of com-plex events within 90 d of follow-up.Based on the optimal cut-off value of serum sAxlTK level,they were also assigned into high level group(80 cases)and low level group(158 cases).Serum levels of sAxlTK,troponin Ⅰ(cTnⅠ)and N-terminal B-type natriuretic peptide precursor(NT-proBNP)were detected.Results Serum sAxlTK level was significantly higher in the poor prognosis group than the good prognosis group[43.89(33.95,51.44)μg/L vs 23.89(18.73,33.92)μg/L,P＜0.01].Multivariate logistic regression analysis showed that serum cTnⅠ and sAxlTK levels were independent risk factors for short-term poor prognosis in ADHF patients(OR=1.922,95％CI:1.035-3.568,P=0.039;OR=1.021,95％CI:1.008-1.034,P=0.001).ROC curve analysis indicated that the AUC value of combined serum sAxlTK,cTnⅠ and NT-proBNP levels to predict short-term poor prognosis was 0.836(95％CI:0.778-0.895).The incidence of complex events within 90 d was significantly higher in the high level group than the low level group(45.0％vs 5.7％,P＜0.05).Kaplan-Meier curve analysis revealed that the cumulative inci-dence of complex events was also higher in the high level group than the low level group(X2=66.991,Plog rank＜0.01).The high level group had significantly lower overall survival rate and worse survival prognosis than the low level group(X2=16.899,Plog rank＜0.01).Conclusion High serum sAxlTK level in elderly ADHF patients at admission is associated with a higher risk of 90-day short-term poor prognosis.Serum sAxlTK has the potential to become a useful tool for early prediction of short-term poor prognosis,and its combination with cTnⅠ and NT-proBNP can fur-ther improve the accuracy of prognosis prediction.

OBJECTIVE To examine the reversal effect of desipramine (DMI) on resistance to temozolomide(TMZ) in U251/TR cells and explore its mechanism. METHODS U251/TR cells were exposed to DMI (20-80μmol · L-1) or TMZ (0.5-10 mmol · L-1) for 24 h, cell viability was determined by cell counting kit-8 assay with IC50 calculated. The cytotoxicity of U251/TR cells treated with TMZ (1 or 2 mmol·L-1) in combination with DMI (20, 30 or 40 μmol · L-1) for 24 h was detected using CCK-8 assay. Synergism between DMI and TMZ was analyzed by the JIN Zheng-jun method. Apoptosis of U251/TR cells induced by TMZ 1 mmol · L-1, DMI 30 μmol · L-1,or their combination was examined by Hoechst33258 stains and caspase 3 activity was detected by luminescence analysis. Expression of C/EBP homologous protein (CHOP) was measured using quantitative real-time PCR and Western blotting. The survival rate of U251/TR cells treated with TMZ 1 mmol·L-1 and/or DMI 30μmol·L-1 was also assessed after silencing CHOP expression by small interference RNA (siRNA). RESULTS DMI or TMZ alone inhibited the growth of U251/TR cells significantly in a concentration-dependent manner (r 2=0.983,0.982,P<0.05), with the IC50 (33.6 ± 0.5)μmol · L-1 and (2.5 ± 0.6)mmol · L-1, respectively. The cell viability inhibitory rate of U251/TR cells by TMZ (1 or 2 mmol · L-1) combined with DMI (20, 30, or 40μmol · L-1) was greater than that by TMZ or DMI alone (P<0.05). The JIN Zheng-jun analysis revealed that combination of DMI and TMZ produced synergistic cytotoxicity (Q>1.15), ie, compared with TMZ alone, TMZ (1 mmol·L-1) com?bined with DMI (30 μmol · L-1) produced significant nuclear fragmentation and condensation (P< 0.05). In addition, DMI and TMZ in combination activated caspase 3 activity in U251/TR cells (P<0.05). Knock?down of CHOP by specific siRNA attenuated the synergistic effect of DMI in the presence of TMZ, the survival rate of the combined drug group raised from 51.8%to 62.2%(P<0.05). CONCLUSION The results suggest that DMI reverse resistance of U251/TR cells to TMZ through activation of the CHOP-depend?ently apoptosis pathway.

Objective To analyze the progress and characteristics of China' s "Free AIDS treatment strategy" since the implementation of the national "four free and one care" policy against AIDS 12 years ago.Methods Retrospective cohort study and cross-sectional analysis had been conducted in this study.368 449 cases that had received the ‘free antiviral therapy’ from 2002 to 2014 were selected from the National Treatment Database.Data from the baseline (initial time of ART,CD4 cell count,and antiretroviral regimen) and from the follow-up program (dates and status of follow-up,CD4 cell counts) were gathered and analysed by SAS 9.3.Results The number of cases that having received new treatment was increasing year by year,accounting for 75.4％ of all the cases identified from 2010 to 2014.Constituent ratios of patients with baseline CD4 cell count ＜200 cells/μl and clinical diagnosis of AIDS were decreasing from 81.0％ in 2006 to 39.7 ％ in 2014.Status on drug optimization showed that:3TC replaced DDI,EFV replaced NVP and TDF replaced D4T,making the utilization rates as 99.5％,75.7％,and 60.6％,respectively,by 2014.Regions that were covered by the treatment accounted for 75.4％ of all the counties/districts involved.The previous CDC-led AIDS treatment program and mode of management had been transferred to the hospital-based model.Proportion on the twice-CD4-testing model had been 75.2％ since 2010,with the rate of virological detection increased from 70.8％ in 2010 to 87.4％ in 2014 and the virological unsuccessful testing rate decreased from 17.6％ in 2010 to 11.8％ in 2014.Among all the patients,the 1,5 and 10 year survival rates appeared as 92.2％,80.5％ and 69.6％,respectively.For patients with baseline CD4 cell counts as ＜50 cells/μl or ＞350 cells/μl,the corresponding survival rates showed as 81.6％,69.9％,60.9％ and 97.9％,89.8％,81.0％,respectively.Conclusion China's HIV/AIDS free anti-retroviral therapy program appeared as a national treatment cohort which involved large number of participants,with new patients joining in,annually.Criterion on drug optimization and treatment were consistently following the recommendation and guidelines set by WHO.Management program on treatment had gradually turned to hospital-based,with follow-up and laboratory testing programs guaranteed,ended up with satisfactory treatment effects.

Objective:To explore the application of weighted adjustments of dropout rates in sensitivity analysis of medically repeated measurements data and the implementation with SAS 9.4 software.Methods:By compiling SAS codes, mixed-effects models for repeated measures were used to conduct the covariance analysis of multivariable repeated measurements data. Meanwhile, the overall dropout rate and the dropout rates of each group were used to make weighted adjustments by applying pattern-mixture models, which was considered to be a sensitivity analysis to validate the stability of results.Results:The dropout rates of placebo group, low-dose and high-dose groups were 8.77%, 11.79% and 16.15%, respectively, the differences were significant ( P=0.025). The results of mixed-effects models for repeated measures showed the differences of curative effect indicators changes from baselines of between high-dose, low-dose groups and placebo group were significant ( P=0.008 and P=0.002). The results of pattern-mixture models considering weighted adjustments of the respective groups' dropout rates were consistent with those of mixed-effects models for repeated measures. Conclusions:The pattern-mixture models considering weighted adjustments of dropout rates can be used in the sensitivity analysis of repeated measurements data. The SAS codes can provide a practical basis for the popularization and application of weighted adjustments of dropout rates in the sensitivity analysis of repeated measurements data.

Objective To compare the differences of CD4 +T lymphocyte (CD4) counts between patients aged 18 and over,to explore the effect of age on treatment,36 months after having received the China National Free AIDS Antiretroviral Treatment on HIV/AIDS.Methods Through the National ART Information Ssystem,we selected those HIV/AIDS patients who initiated the ART 36 months after the ART,between January 1,2010 and December 31,2012 in Guangzhou,Liuzhou and Kunming.Patients were divided into age groups as 18-49,50-59 and 60 or over year olds,at the baseline of treatment.Under different levels of baseline CD4 counts,we chose the baseline and different time-point of CD4 counts as dependent variables,applied mixed linear model to analyze the effects of age,viral suppression,gender,baseline CD4/CDs ratio and initial treatment regimen.Results A total of 5 331 HIV/AIDS patients were recruited.No differences were found on age group ratios between different levels of baseline CD4 counts.At the level of baseline CD4＜200 cells/μl,both the 50-59 and 60 or above years old groups had lower CD4 counts than the 18-49 year-old group,within 36 months after the initiation of ART.However,at the baseline CD4 level of 200-350 cells/μl,no signiftcant differences on CD4 counts between the 50-59 year-old and 18-49 year-old groups were noticed.CD4 counts seemed lower in the 60 and above year-old group than in the 18-49 year-old group.Conclusion Age might serve as an influencing factor on CD4 counts within 36 months after the initiation of ART,suggesting that earlier initiation of ART might be of help to the recovery of immune function in the 50-59 year-old group.

Objective To investigate the value of combining preoperative magnetic resonance imaging(MRI)and postoperative pathological assessment of lymph node metastasis in predicting overall survival in rectal cancer patients.Methods This retrospective study collected clinical,pathological and image information of 2610 patients histopathologically confirmed with rectal adenocarcinoma at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2016 and December 2021.All patients underwent MRI scans and were divided into three groups according to lymph node status assessed by preoperative MRI(MRIN)and postoperative pathology(PN):MRIN+but PN-(MRIN+group),PN+but MRIN-(PN+group),MRIN+and PN+(MRI-PN+group).Inverse probability weighting(IPW)was used to adjust for confounding factors.Kaplan-Meier curves were used to estimate overall survival and log-rank tests were used to compare the difference.Univariate Cox regression models were used to analyze the correlation between tumor characteristics and overall survival,and bidirectional stepwise Cox regression models were used to identify independent risk factors for overall survival.Results The MRI-PN+group showed higher tumor staging,more frequent perineural invasion,more distant metastases,and a higher risk of death compared to the P N+group and MRIN+group(all P＜0.05).Kaplan-Meier curves showed that the 3-year survival rates for the MRIN+group,PN+group,and MRI-PN+group were 90.5%,79.1%,and 76.4%,respectively;the 5-year survival rates were 85.7%,71.5%,and 59.2%,respectively.Stepwise Cox regression showed that age,tumor location,carcino-embryonic antigen,carbohydrate antigen 19-9,lymph nodes number,pathological tumor stage,lymphovascular invasion,perineural invasion,distant metastasis,neoadjuvant therapy and adjuvant therapy,and MRI-pathology lymph node status were independent risk factors for overall survival in rectal cancer(all P＜0.05).Conclusion Evaluating the lymph node status by combining preoperative MRI and postoperative pathology helps predict overall survival in rectal cancer patients more accurately.