Objective To investigate epidemiologic features of genital Chlamydia trachomatis (Ct) infection in China,and to provide scientific evidence for developing control strategies.Methods A descriptive epidemiological study was conducted to analyze personal,spacial and temporal distribution of genital Ct infection cases reported from 105 national sexually transmitted disease (STD) surveillance sites in China between 2008 and 2015.Results The reported incidence rate of genital Ct infection increased from 32.48 per 100 000 in 2008 to 37.18 per 100 000 in 2015,with the average annual rate of increase being 1.95％.There was marked variation in the reported incidence of genital Ct infection (range,＜ 1/100 000-615.99/100 000) among different STD surveillance sites,which was relatively high in the Pearl River Delta region,Yangtze River Delta region,Minjiang River region and some ethnic minority areas in western China,but low in north China and central China.In addition,no cases were reported at a few sites in rural areas.The reported annual incidence rate was higher in females than in males from 2008 to 2015,and the ratio of male to female cases decreased from 0.61:1 in 2008 to 0.46:1 in 2015.Among all age groups,the sexually active population aged 20-44 years showed high reported incidence of genital Ct infection,with the highest reported incidence observed in the group aged 25-29 years (range,116.72/100 000-142.98/100 000);the group aged 15-19 years showed the highest average annual rate of increase (10.06％) in the reported incidence of genital Ct infection.Among all kinds of medical institutions,general hospitals had the largest number of reported cases (range,66.00％-74.22％),followed by gynecology hospitals,Maternal and Child Health (MCH) hospitals and specialized dermatovenereology hospitals.Conclusions Genital Ct infection has been one of important public health issues in China,more attention should be paid to its prevention,and effective preventive measures are needed to be developed according to epidemiologic features.

Objective To investigate epidemiological characteristics and trends of gonorrhea in China, and to provide a scientific basis for the development of control strategies. Methods An epidemiological study was performed on gonorrhea cases reported from 31 provinces, autonomous regions or municipalities directly under the central government between 2000 and 2014. Results The reported incidence rate of gonorrhea decreased from 22.92 per 100 000 in 2000 to 7.25 per 100 000 in 2014, with the average annual rate of decrease being 7.89%. There was a significant difference in the incidence of gonorrhea between different regions. The regions with the highest incidence rate of gonorrhea were Yangtze River Delta region(Zhejiang, Shanghai, Jiangsu)and Zhujiang River Delta region(Guangdong, Guangxi, Hainan), followed by northwest China (Xinjiang, Ningxia, Inner Mongolia). The incidence of gonorrhea was higher in males than in females, and the average male/female ratio increased from 1.96 ∶ 1 in 2000 to 4.52 ∶ 1 in 2014. The population aged 20 - 44 years showed high incidence of gonorrhea, and the highest incidence rate of gonorrhea was observed in the age group 25 - 29 years in both men and women. The incidence of gonorrhea decreased in all the age groups from 2000 to 2014 except the age group 15 - 19 years with an annual growth rate of 4.18%. Of 20 occupations, peasant workers accounted for the highest proportion (26.00%)of reported gonorrhea cases, and the number of reported gonorrhea cases showed a decreasing trend in all the occupations. Conclusions Gonorrhea remains a major public health issue in China, and effective measures based on epidemiological features are urgently needed to control gonorrhea.

In order to investigate the clinicopathological characteristics of aortic valve disease in children, all the native surgically excised aortic valves obtained between January 2003 and December 2005 were studied macroscopically and microscopically. The patients' medical records were reviewed and the clinical information was extracted. According to preoperative echocardiography, intraoperative assessment, and postoperative pathology, combined with clinical symptoms and signs, aortic valve diseases were divided into three categories: aortic stenosis (AS), aortic insufficiency (AI), and aortic stenosis with insufficiency (AS-AI). The etiology was determined according to the macroscopic, microscopic and clinical findings. The results showed that among 70 aortic valves, patient age ranged from 6 to 18 years, with a mean of 15.4 years, and there were 56 boys and 14 girls (male: female=4:1). Forty-four children only had pure aortic valve disease, and the other 26 children had aortic valve disease associated with other heart valve diseases. There were 5 cases of AS (7.14%), 60 cases of AI (85.71%) and 5 cases of AS-AI (7.14%). The causes were congenital aortic valve malformation (32 cases, 45.71%), rheumatic disease (28 cases, 40%), infective endocarditis (7 cases, 10%), Marfan syndrome (2 cases, 2.86%), and undetermined (1 case, 1.43%). It was concluded that the common causes of aortic valve disease in order of frequency in children were congenital aortic valve malformation, rheumatic disease, infective endocarditis, and Marfan syndrome. AI was more common in children with aortic valve disease. Compared with adult patients, congenital bicuspid aortic valve in children was often AI. Histologically, the leaflets of congenital bicuspid aortic valve were mainly myxomatous, fibrosis and calcification less seen. AI was frequently found in rheumatic disease, mostly associated with other heart valve diseases. Macroscopic and microscopic examinations together with clinical information, echocardiographic findings and operative details were important in evaluating the etiology of aortic valve disease.

The changes of adrenomedullin (ADM), endothelin-1 (ET-1) and nitric oxide (NO) levels before and after operation in congenital heart disease (CHD) associated with pulmonary hypertension (PH) were observed in order to investigate their role in CHD with PH and their clinical significance. The CHD patients were divided into 3 groups according to pulmonary artery systolic pressure (PASP): Non-PH group: PASP < or = 30 mmHg (n = 11); mild-PH group: PASP 31-49 mmHg (n = 10); moderate or severe-PH group: PASP > or = 50 mmHg (n = 12). The control group consisted of 15 health children. Plasma ADM, ET-1 and NO levels were determined by radioimmunoassay and colorimetry methods. The correlation between ADM and ET-1, NO, PASP was analyzed. The changes in plasma ADM, ET-1 and plasma NO on the 7th day after operation among the groups were compared. The results showed that plasma ADM levels in non-PH group were significantly higher than that in control group (P < 0.05), but there was no significant difference in ET-1 and NO levels between the two groups (P > 0.05). ADM and ET-1 levels in mild-PH group were significantly elevated as compared with those in non-PH group (both P < 0.05), but NO levels were decreased (P < 0.05). ADM and ET-1 levels in moderate or severe-PH groups were increased as compared with those in mild-PH group (both P < 0.01), but NO level significantly declined (P < 0.05). On the 7th day after operation, plasma ADM and ET-1 levels in PH group were significantly decreased (P < 0.05, P < 0.01) as compared with those before operation, but there was no significant difference in NO levels (P > 0.05). But NO levels in non-PH group were significantly increased (P < 0.05). Plasma ADM levels in CHD were positively correlated with PASP and ET-1 (r = 0.77, P < 0.01; r = 0.82, P < 0.01), negatively correlated with NO (r = -0.56, P < 0.05). It was concluded that during the progression of PH in the cases of CHD, plasma ADM, ET-1 and NO might play an important role in the development of PH. The increased ADM may represent a compensatory mechanism. It can interact with NO and ET-1 to regulate pulmonary circulation in the pathophysiology of PH with CHD. ADM may be involved in the defence mechanism against further increase of pulmonary arterial pressure. ADM could be used as a reliable indicator of the severity of CHD associated PH.
Adolescent ; Adrenomedullin ; Child ; Child, Preschool ; Endothelin-1 ; metabolism ; Female ; Heart Septal Defects, Atrial ; complications ; metabolism ; surgery ; Heart Septal Defects, Ventricular ; complications ; metabolism ; surgery ; Humans ; Hypertension, Pulmonary ; etiology ; metabolism ; Infant ; Male ; Nitric Oxide ; metabolism ; Peptides ; metabolism ; Postoperative Period

Summary: In order to objectively evaluate the efficacy of intravenous gammaglobulin (IVIG) in the prevention and treatment of coronary artery lesion (CAL) in Kawasaki disease (KD) and the related factors influencing the IVIG efficacy, 314 children with KD were reviewed retrospectively and comparatively and were divided into IVIG plus aspirin group and ASA group. The occurrence and restoration of CAL in these two groups as well as many laboratory and clinical indexes including average hospital stay (days), total fever duration, defervescence time, platelet count, erythrocyte sedimentation rate, C reactive protein etc. were observed. The incidence of CAL was 39.5 % in the children with KD. In the IVIG+ASA group, the incidence of CAL was 34.3 % and 56.0 % in ASA group respectively (P<0.001). The incidence of CAL was reduced in the group in which 2.0 g/kg or 1.0 g/kg IVIG was administered as compared with the group in which IVIG was administered at a dose ≤0.6 g/kg or ≥3.0 g/kg (P<0.05). CAL occurred less frequently when IVIG was administered at 3-10 days of the course than that when IVIG was administered ≤3 days or >10 days (P<0.05). About 13.4 % of the CAL treated with IVIG was not recovered at the 12 th month of the course, mostly in the groups in which only ASA was administered and IVIG treatment was started 10 days later. The hospital stay (days), defervescence time, total fever duration, platelet count, erythrocyte sedimentation rate and C reactive protein were significantly reduced in IVIG+ASA group as compared with those in the ASA group (P<0.05). IVIG treatment can remarkably shorten the course of patients with KD and decrease the incidence of CAL, but the efficacy of IVIG in the prevention and treatment of KD disease is not as expected by people, therefore, reevaluation of the practical efficacy of IVIG is required.

The present study evaluated the application of three dimensional echocardigraphy (3DE) in the diagnosis of atrial septal defect (ASD) and the measurement of its size by 3DE and compared the size with surgical findings. Two-dimensional and real-time three dimensional echocardiography (RT3DE) was performed in 26 patients with atrial septal defect, and the echocardiographic data were compared with the surgical findings. Significant correlation was found between defect diameter by RT3DE and that measured during surgery (r=0.77, P<0.001). The defect area changed significantly during cardiac cycle. Percentage change in defect size during cardiac cycle ranged from 6%-70%. Our study showed that the size and morphology of atrial septal defect obtained with RT3DE correlate well with surgical findings. Therefore, RT3DE is a feasible and accurate non-invasive imaging tool for assessment of atrial septal size and dynamic changes.
Echocardiography, Three-Dimensional ; Heart Septal Defects, Atrial/*diagnosis ; Heart Septal Defects, Atrial/*pathology ; Heart Septal Defects, Atrial/surgery ; Young Adult

In order to investigate the clinicopathological characteristics of aortic valve disease in children, all the native surgically excised aortic valves obtained between January 2003 and December 2005 were studied macroscopically and microscopically. The patients' medical records were reviewed and the clinical information was extracted. According to preoperative echocardiography, intraoperative assessment, and postoperative pathology, combined with clinical symptoms and signs, aortic valve diseases were divided into three categories: aortic stenosis (AS), aortic insufficiency (AI), and aortic stenosis with insufficiency (AS-AI). The etiology was determined according to the macroscopic, microscopic and clinical findings. The results showed that among 70 aortic valves, patient age ranged from 6 to 18 years, with a mean of 15.4 years, and there were 56 boys and 14 girts (male: female=4:1). Forty-four children only had pure aortic valve disease, and the other 26 children had aortic valve disease associated with other heart valve diseases. There were 5 cases of AS (7.14%), 60 cases of AI (85.71%) and 5 cases of AS-AI (7.14%). The causes were congenital aortic valve malformation (32 cases, 45.71%), rheumatic disease (28 cases, 40%), infective endocarditis (7 cases,10%), Marfan syndrome (2 cases, 2.86%), and undetermined (1 case, 1.43%). It was concluded that the common causes of aortic valve disease in order of frequency in children were congenital aortic valve malformation, rheumatic disease, infective endocarditis, and Marfan syndrome. AI was more common in children with aortic valve disease. Compared with adult patients, congenital bicuspid aortic valve in children was often AI. Histologically, the leaflets of congenital bicuspid aortic valve were mainly myxomatous, fibrosis and calcification less seen. AI was frequently found in rheumatic disease, mostly associated with other heart valve diseases. Macroscopic and microscopic examinations together with clinical information, echocardiographic findings and operative details were important in evaluating the etiology of aortic valve disease.

Objective:Focusing on the medical protection of marine sports events at the 19th Asian Games in Hangzhou. This paper analyzes the effect of the development and implementation of the medical protection program to provide a referable summary of experience for the medical protection of future large-scale international maritime events.Method:This paper retrospectively analyzed the medical protection of Ningbo Xiangshan Yafan Center during the preparation stage of the Asian Games Sailing Competition, and during the period from September 21 to September 27, 2023 when the Asian Games Sailing Competition is held. Analyze the organizational structure and scheme of medical support.Results:During this Asian Games sailing competition, there were a total of 14 paramedics, 4 rescue helicopter crews, 2 ambulances and 1 rescue helicopter in and around the competition venues. In the city, the designated hospital has set up a total of 12 working groups, 15 protection outpatient clinics and a number of various types of clinic areas. There are 129 medical and nursing staff directly participating in the medical protection work of the Asian Games. A total of 44 specialized beds were reserved in the designated hospitals. There were also a number of volunteers and logistic staff who relied on the support work. The top three major disease types were trauma with 66 cases (29.2%), upper respiratory tract infection with 34 cases (15.04%) and skin allergy with 19 cases (8.51%). The top two population groups consulted were staff with 95 visits (44.19%) and technical officers with 89 visits (41.40%).Conclusions:During the sailing competitions of the Asian Games, the medical care was smooth and orderly. Trauma, upper respiratory tract infections and skin allergies are the most prominent diseases. The number of medical consultations for staff and technical officials of the Asian Games Sailing Competition accounted for more than 80% of the total number of consultations for all personnel. They should be given priority care.

Objective To explore the potential categories and influencing factors of dietary behavioral adherence trajectories in young and middle-aged patients with type 2 diabetes mellitus.Methods A convenience sampling method was used to investigate 277 young and middle-aged patients with type 2 diabetes mellitus admitted to the Department of Endocrinology of a tertiary A hospital in Huai'an City,China,from September 2022 to March 2023.The baseline data were collected using a general information questionnaire,the Dietary Behavioral Compliance Scale for Patients with Type 2 Diabetes Mellitus,the Diabetes Self-Efficacy Scale,the Diabetes Knowledge Text,the Health Beliefs Questionnaire,and the Family APGAR Index Questionnaire.The baseline information was collected on the patients'behavioral adherence trajectories a day prior to hospital discharge(T0),a week post-discharge(T1),a month post-discharge(T2),and 3 months post-discharge(T3)to assess the level of patients'dietary behavioral adherence,using latent variable growth mixed models to identify trajectory categories,and univariate and multivariate logistic regression to analyze the influences on dietary adherence trajectories.Results A total of 3 trajectories of dietary behavior adherence in young and middle-aged patients with type 2 diabetes mellitus were identified,namely,low adherence-fluctuating group(49.8%),high adherence-slowly regressing group(31.4%),and medium adherence-continuously rising group(18.8%),and the results showed that age,literacy level,self-efficacy,health beliefs,and family caring were the factors influencing potential categories of dietary behavioral adherence for young and middle-aged patients with type 2 diabetes mellitus.Conclusion There is heterogeneity in the adherence trajectories of young and middle-aged patients with type 2 diabetes mellitus,and healthcare professionals can develop targeted interventions according to the influencing factors of the trajectory categories in order to improve their adherence.

Objective:To investigate the influence of maternal autoimmune diseases and anticoagulants, including low-molecular-weight heparin (LMWH) and aspirin, on the fetal fraction of maternal plasma cell-free DNA of non-invasive prenatal testing (NIPT).Methods:A prospective cohort study was conducted on women with singleton pregnancies receiving NIPT in the Nanjing Drum Tower Hospital from March 2021 to July 2022. NIPT was carried out using a polymerase chain reaction (PCR)-free amplification platform. In this study, four types of maternal autoimmune diseases, which were antiphospholipid syndrome, undifferentiated connective tissue disease, Sj?gren's syndrome, and systemic lupus erythematosus (SLE), and two anticoagulants, LMWH and aspirin, were studied. Univariate and multivariate linear regression models were used to analyze the factors influencing fetal fraction of maternal plasma cell-free DNA.Results:A total of 4 102 singleton pregnant women were enrolled in the prospective cohort, and 3 948 were finally included after excluding the cases with unclear dosing time of LMWH or aspirin, other autoimmune diseases, conceiving through ovulation induction alone, and having true positive or failed NIPT result. There were 96 cases with antiphospholipid syndrome, 35 with undifferentiated connective tissue disease, 34 with Sj?gren's syndrome, and 18 with SLE. A total of 108 patients only received LMWH treatment, 121 only received aspirin treatment, and 113 received both LMWH and aspirin treatment. Univariate linear regression analysis showed that maternal body mass index at blood collection ( B=－0.423), conceived by assisted reproductive technology ( B=－0.803), male fetus ( B=－0.458), undifferentiated connective tissue disease ( B=1.774), and SLE ( B=3.467) had influence on the fetal fraction (all P<0.05). Multivariate linear regression analysis showed that maternal body mass index at blood collection ( B=－0.415), conceived by assisted reproductive technology ( B=－0.585), male fetus ( B=－0.322), SLE ( B=3.347) and undifferentiated connective tissue disease ( B=1.336) were factors influencing fetal fraction (all P<0.05). Conclusions:Maternal use of LMWH or aspirin does not affect fetal fraction when performing NIPT on a PCR-free amplification platform, but undifferentiated connective tissue disease and SLE are the influencing factors. Therefore, pregnant women should be informed before the NIPT that the fetal fraction of maternal plasma cell-free DNA may be affected by maternal autoimmune diseases.