Objective: To investigate the status of regular HIV testing and post exposure prophylaxis (PEP) behaviors among men who have sex with men (MSM) in Lishui City, Zhejiang Province, so as to provide the reference for developing targeted intervention strategies. Methods: A total of 389 MSM were selected from Lishui City by convenient sampling method from April to August 2022, and demographic information, sexual behaviors, HIV testing and PEP behaviors were collected through questionnaire surveys. MSM were clustered using two step clustering analysis, and regular HIV testing and PEP behaviors among different groups of MSM were compared. Factors affecting regular HIV testing and PEP behaviors were evaluated using a multivariable logistic regression model. Results: The MSM surveyed had a median age of 31.00 (interquartile range, 16.00) years. There were 146 MSM undergoing regular HIV testing, accounting for 37.53%, and 47 MSM receiving PEP, accounting for 12.08%. MSM were divided into two groups. There were 28.05% of MSM with regular HIV testing in group 1, which was lower than the 44.44% in group 2; and 22.56% receiving PEP, which was higher than the 4.44% in group 2 (both P<0.05). Multivariable logistic regression analysis identified age (OR=1.030, 95%CI: 1.011-1.050), sexual roles (both receptive and insertive, OR=2.999, 95%CI: 1.732-5.194) and homosexual behaviors in the past 6 months (use condoms every time, OR=4.567, 95%CI: 2.593-8.044) as factors affecting regular HIV testing among MSM; age (OR=0.970, 95%CI: 0.942-0.999), sexual orientation (OR=0.292, 95%CI: 0.139-0.612) and homosexual behaviors in the past 6 months (not use condoms, OR=0.135, 95%CI: 0.040-0.460; use condoms every time, OR=0.076, 95%CI: 0.018-0.326) as factors affecting PEP behaviors among MSM. Conclusion MSM with different characteristics of sexual behaviors have different preferences for HIV regular testing and PEP, with homosexual behaviors in the past 6 months, sexual roles and sexual orientation being the main influencing factors.

Objective To conduct an epidemiological survey of common congenital heart disease(CHD)among children in ethnic minority areas in southeastern Guizhou and to explore the influencing factors of delayed medical treatment.Methods From January 2019 to July 2022,18 850 children aged 3 months to 14 years in Qiandongnan Miao and Dong Autonomous Prefecture were selected;105 children with CHD were included in the training set,and they were divided into delayed group(80 cases)and non-delayed group(25 cases)according to whether or not to delay medical treatment.In addition,children with CHD(35 cases)from July 2022 to December 2022 were included in the validation set.The general data of the subjects in the two groups were compared and ana-lyzed.Multivariate logistic regression was performed and risk scoring model was constructed.Results The preva-lence of CHD in 18 850 children was 5.57‰(105/18 850),with the highest prevalence in Liping County,and the lowest in Huangping County.The proportion of children with secondary atrial septal defect was the highest,and that of the aortic valve malformation was the lowest.Among the complex cases of CHD,the proportion of children with single type was the highest,and that of children with three or more types were the lowest.Among children with CHD,the rate of delayed medical treatment was 76.19% (80/105).The median delay in medical treatment was 12 months,with an average of(18.78±4.77)months.Multifactor logistic regression analysis showed that heart murmur(level 2～3),less-educated(primary and secondary school)guardian,family per capita income<2 000 yuan,and frequent drinking of the guardian were independent risk factors for delayed medical treatment(P<0.05),and commercial settlement of medical expenses was independent protective factor(P<0.05).Risk scoring model divided the children into three groups:low risk(≤80 points),medium risk(>80 points and≤134 points)and high(>134 points)risk group.The evaluation of the model show that it was accurate,effective,safe,and reliable.Conclusion The highest prevalence is observed in Liping County.The proportion of children with secondary atrial septal defect and the proportion of children with single type are the highest.Delayed medical treat-ment is found in most of the children with CHD.Cardiac murmur,education background of the guardian,per capita family income,guardian alcohol consumption,and medical expense settlement method are all independent influencing factors for delayed medical treatment.

Objective To investigate the relationship of the expression levels of serum miR-140 and miR-211 in elderly patients with coronary heart disease(CHD)and collateral circulation forma-tion.Methods A total of 151 CHD elderly patients undergoing surgical treatment in our hospital were included as the study subjects,and were divided into non-collateral circulation group(100 cases)and collateral circulation group(51 cases)according to the presence or absence of collateral circulation.RT-qPCR was applied to detect the expression levels of miR-140 and miR-211 in the serum.Results Larger proportions of culprit coronary artery＞3 branches and stenosis ≥75％and higher serum miR-211 level,but lower miR-140 level were observed in the non-collateral cir-culation group than the collateral circulation group(P＜0.01).The number of coronary artery lesions and the severity of coronary artery stenosis were negatively correlated with serum miR-140 level(r=-0.546,P＜0.01;r=-0.562,P＜0.01),and positively with miR-211 level(r=0.539,P＜0.01;r=0.528,P＜0.01).Multivariate logistic regression analysis indicated that miR-140 was a protective factor while miR-211 was an independent risk factor for collateral circulation formation in elderly CHD patients(P＜0.01).The area under the curve of the two indicators com-bined together in predicting collateral circulation formation was 0.896(95％CI:0.834-0.938,P＜0.05).Conclusion Serum miR-140 and miR-211 are both influencing factors for collateral cir-culation formation,and their combination has high predictive value for the formation.

Objective:To compare the recovery effect of continuous infusion of dexmedetomidine combined with oxycodone or sufentanil in the anesthesia intensive care unit (AICU) in elderly patients after thoracoscopic radical surgery for lung cancer.Methods:Using the method of prospective study, 80 elderly lung cancer patients underwent selective thoracoscopic radical surgery under general anesthesia in Nanjing First Hospital from February 2021 to May 2022 were selected. The patients were divided into dexmedetomidine combined with sufentanil group (S group) and dexmedetomidine combined with oxycodone group (Q group) by random digits table method with 40 cases each group. On the basis of routine monitoring and treatment after operation, the patients in Q group were continuously injected with oxycodone 0.03 mg/(kg·h) and dexmedetomidine 0.4 μg/(kg·h) through analgesia pump, the patients in S group were continuously injected with sufentanil 0.03 mg/(kg·h) and dexmedetomidine 0.4 μg/(kg·h) through analgesia pump. The wake-up time, extubation time, awakening quality (Aldrete score and bucking score) and comfort level (Bruggrmann comfort scale score, BCS score) after entering the AICU were record; the sedation score (Ramsay score) and pain relief score (numerical rating scale score, NRS score) and hemodynamic changes (mean arterial pressure and heart rate) 3, 5, 7, 10 and 14 h after entering the AICU were record; the level of serum inflammatory factors, including tumor necrosis factor (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) immediately, 5 h and 14 h after entering the AICU; press times of analgesia pump, adverse events, bleeding volume of drainage tube during AICU and overall satisfaction score when leaving the AICU were record.Results:The bucking score in Q group was significantly lower than that in S group: (1.02 ± 0.77) scores vs. (1.88 ± 0.34) scores, the Aldrete score and BCS score were significantly higher than those in S group: (8.93 ± 0.25) scores vs. (5.97 ± 0.32) scores and (3.03 ± 0.32) scores vs. (0.93 ± 0.52) scores, and there were statistical differences ( P<0.01); there were no statistical difference in wake-up time and extubation time between two groups ( P>0.05). There were no statistical difference Ramassy score, NRS score 3 and 5 h after entering the AICU, mean arterial pressure and heart rate between two groups ( P>0.05); the Ramassy score 7, 10 and 14 h after entering the AICU in Q group was significantly lower than that in S group, the NRS score, mean arterial pressure and heart rate were significantly lower than those in S group, and there were statistical differences ( P<0.01). There were no statistical differences in TNF-α, IL-6 and CRP immediately after entering the AICU between two groups ( P>0.05); the TNF-α, IL-6 and CRP 5 and 14 h after entering the AICU in Q group were significantly lower than those in S group, and there were statistical difference ( P<0.01). The press times of analgesia pump, bleeding volume of drainage tube and the incidences of nausea vomiting, respiratory depression, lethargy, restlessness, fever and lung infection in Q group were significantly lower than those in S group: (4.63 ± 1.10) times vs. (18.80 ± 1.54) times, (129.67 ± 4.14) ml vs. (164.00 ± 8.14) ml, 10.0% (4/40) vs. 52.5% (21/40), 2.5% (1/40) vs. 25.0% (10/40), 7.5% (3/40) vs. 47.5% (19/40), 0 vs. 20.0% (8/40), 2.5% (1/40) vs. 22.5% (9/40) and 2.5% (1/40) vs. 20.0% (8/40), and there were statistical differences ( P<0.01 or <0.05); there was no severe hypotension, severe bradycardia and delirium in both groups. The overall satisfaction score in Q group was significantly higher than that in S group: (3.53 ± 0.63) scores vs. (2.70 ± 0.65) scores, and there was statistical difference ( P<0.01). Conclusions:Continuous micro-pump infusion of dexmedetomidine combined with oxycodone in AICU elderly patients with lung cancer after thoracoscopic radical surgery can significantly improve the quality of recovery and comfort during extubation, without affecting the extubation time, and can effectively reduce the degree of pain, stress and inflammatory reaction in the early recovery period, and reduce the incidence of adverse events after surgery.

OBJECTIVE: To explore the genetic basis for a fetus with structural brain abnormalities. METHODS: The karyotypes of the fetus and its parents were analyzed by conventional G-banding. Chromosome microarray analysis (CMA) was carried out to detect chromosomal microdeletion and microduplication. RESULTS: No kartotypic abnormality was detected in the fetus and its parents. CMA has identified a 194 kb microduplication at Xq25 in the fetus, which encompassed exons 4-35 of the STAG2 gene and was derived from its mother. CONCLUSION The Xq25 duplication encompassing part of the STAG2 gene probably underlay the brain malformation in the fetus.
Chromosome Banding ; Female ; Fetus ; Genetic Testing ; Humans ; Karyotyping ; Pregnancy ; Prenatal Diagnosis

Objective:To explore the application value of chromosome karyotype analysis, chromosomal microarray analysis (CMA) and whole exome sequencing (WES) in prenatal diagnosis of isolated corpus callosum abnormality (CCA) fetus.Methods:Fetuses diagnosed with isolated CCA by ultrasound and MRI and receiving invasive prenatal diagnosis in Guangzhou Women and Children′s Medical Center and Qingyuan People′s Hospital from January 2010 to April 2021 were selected. Karyotype analysis and/or CMA [or copy number variation sequencing (CNV-seq)] were performed on all fetal samples, and WES was performed on fetal samples and their parents whose karyotype analysis and/or CMA (or CNV-seq) results were not abnormal.Results:Among 65 fetuses with isolated CCA, 38 cases underwent karyotype analysis, and 3 cases were detected with abnormal karyotypes, with a detection rate of 8% (3/38). A total of 49 fetuses with isolated CCA underwent CMA (or CNV-seq) detection, and 6 cases of pathogenic CNV were detected, the detection rate was 12% (6/49). Among them, the karyotype analysis results were abnormal, and the detection rate of further CMA detection was 1/1. The karyotype results were normal, and the detection rate of further CMA (or CNV-seq) detection was 14% (3/21). The detection rate of CMA as the first-line detection technique was 7% (2/27). A total of 25 fetuses with isolated CCA with negative results of karyotyping and/or CMA were tested by WES, and 9 cases (36%, 9/25) were detected with pathogenic genes. The gradient genetic diagnosis of chromosomal karyotyping, CMA and WES resulted in a definite genetic diagnosis of 26% (17/65) of isolated CCA fetuses.Conclusions:Prenatal genetic diagnosis of isolated CCA fetuses is of great clinical significance. The detection rate of CMA is higher than that of traditional karyotyping. CMA detection could be used as a first-line detection technique for fetuses with isolated CCA. WES could increase the pathogenicity detection rate of fetuses with isolated CCA when karyotype analysis and/or CMA test results are negative.

Objective:To understand the molecular transmission characteristics of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome(AIDS) patients in the mountainous area of southwest Zhejiang Province(Lishui city).Methods:A total of 147 blood samples were collected from newly-diagnosed HIV-1 infected who received no antiviral therapy, and pol gene was amplified, followed by sequencing. MEGA6.0 software was used to construct phylogenetic tree and determine gene subtypes. HIVDB online was used to analyze drug resistance mutation, then the pairwise genetic distance(GD) was calculated and the opitimal threshold of GD was selected, finally the molecular transmission network was constructed by Cytoscape3.7.0 software. Chi-square or Fisher′s exact probability method was used for statistical analysis. Results:A total of 134 sequences were obtained successfully, and nine subtypes were detected. The dominant subtypes were CRF08_BC (34.33%, 46/134), CRF01_AE (29.85%, 40/134) and CRF07_BC (23.88%, 32/134). It also found that age, registered residence, education level and transmission route had significant differences in distribution of subtypes ( P<0.05). Nineteen drug resistance individuals were found, and the total drug resistance rate was 14.18% (19/134). The HIV-1 molecular transmission network was plotted based on 1.2% GD threshold. A total of 15 transmission clusters (cluster size ranging from 2 to 29) were found. The network access rate was 49.25% (66/134), mainly including male (75.76%, 50/66), heterosexual (81.82%, 54/66) and patientsrinfected with CRF08_ BC (50.00%, 33/66). A transmission cluster including two cases of female sex workers and seven cases of drug resistance was identified, in which the average age of the patients was 57.21 years old and the average degree value was 22.7, and the cases were mainly infected through heterosexual contact (96.55%, 28/29). The highest homology of the sequences in the cluster was in Yunnan. Conclusions:The HIV-1 subtypes were diverse in the mountainous area of southwest Zhejiang Province(Lishui city). Drug resistant transmission had reached a moderate epidemic level. There were molecular transmission clusters with the aggregation characteristics of elderly clients in specific regions. It was urgent to formulate and implement precise intervention strategies to curb the spread of HIV.

Objective:To explore the effects of empathic nursing combined with therapeutic communication on self-burden, negative emotions and coping styles in elderly inpatients with coronary heart disease.Methods:Using the convenient sampling, a total of 135 elderly patients with coronary heart disease who were admitted to Second Hospital of Shanxi Medical University from February 2020 to May 2021 were selected as the research objects. The patients were divided into the observation group ( n=67) and the control group ( n=68) by the random number table method. The control group was given empathy nursing and routine psychological intervention, while the observation group was given empathy nursing combined with therapeutic communication intervention. Self Perceived Burden Scale (SPBS) , Self-Rating Anxiety Scale (SAS) , Self-Rating Depression Scale (SDS) and Medical Coping Modes Questionnaire (MCMQ) were used to evaluate self-burden, negative emotions and coping styles of patients before and after intervention. Results:After the intervention, scores of SPBS, SAS and SDS of the observation group were lower than those of the control group, and the differences were statistically significant ( P<0.05) . The face dimension score in the MCMQ of the observation group was higher than that of the control group, and the avoidance and yield dimension scores were lower than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Empathy nursing combined with therapeutic communication in elderly inpatients with coronary heart disease can help relieve the patients' sense of self-burden and improve negative emotions and coping styles, which has high application values.

Objective:To explore the effect of behavioral training of creative art therapy(CAT) on interpersonal communication in teenagers.Methods:Eighty teenagers were randomly divided into study group( n=40) and control group( n=40).The study group was received the behavioral training of CAT (12 times, each activity lasts for 120 min), and the control group did not take part in the behavioral training of CAT.The two groups were measured with self-esteem scale(SES), shyness scale(SS) and social anxiety scale for children(SASC) before and after behavior training.SPSS 17.0 software was used for statistical analysis, and t-test variance analysis and Mann-Whitney U test were used to compare the differences between groups or within groups. Results:Before and after behavioral training, changes in the SES total score (7.00(5.00, 9.75) vs 1.00(0, 2.00)), the SS total score (7.00(6.00, 12.75) vs 2.00(1.00, 3.00)), the SASC total score (5.00(2.00, 8.75) vs 0(0, 1.00)) and two factor scores (3.00(0.25, 5.00) vs 1.00(0, 1.00), 2.00(1.00, 4.00) vs 0(0, 1.00))in the study group were obviously higher than those in the control group( Z=-7.347, -7.338, -5.841, -4.122 and -5.393, all P<0.05).The score differences of the SASC total score ((7.19±3.82) vs (3.21±3.04)) and two factor scores ((4.00±2.23) vs (1.68±2.05), 3.00 (1.00, 5.00) vs 2.00 (0, 2.00)) of girls were significantly higher than those of boys in the study group ( t=-3.611, -3.398, Z=-2.111, P=0.001, 0.002, 0.035). Conclusion:Behavioral training of CAT can improve teenagers' self-esteem, relieve their shyness and social anxiety, as well as promote their interpersonal communication.

OBJECTIVE: To assess the value of chromosomal microarray analysis (CMA) for fetal duodenal obstruction (DO). METHODS: Fifty-one fetuses with DO identified by prenatal ultrasound were divided into DO only group and DO with other anomaly group. CMA was carried out on amniotic fluid or umbilical blood samples, and the outcome of pregnancy of all cases were followed up. RESULTS: Eight fetuses (15.7%) were found with genomic abnormalities, which included 3 chromosomal aneuploidies and 5 copy number variations (CNVs), including one 17q12 microduplication syndrome, one 13q21.33q31.1 microdeletion, one 13q21.32q22.3 deletion, one 13q21.2q31.1 deletion and one 1q43q44 duplication. EDNRB from 13q and HNF1B from 17q12 are candidate genes for fetal DO. No significant difference was found in the detection rate of pathogenic CNVs between the DO only and DO with other anomaly groups (9.5% vs.11.1%, P> 0.05). There were 39 live borns, 1 stillbirth, and 11 artificial abortions (8 with abnormal CMA results). CONCLUSION There is a correlation between fetal DO and abnormal copy number of the genome, for which prenatal diagnosis is necessary. CMA not only can detect microdeletions/microduplications, but also identify pathogenic genes, which can facilitate prenatal diagnosis, genetic counseling and prognosis for the fetus.
Chromosome Aberrations ; DNA Copy Number Variations ; Duodenal Obstruction/genetics* ; Female ; Fetus ; Humans ; Microarray Analysis ; Pregnancy ; Prenatal Diagnosis