Objective:To understand the consultation for post-exposure prophylaxis(PEP) services and their related factors among college students who were at high risk for HIV infection in Hangzhou,and to provide a reference basis for formulating an intervention model for college students at high risk of HIV infection.Methods:A cross-sectional survey was conducted between November 2022, and March 2023, in 5 different types of schools in Hangzhou. The subjects should meet the inclusion criteria of age between 18 years and 24 years old self-reported having ever had sex in the past. The sample size was estimated at 864. An online survey was conducted among college students by questionnaire star of an online survey platform to collect their demographic information, sexual behavior characteristics, HIV test status, and consultation for PEP services. The HIV infection risk among participants was evaluated according to their sexual behavior. The consultation for PEP services and the related factors of college students who were at high risk for HIV infection were analyzed.Results:A total of 20 973 college students were surveyed, and 2 291 who have ever had sex were recruited in the study. The proportion assessed as being at high risk for HIV infection was 43.47% (996/2 291), and the proportion of consultation for PEP services was 9.24% (92/996). Multivariate logistic regression analysis showed that among college students who were at high risk for HIV infection, the positive related factors of consultation for PEP services included knowing about PEP services (a OR=17.49, 95% CI: 7.98-38.36) ,having HIV tests (a OR=3.92, 95% CI: 2.08-7.42) and access to condoms on campus (a OR=3.38, 95% CI: 2.02-5.65), and the negative related factor was homosexual orientation (a OR=0.24, 95% CI: 0.06-0.91). Conclusions:Among college students who were at high risk for HIV infection, the proportion of consultation for PEP services was at a lower level. It is necessary to strengthen further the health education of PEP services knowledge among college students, improve the PEP services system, and promote the utilization of PEP services to reduce new HIV infections among college students.

Objective: To analyze the infection characteristics of newly reported HIV/AIDS cases in Hangzhou City, so as to provide the reference for effective AIDS intervention. Methods: Newly reported HIV/AIDS cases in Hangzhou City in 2022 were recruited. Demographic information, HIV testing status, infection routes and sexual behaviors were collected using questionnaire surveys. Blood samples were collected before antiviral treatment, and HIV-1 pol gene sequences were detected to construct molecular transmission networks. The characteristics of HIV/AIDS cases, including infection routes, time, and location were analyzed. Factors affecting infection time and location among HIV/AIDS cases were analyzed using a multivariable logistic regression model. Results: A total of 1 007 HIV/AIDS cases were reported in Hangzhou City in 2022, with 907 cases (90.07%) completing questionnaire surveys. Among them, 833 were males (91.84%), and 532 had out-of-province household registrations (58.65%). Ninety-one molecular transmission networks were established, and 276 cases were involved, with homosexual contact as the main infection route (199 cases, 72.10%). There were 311 recently infected cases (35.34%) and 569 previously infected cases (64.66%) among 880 cases whose infection time could be determined. There were 531 locally infected. cases (70.24%) and 225 imported cases (29.76%) among 756 cases whose infection location could be determined. Multivariable logistic regression analysis showed that the HIV/AIDS cases who were identified through voluntary counseling and testing (OR=1.826, 95%CI: 1.055-3.175) and sought sexual partners through homosexual dating apps (OR=2.461, 95%CI: 1.193-5.234) were more likely to be recently infected; the cases who lived in Hangzhou City for more than one year (>1 to 5 years, OR=2.853, 95%CI: 1.552-5.358; >5 years, OR=3.534, 95%CI: 1.382-9.804), sought sexual partners through entertainment venues (OR=3.449, 95%CI: 1.390-8.935), online/social apps (OR=2.416, 95%CI: 1.084-5.488) and homosexual dating apps (OR=3.734, 95%CI: 1.677-8.493) were more likely to be locally infected; student cases were more likely to be infected outside Hangzhou City (OR=0.115, 95%CI: 0.019-0.525). Conclusions The newly reported HIV/AIDS cases in Hangzhou City in 2022 were primarily infected through homosexual contact, previously and locally. Seeking sexual partners through homosexual dating apps is an important influencing factor for recent and local infections, highlighting the need for strengthening traceback investigations of related cases.

Objectives:Coronary slow flow(CSF)has long been regarded as a marker of coronary microvascular dysfunction(CMD).This study aims to evaluate the diagnostic value of CSF for CMD in patients with angina and nonobstructive coronary arteries(ANOCA).Methods:The study data were derived from the ANOCA-CMD prospective cohort study.All enrolled patients underwent coronary angiography and concurrent coronary physiological assessments in the left anterior descending artery using pressure-wire and thermodilution techniques to obtain coronary flow reserve(CFR)and the index of microcirculatory resistance(IMR).Based on the results,CMD was classified into four subtypes:CMD with elevated IMR(IMR≥25),CMD with reduced CFR(CFR<2.5),CMD with either reduced CFR or elevated IMR(CFR<2.5 or IMR≥25),and CMD with both reduced CFR and elevated IMR(CFR<2.5 and IMR≥25).The corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC)in the left anterior descending artery was calculated from coronary angiography images,with CSF defined as CTFC>27.This study evaluated the correlation between CTFC,CFR,and IMR,and investigated the diagnostic value of CSF for CMD in ANOCA patients.Results:A total of 103 ANOCA patients were enrolled in this study,with a mean age of(64.2±10.6)years,and 53.4％were female.Among them,57 patients(55.3％)were diagnosed with coronary slow flow.Patients with slow flow had higher IMR(P<0.001)and CFR(P=0.041).Similarly,the proportion of CMD with elevated IMR was higher in the slow flow group(P<0.001),while the proportion of CMD with reduced CFR was lower(P=0.044).There was no significant difference between the groups in the proportions of CMD with either reduced CFR or elevated IMR or CMD with both reduced CFR and elevated IMR(all P>0.05).CTFC was positively correlated with hyperemic mean transit time(r=0.424,P<0.001),IMR(r=0.430,P<0.001),and CFR(r=0.211,P=0.032).The area under the curve(AUC)of CTFC for diagnosing CMD with elevated IMR was 0.721(95％CI:0.623-0.819)with an accuracy of 67％(57％,76％),for diagnosing CMD with reduced CFR was 0.610(95％CI:0.499-0.720)with an accuracy of 60％(50％,70％),for diagnosing CMD with either reduced CFR or elevated IMR was 0.549(95％CI:0.425-0.673)with an accuracy of 47％(37％,57％),and for diagnosing CMD with both reduced CFR and elevated IMR was 0.582(95％CI:0.471-0.693)with an accuracy of 47％(37％,57％).Thus,CSF demonstrated limited diagnostic values across all subtypes of CMD.Conclusions:In ANOCA patients,CSF cannot serve as an effective diagnostic marker for CMD.Therefore,in clinical practice,the slow flow phenomenon should not be directly equated with the presence of coronary microvascular dysfunction in ANOCA patients.

Objectives:Coronary slow flow(CSF)has long been regarded as a marker of coronary microvascular dysfunction(CMD).This study aims to evaluate the diagnostic value of CSF for CMD in patients with angina and nonobstructive coronary arteries(ANOCA).Methods:The study data were derived from the ANOCA-CMD prospective cohort study.All enrolled patients underwent coronary angiography and concurrent coronary physiological assessments in the left anterior descending artery using pressure-wire and thermodilution techniques to obtain coronary flow reserve(CFR)and the index of microcirculatory resistance(IMR).Based on the results,CMD was classified into four subtypes:CMD with elevated IMR(IMR≥25),CMD with reduced CFR(CFR<2.5),CMD with either reduced CFR or elevated IMR(CFR<2.5 or IMR≥25),and CMD with both reduced CFR and elevated IMR(CFR<2.5 and IMR≥25).The corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC)in the left anterior descending artery was calculated from coronary angiography images,with CSF defined as CTFC>27.This study evaluated the correlation between CTFC,CFR,and IMR,and investigated the diagnostic value of CSF for CMD in ANOCA patients.Results:A total of 103 ANOCA patients were enrolled in this study,with a mean age of(64.2±10.6)years,and 53.4％were female.Among them,57 patients(55.3％)were diagnosed with coronary slow flow.Patients with slow flow had higher IMR(P<0.001)and CFR(P=0.041).Similarly,the proportion of CMD with elevated IMR was higher in the slow flow group(P<0.001),while the proportion of CMD with reduced CFR was lower(P=0.044).There was no significant difference between the groups in the proportions of CMD with either reduced CFR or elevated IMR or CMD with both reduced CFR and elevated IMR(all P>0.05).CTFC was positively correlated with hyperemic mean transit time(r=0.424,P<0.001),IMR(r=0.430,P<0.001),and CFR(r=0.211,P=0.032).The area under the curve(AUC)of CTFC for diagnosing CMD with elevated IMR was 0.721(95％CI:0.623-0.819)with an accuracy of 67％(57％,76％),for diagnosing CMD with reduced CFR was 0.610(95％CI:0.499-0.720)with an accuracy of 60％(50％,70％),for diagnosing CMD with either reduced CFR or elevated IMR was 0.549(95％CI:0.425-0.673)with an accuracy of 47％(37％,57％),and for diagnosing CMD with both reduced CFR and elevated IMR was 0.582(95％CI:0.471-0.693)with an accuracy of 47％(37％,57％).Thus,CSF demonstrated limited diagnostic values across all subtypes of CMD.Conclusions:In ANOCA patients,CSF cannot serve as an effective diagnostic marker for CMD.Therefore,in clinical practice,the slow flow phenomenon should not be directly equated with the presence of coronary microvascular dysfunction in ANOCA patients.

Objective:To understand the consultation for post-exposure prophylaxis(PEP) services and their related factors among college students who were at high risk for HIV infection in Hangzhou,and to provide a reference basis for formulating an intervention model for college students at high risk of HIV infection.Methods:A cross-sectional survey was conducted between November 2022, and March 2023, in 5 different types of schools in Hangzhou. The subjects should meet the inclusion criteria of age between 18 years and 24 years old self-reported having ever had sex in the past. The sample size was estimated at 864. An online survey was conducted among college students by questionnaire star of an online survey platform to collect their demographic information, sexual behavior characteristics, HIV test status, and consultation for PEP services. The HIV infection risk among participants was evaluated according to their sexual behavior. The consultation for PEP services and the related factors of college students who were at high risk for HIV infection were analyzed.Results:A total of 20 973 college students were surveyed, and 2 291 who have ever had sex were recruited in the study. The proportion assessed as being at high risk for HIV infection was 43.47% (996/2 291), and the proportion of consultation for PEP services was 9.24% (92/996). Multivariate logistic regression analysis showed that among college students who were at high risk for HIV infection, the positive related factors of consultation for PEP services included knowing about PEP services (a OR=17.49, 95% CI: 7.98-38.36) ,having HIV tests (a OR=3.92, 95% CI: 2.08-7.42) and access to condoms on campus (a OR=3.38, 95% CI: 2.02-5.65), and the negative related factor was homosexual orientation (a OR=0.24, 95% CI: 0.06-0.91). Conclusions:Among college students who were at high risk for HIV infection, the proportion of consultation for PEP services was at a lower level. It is necessary to strengthen further the health education of PEP services knowledge among college students, improve the PEP services system, and promote the utilization of PEP services to reduce new HIV infections among college students.

Objective:To analyze the survival status and death factors of confirmed HIV-infected patients in Hangzhou to provide a basis for the formulation of AIDS prevention and treatment strategies.Methods:A retrospective cohort study was conducted. The data were from the HIV/AIDS Comprehensive Response Information Management System of the Chinese Disease Control and Prevention Information System.Epidemiological characteristics of HIV-infected patients were comparied in Hangzhou City from 2004 to 2023 by using chi-square Test. The survival rate of HIV-infected patients in Hangzhou was calculated by the life table method, the survival curves of different subgroups were described by the Kaplan-Meier method, and the Cox proportional hazard regression model was used to analyze the influencing factors of death risk. The SPSS 26.0 software was used for statistical analysis.Results:Among the 9 457 subjects, the total follow-up time was 58 004.18 person-years, 494 patients died, fatality rate of all-cause cases was 0.85 per 100 person-years.The average survival time was 18.59 (95% CI:18.40-18.78) years. Malignant neoplasms and pneumocystis pneumonia were the first (14.37%,71/494) and second (10.73%, 53/494) causes of death, respectively. Death within 6 months after diagnosis accounted for 42.51% (210/494), and suicide accounted for 4.25% (21/494). Multivariate Cox regression analysis showed that compared with those who received antiviral treatment (ART) within 3 months of diagnosis, those who received ART outside 3 months and those who did not receive ART had a 1.65 (95% CI:1.25-2.19) and 20.68 (95% CI:15.80-27.06) times risk of death, respectively. The HIV-infected patients with high CD4 +T lymphocytes (CD4) counts for the first time had a lower risk of death. The risk of death of patients with baseline CD4 counts of 200-349 cells/μl, 350-499 cells/μl, and ≥500 cells/μl was 0.38 (95% CI:0.29-0.49), 0.26 (95% CI:0.19-0.36), 0.21 (95% CI:0.14-0.31) times higher than that of baseline CD4 counts <200 cells/μl, respectively. Conclusions:The overall survival of the HIV-infected patients was good in Hangzhou from 2004 to 2023. Early detection of HIV infection and timely mobilization to participate in ART was the key to improving the survival rate of patients. At the same time, given the suicide problem of HIV-infected patients, suicide surveillance and depression and anxiety screening of HIV-infected patients should be further strengthened, and targeted psychological intervention policies should be implemented.

Objective: To investigate the immune reconstitution of HIV/AIDS patients and its influencing factors after receiving antiviral therapy (ART) in Hangzhou City, so as to provide insights into improving the treatment effects and quality of life in HIV/AIDS patients. Methods: A retrospective cohort of HIV/AIDS patients who began antiviral treatment between January 1, 2016 and August 31, 2021 and had a baseline CD4+T lymphocyte (CD4) counts of less than 500 cells/μL or a baseline CD4/CD8+T lymphocyte (CD8) ratio of less than 0.8 in Hangzhou City was followed up until August 31, 2023. Demographic information, antiviral therapy in formation, CD4 counts, and CD4/CD8 were collected from the Chinese Disease Prevention and Control Information System. A good immune reconstitution was defined as having CD4≥500 cells/μL and CD4/CD8≥0.8. The immune reconstitution status of HIV/AIDS patients were analyzed, and factors affecting immune reconstitution were identified using a multivariable Cox proportional risk regression model. Results: A total of 3 349 HIV/AIDS patients were enrolled, with a median age at ART of 31 (interquartile range, 20) years. There were 3 075 males (91.82%), 1 600 cases with college education and above (47.78%) and 2 455 cases at WHO clinical stage Ⅰ-Ⅱ(73.31%). There were 1 368 cases with good immune reconstitution, accounting for 40.85%, and the proportion of HIV/AIDS patients with good immune reconstitution that began ART in 2016 was the highest, reaching 51.90%. Multivariable Cox proportional risk regression model identified WHO clinical stage (Ⅰ-Ⅱ, HR=2.529, 95%CI: 2.023-3.162), timely ART (HR=1.196, 95%CI: 1.027-1.394), initial treatment regimen (TDF+3TC+NVP/EFV, HR=2.185, 95%CI: 1.891-2.524; integrase inhibitors, HR=8.509, 95%CI: 6.706-10.795), baseline CD4/CD8 (≥0.1, HR: 1.600-4.515, 95%CI: 1.061-6.661), baseline hemoglobin (<90 mg/dL, HR=0.327, 95%CI: 0.121-0.880), hepatitis B infection (HR=0.619, 95%CI: 0.457-0.840) and hepatitis C infection (HR=0.308, 95%CI: 0.099-0.956) as factors affecting immune reconstitution in HIV/AIDS patients. Conclusion The immune reconstitution in HIV/AIDS patients after ART is associated with WHO clinical stage, timely ART, initial treatment regimen, baseline CD4/CD8, baseline hemoglobin and hepatitis B or C infection.

Objective:To understand the molecular epidemiological characteristics of unique recombinant forms (URFs) in newly reported HIV-1 patients in Hangzhou, and provide theoretical support for prevention and control of AIDS.Methods:The blood samples of newly-diagnosed HIV-1 infected cases who received no antiviral therapy from 2019 to 2023 were collected, pol gene was amplified by RT-PCR and nested PCR, followed by sequencing. The URFs were screened using phylogenetic tree, followed by recombinant analysis. Genetic distances between URFs sequences were calculated and molecular transmission networks were constructed. The calibrated population resistance program (CPR) was used to analyze transmissible drug-resistant mutations. Results:A total of 222(5.0%, 222/4 471) URFs pol gene sequence were obtained, and the recombination types were CRF01_AE/CRF07_BC (60.4%, 134/222), CRF01_AE/C (11.7%, 26/222), CRF01_AE/B (9.5%, 21/222), CRF01_AE/B/C (8.1%, 18/222), B/C (7.6%, 17/222) and CRF55_01B/CRF07_BC (2.7%, 6/222), respectively. 78.8% (175/222) were infected by men who have sex with man(MSM), whoes mean age was 31.3±10.5. The proportion of URFs increased from 4.0% (34/843) to 7.4% (60/807) from 2019 to 2023. Under the optimal gene distance threshold of 1.5%, the molecular network access rate was 49.5% (110/222), included 23 clusters. We found a large active transmission cluster with 39 cases mixed homosexual and heterosexual, the recombination types was CRF01_AE/CRF07_BC, and the average gene distance was 0.005. Prevalence of URFs transmissible resistance was 3.2% (7/222). Conclusions:URFs are mainly produced and transmitted in young MSM, which shows an increasing trend year by year. There is a large active transmission cluster required major attention and effective intervention to prevent further expansion. At the same time, the occurrence and transmission of URFs should be continuously monitored to understand the clusters and drug resistance dynamics.

Objective:To investigate the effects of educational level on smoking cessation in patients with moderate to severe tobacco dependence, explore effective individualized smoking cessation methods, and increase smoking cessation rate.Methods:A total of 480 patients with moderate to severe tobacco dependence who were willing to quit smoking and received treatment in the Department of Respiratory and Critical Care Medicine, Shengli Oilfield Central Hospital from January to December 2020 were included in this study. They were divided into four groups ( n = 120/group) according to their educational level: group A (elementary school and below), group B (junior high school and senior high school), group C (technical secondary school or college), and group D (university and above). All patients were randomly assigned to undergo "5A" intervention alone or "5A" intervention combined with varenicline intervention (combined intervention). Patients' awareness of the health risks of tobacco smoking was compared among the four groups. The smoking cessation rate measured at different time points was compared between different intervention strategies. Results:The scores of health risk of tobacco smoking in groups D, C, B, and A were (806.5 ± 35.7) points, (710.8 ± 26.2) points, (643.6 ± 43.4) points, and (512.4 ± 30.1) points, respectively. Patients with high education levels had high awareness of the health risk of tobacco smoking ( F = 1 543.26, P < 0.001). At 1, 3, and 6 months, the smoking cessation rate of combined intervention was higher than that of "5A" intervention alone in each group (group A: χ2 = 3.85, 4.23, 4.10, group B: χ2 = 4.30, 4.09, 4.60, group C: χ2 = 6.81, 4.30, 4.03, group D: χ2 = 6.71, 6.51, 4.73, all P < 0.05). The smoking cessation rate after 6 months of "5A" intervention alone or combined intervention in group D was 60.0% and 78.3% respectively, which were significantly higher than 41.7% and 60.0% in group C, 23.3% and 41.7% in group B, and 20.0% and 36.7% in group A ( χ2 = 26.59, 26.12, both P < 0.001). At different time points, the smoking cessation rates of the "5A" intervention alone in group D were significantly higher than those of combined intervention in groups A and B ( χ2 = 9.25, 25.04, 7.29, all P < 0.05). Conclusion:Awareness of the health risks of tobacco smoking is related to a patient's educational level, and affects smoking cessation. Individualized smoking cessation interventions based on a patient's educational level can increase the rate of smoking cessation.

Objective:To study the clinical characteristics of patients with difficulty in decannulation after a tracheotomy in a neurological intensive care unit.Methods:A total of 122 patients undergoing tracheotomy were divided into a decannulation success group ( n=73) and a difficult decannulation group ( n=49). The Full Outline of Unresponsiveness (FOUR) and the revised version of the Coma Recovery Scale (CRS-R) were used to assess the consciousness of those in both groups. Their swallowing ability, airway anatomy, secretion retention and aspiration were documented using the Functional Oral Intake Scale (FOIS), fiberoptic endoscopic examination, Marianjoy′s 5-point secretion severity scale and the penetration-aspiration scale (PAS). Univariate analysis and multiva-riate logistic regression analysis were conducted to isolate risk factors. Results:The univariate analysis showed that age, status of consciousness, swallowing ability, secretion retention, aspiration and opening of the glottis may be indicators of difficult decannulation after a tracheotomy among those with severe neurological diseases. The logistic regression analysis found that too much retention of pharyngeal secretions and insufficient opening of the glottis should also be treated as risk factors for difficult decannulation with such patients.Conclusions:Too much retention of pharyngeal secretions and poor opening of the glottis are independent risk factors for difficult decannulation after a tracheotomy. Endoscopic examination can play an important role in the prediction and treatment of difficult decannulation.