The human cytomegalovirus (HCMV) is a widespread herpesvirus. Virus reactivation from latency can lead to stillbirth, miscarriage, fetal anomalies, and intrauterine growth retardation. During latent infection with the HCMV, the virus can be cleared by the immune response or apoptosis of host cells. However, the HCMV has developed several strategies to manipulate expression of its genes and the microenvironment of host cells. Recent studies have shown that latent infection with the HCMV is associated with viral: regulation of early expression of genes; evasion of cell death; evasion of the immune response; regulatin of non-coding RNAs. This review summarizes recent research progress on the mechanisms underpinning latent infection with the HCMV.
Animals ; Cytomegalovirus ; genetics ; physiology ; Cytomegalovirus Infections ; immunology ; virology ; Humans ; Viral Proteins ; genetics ; metabolism ; Virus Latency

Objective To evaluate the clinical value of high-risk HPV( HR-HPV) genotyping in risk stratification and management of cervical cancer screening.Methods Totally 9 331 women underwent routine cervical cancer screening at the first time of medical visit in gynecological clinic at Taizhou Hospital of Zhejiang Province.Cervical samples were collected by liquid-based method and analyzed for cytology and HPV genotyping ( Co-testing ) .The clinical value of HPV 16 and 18 genotyping in risk stratification and management of cervical cancer screening was evaluated.Results Patients were comprised of women aged 30 to 65 years with HPV-positive 21.6% ( HR-HPV infection accounting for 79.0%) , with abnormal cytology 5.0%( HR-HPV infection accounting for 56.2%) .The sensitivity of HR-HPV genotyping for CIN2+was significantly higher than that of cytology using a positive cut point of ASCUS(χ2 =42.36,P<0.05). Histopathological diagnosis of CIN2+which in 80 cases (13.5%) , including HR-HPV types were 74 cases (92.5%) and abnormal cervical cytology were 59 cases (73.8%) .The positive of HR-HPV infection was a significant factor associated with the development of CIN (χ2 =10.00,P <0.05).Conclusions The sensitivity of HR-HPV genotyping in cervical cancer screening was significantly higher than cytology as suspicious or mildly abnormal cytology results who were followed up diversion can be found cytology missed cervical tissue lesions, thereby reducing cancer precancerous lesions and cervical cancer incidence and mortality.

Objective To study the disease process of vulvovaginal candidiasis (VVC) infection in rat model of VVC, and to study the immuno-repairing effect of different treatments on vaginal epithelium and the ultra-structural changes of vaginal epithelial cells. Methods The VVC model of female rats were established. After successful modeling, the rats were treated with no treatment (model control group), nystatin and Kangfu Xiaoyan suppository. The vaginal epithelium was observed by transmission electron microscopy and immunohistochemical staining. The ultra-structural changes of epithelial cells and the expression of cytokines interferon γ (IFN-γ), interleukin (IL) 4, IL-17 and IgG in epithelial cells were observed and analyzed statistically. Results The negative conversion rate of model control group was 0, and that of nystatin group was 6/6, and that of Kangfu Xiaoyan suppository group was 5/6; significant difference existed between nystatin, Kangfu Xiaoyan suppository group and model control group (P<0.05). The ultrastructures of vaginal epithelial cells were damaged obviously after VVC infection, and the ultrastructures were repaired by nystatin and Kangfu Xiaoyan suppository under transmission electron microscope. Immunohistochemical staining showed, the expressions of IFN-γ and IgG in the four cytokines which played a protective role increased after Kangfu Xiaoyan suppository treatment, significantly different from that of model control group (P<0.05), but there were no significant differences of the IFN-γ and IgG expression between Kangfu Xiaoyan suppository group and those of nystatin group (P>0.05); the expression of IL-17 was increased after nystatin treatment, but decreased after Kangfu Xiaoyan suppository treatment, and the difference between the two groups had statistical significance (P<0.05). Conclusions The ultrastructure of vaginal epithelial cells after VVC infection could be damaged obviously, the local immune state is disordered, and the antifungal drug nystatin has a good therapeutic effect on VVC, it could significantly repair the damaged vaginal epithelium structure after VVC infection and strengthen the protective immune function of vaginal epithelium. Kangfu Xiaoyan suppository, one of Chinese medicine, has similar therapeutic effect with nystatin.

Objective:To investigate the microbiota distribution and drug resistance in gravidas with suspected infection to provide a reference for the treatment of maternal infectious diseases.Methods:This retrospective study analyzed the distribution and in vitro antimicrobial susceptibility of microorganisms isolated from obstetric patients in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University (Beijing Maternal and Child Health Care Hospital) from January 1, 2016. to December 31, 2019. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was used to identify pathogenic microorganisms. The susceptibility of isolated pathogenic bacteria to common antimicrobial agents was detected using bioMerieux VITEK-2 (France). Descriptive statistical methods was used. Results:A total of 4 086 strains were isolated from 3 781 samples of 3 225 gravidas and 44.17% (1 670) of the strains were from secretion specimens, including 767 cervical, 423 vulvovaginal, 318 perineum wound and 117 uterine secretion specimens. The most common bacterium was Escherichia coli (1 728, 42.29%), followed by Saccharomyces (901, 22.05%), Streptococcus (429, 10.50%), Enterococcus (377, 9.23%), and Staphylococcus (300, 7.34%). The proportion of Enterococcus among all the positive bacteria increased during the study period with its ranking rising from the 5th in 2016 to the 3rd in 2019, while the ranking of the proportion of Staphylococcus fell from the 4th in 2016 to the 5th in 2019. More than 90% of Escherichia coli were sensitive to carbapenems, piperacillin/tazobactam, amikacin, nitrofurantoin and ceftazidime, but only 35% or less to ampicillin and cefazolin. More than 98% of Candida strains were sensitive to amphotericin, but less than 56% to itraconazole. From 2016 to 2019, the sensitivity of Escherichia coli to cefuroxime sodium and ceftriaxone remained around 65%. The sensitive rate of Candida albicans to voriconazole and fluconazole gradually decreased from about 90% to 56%. The most common Enterococcus was Enterococcus faecalis and its susceptibility to vancomycin, ampicillin, penicillin, linezolid, nitrofurantoin and levofloxacin were all over 90%. Conclusions:Escherichia coli is the most common pathogenic microorganism in gravidas with suspected clinical infection and its susceptibility to cefuroxime sodium and ceftriaxone is stable. Candida albicans shows a gradually decreased susceptibility to voriconazole and fluconazole, which needs close attention. The proportion of Enterococcus in all pathogenic bacteria increases significantly over time, while that of Staphylococcus decreases.

Objective:To analyze the clinical characteristics of intestinal tuberculosis improving the diagnosis rate of intestinal tuberculosis.Methods:From January 2014 to June 2018, at Wuhan Pulmonary Hospital, the data of clinical symptoms, laboratory examination, imaging, endoscopy, surgery and pathological examination of 205 patients with intestinal tuberculosis were retrospectively analyzed. Descriptive analysis was performed for statistical analysis.Results:Among 205 patients with intestinal tuberculosis, 145 cases were male and 60 cases were female, aged 14 to 85 years old. A total of 189 cases (92.2%) were complicated with lung tuberculosis, of which 151 cases (79.9%) were positive for sputum acid fast staining. A total of 126 cases were tested for feces acid fast staining, of which 83 cases (65.9%) were positive. A total of 60 cases (29.3%) were tested for GeneXpert Mycobacterium tuberculosis/rifampicintablet (GeneXpert MTB/RIP), of which 49 cases (81.7%) were positive. A total of 44 cases of intestinal tuberculosis were diagnosed by biopsy under electronic enteroscopy, and 21 cases were pathologically diagnosed with intestinal tuberculosis after surgical resection. The 21 patients were tested for GeneXpert MTB/RIP, of which 19 cases (90.5%) were positive and 10 cases (47.6%) were positive for tuberculin test. Six patients were clinically diagnosed with intestinal tuberculosis after effective treatment of antituberculosis drugs. Conclusions:Combination of clinical symptoms and laboratory, imaging, endoscopic and pathological examination, as well as the therapeutic effect of diagnostic antituberculosis treatment could make comprehensive diagnosis of intestinal tuberculosis. The GeneXpert MTB/RIP examination is of great value in the diagnosis of intestinal tuberculosis.

Objective:To detect karyotype homology of vaginal isolates from patients with recurrent vulvovaginal candidiasis (RVVC) in recurrent episodes, and to discuss changes of susceptibility of Candida strains to antifungal drugs with clinical progress.Method:s Ten patients were recruited from Beijing Obstetrics and Gynecology Hospital, Capital Medical University from September 2018 to June 2019, who were firstly diagnosed with RVVC. Vaginal discharges were collected before first treatment and after first relapse. Vaginal strains were isolated, purificated and identificated. Then karyotype of 20 strains isolated from 10 patients were detected by restriction endonuclease analysis of genomic DNA (REAG) using enzyme BssHⅡand pulsed field gel electrophoresis (PFGE) methods, and sensitivity of clinical isolates to 5 antifungal drugs (clostridium, fluconazole, miconazole, itraconazole and nystatin) was also detected using disk diffusion method. Result:s (1) All 20 strains of 10 patients with RVVC were Candida albicans, and their chromosomes were extremely similar after BssHⅡ enzyme digestion. The gene bands of isolated strains from the same patient were completely identical. (2) After clinical medication, the sensitivity of vaginal isolates to azoles was generally decreased, but remained highly sensitive to nystatin, nystatin (first and second clinical isolates: 100% sensitivity and 100% sensitivity)>clotrimazole (100% sensitivity and 90% sensitivity)>fluconazole (80% sensitivity and 70% sensitivity)>itraconazole (60% sensitivity and 50% sensitivity)>miconazole (30% sensitivity and 20% sensitivity). Conclusions:(1) The latency of the same colonized strain in the vagina may be the cause of repeated RVVC episodes. (2) Antifungal agents could selectively induce drug resistance to Candidas, and Candidas show cross-resistance to antifungal agents. Repeated fungal culture and drug sensitivity test in patients with RVVC are very necessary for correct selection of antifungals.

Objective:To construct the Discharge Readiness Assessment Scale of Adult Patients with Type 2 Diabetes and evaluate its reliability and validity so as to provide a scientific assessment scale for clinical practice.Methods:The literature review, group discussion, expert consultation method and questionnaire survey method were used to construct the Discharge Readiness Assessment Scale of Adult Patients with Type 2 Diabetes. Based on the theory of knowledge, attitude and practice, the initial scale was developed through literature review. The Delphi method was used to conduct two rounds expert consultation to develop the pre-test scale. From August to October 2020, a total of 230 pre-discharge patients from China-Japan Union Hospital of Jilin University were selected as the research subjects. The reliability and validity of the scale were tested.Results:The formal scale included 32 items and 4 dimensions. The scale-level content validity index was 0.79-1.00, unanimity scale-level content validity index ( S- CVI/ UA) was 0.81, and average scale-level content validity ( S- CVI/ Ave) was 0.95. The Cronbach's α coefficient of the scale was 0.955, and the half-reliability was 0.846. Conclusions:The Discharge Readiness Assessment Scale of Adult Patients with Type 2 Diabetes has good reliability and validity, which can provide a scientific and effective assessment tool for clinical practice.

Objective:To analyze the vaginal microecological status of vaginitis population and non-vaginitis population of gynecological female outpatients.Methods:A total of 30 265 women who visited the gynecological outpatient clinic of Beijing Obstetrics and Gynecology Hospital from December 2018 to December 2020 completed vaginal microecological examination. After removing the follow-up patients, 23 181 women were divided into group with symptoms and signs of vaginitis (6 697 cases) and group without symptoms and signs of vaginitis (16 484 cases), according to whether the women with symptoms and signs of vaginitis or not. And the vaginal microecological status of the two groups was compared and analyzed.Results:(1) The total detection rate of vaginitis in the initial women was 34.87% (8 083/23 181), of which 46.10% (3 087/6 697) in group with symptoms and signs of vaginitis and 30.31% (4 996/16 484) in group without symptoms and signs of vaginitis, nearly 1/3 of the gynecological outpatients without signs and symptoms of vaginitis had vaginitis. (2) Among the types of simple vaginitis, vulvovaginal candidiasis (VVC) was the most frequent in group with symptoms and signs of vaginitis (16.01%, 1 072/6 697), followed by aerobic vaginitis (AV; 12.83%, 859/6 697), with significant differences compared with group without symptoms and signs of vaginitis (all P<0.001). There were no statistical differences between the two groups of bacterial vaginosis (BV) and trichomonal vaginitis (TV), indicating that BV and TV were more likely to be neglected (all P>0.05). (3) The proportion of various combinations of vaginitis among 2 632 cases of mixed vaginitis were, in descending order: BV+AV, VVC+AV, BV+AV+VVC, AV+TV, AV+TV+BV, BV+VVC. (4) Microecological analysis of 15 098 cases diagnosed with non-vaginitis had normal flora (including those with normal flora and those with normal flora but decreased function) in 14 013 cases (92.81%, 14 013/15 098), abnormal flora in 429 cases (2.84%, 429/15 098) and the BV intermediate in 656 cases (4.34%, 656/15 098); this indicated that the vast majority of the microecological tests were normal in the vaginal microbiota of those without vaginitis. Conclusions:Microecological examination could diagnose multiple pathogenic infections at once, and is especially important as a guide for the definitive diagnosis of mixed vaginitis and vaginitis with atypical clinical symptoms. Vaginal infections such as BV and TV that are easily overlooked should be concerned.

Objective:To explore the safety and feasibility of adrenal tumor resection under day surgery mode for the treatment of unilateral primary aldosteronism (UPA).Methods:The clinical data of 83 patients who underwent adrenalectomy for the treatment of UPA from January 2020 to January 2023 were retrospectively analyzed. There were 42 males (50.6%)and 41 females (49.4%), age (49.0±12.3)years old. Body mass index (25.4±3.6)kg/m 2. There were 17 patients with diabetes, 58 patients with preoperative hypertension, and the duration of hypertension was 8.2(1, 15)years. Systolic blood pressure was 151.8(137.0, 160.0)mmHg (1 mmHg=0.133 kPa), and diastolic blood pressure was 97.4(87.0, 107.0)mmHg. 20 cases had severe preoperative hypokalemia, with preoperative blood potassium levels of (2.9±0.6)mmol/L. The ratio of preoperative plasma aldosterone to renin activity was 54.1(13.0, 77.2). Tumors were located on the left side in 47 cases (56.6%)and on the right side in 36 cases (43.4%). The maximum diameter of the tumor is 1.5(1.0, 1.7)cm. Patients diagnosed with unilateral primary aldosteronism were included, and patients diagnosed with adrenal pheochromocytoma, adrenal malignancy, or severe cardiovascular disease that cannot tolerate surgery were excluded. The patient was admitted to the hospital on the same day, underwent surgery on the same day, and was evaluated after extubation within one day after surgery. The patient had no fever or lower back pain after surgery, was able to freely get out of bed, and had no obvious abnormalities in blood routine, electrolyte and other test indicators. The patient was discharged from the hospital and received continuous care outside the hospital. The patient was guided to undergo regular outpatient follow-up. Evaluate the efficacy using the Primary Aldosterone Hyperaldosteronism Surgical Outcome (PASO)criteria. Results:The patients had a mean length of hospital stay of 43.0(40.3, 44.6)hours, an operation time of 89.6(70.0, 103.0)minutes, and an operation cost of 23 820.2 (21 150.8, 24 948. 3)yuan. The postoperative free position time was 29.5(20.8, 39.7)hours, the postoperative time for fluid placement of the diet was 25.2(20.1, 27.8) hours, and 42.2(37.9, 41.9)hours of postoperative drain removal. The overall postoperative clinical remission rate was 85.5%. There were four postoperative complications, accounting for 4.8% of cases. These included two cases of interosseous vein thrombosis, one case of delayed healing, and one case of peritoneal rupture. No case of readmission was reported within 30 days.Conclusions:UPA adrenal tumour resection in ambulatory mode is safe and effective when strict inclusion and exclusion criteria are followed, adequate preoperative preparation is carried out, and expert physician assessment is provided.

Objective: To evaluate the clinical value of high-risk humam papillomavirus(HR-HPV) genotyping in diagnosis of cervical lesions. Methods: Between December 2012 and March 2015, a total of 4 095 women who were diagnosed as cervical inflammation-related disease were chosen to be evaluated in gynecological clinic at Taizhou Hospital of Zhejiang Province. All the women experienced HPV genotyping, analysis of the epidemiological characteristics of HPV types in Taizhou area and theresult of histopathologic diagnosis of HPV positive women. Logistic regression analysis was used to estimate the risk of HR-HPV genotyping in cervical lesion progression. Results: Overall, HPV52 was the most prevalent genotype, followed by HPV16, 58, 39 and 56. Among the women with cervical intraepithelial neoplasm (CIN), HPV16 was the most frequent type, followed by HPV52, 58, 33 and 31. Logistic regression analysis showed that a higher risk of CIN2+ for women infected with HPV16 or HPV33, the regression coefficients OR were 3.670(95%CI: 2.399-5.612, P<0.05) and 2.045(95%CI: 1.087-3.848, P<0.05), respectively. Logistic regression analysis showed that a higher risk of CIN2+ for NILM with positive HPV16, and the regression coefficients OR were 2.539(95%CI: 1.622-3.976, P=0.000); the ASCUS with positive HPV16 and 58 had higher risk of CIN2+ , the regression coefficients OR were 1.911(95%CI: 0.530-6.893) and 1.757(95%CI: 0.557-5.548), respectively. Conclusions HPV genotyping has important clinical value to detect precancerous cervical lesions, especially when cervical cytology is negative, in management of patiemts with atypical squamous cells of an undertermined significance(ASCUS) or low grade squamous intraepithelial lesion(LSIL).