Epidemiology of maternal morbidity and mortality

Maternal morbidity and mortality remains a significant health care concern in the United States, as the rates continue to rise despite efforts to improve maternal health. In 2013, the United States ranked 60th in maternal mortality worldwide. We review the definitions, rates, trends, and top causes of severe maternal morbidity and mortality, as well as risk factors for adverse maternal outcomes. We describe current local and national initiatives in place to reduce maternal morbidity and mortality and offer suggestions for future research.     

Anal human papillomavirus infections in young unvaccinated men who have sex with men attending a sexual health clinic for HPV vaccination in Melbourne,Australia

The Victorian Government introduced a time-limited quadrivalent human papillomavirus (HPV) vaccination catch-up program targeting gay and bisexual men who have sex with men (MSM) aged up to 26 years in 2017. As of 2017, men aged ≥20 years were not eligible for the school-based HPV vaccination program. This study examined the prevalence of anal HPV among 496 MSM aged 20–26 years before they received the first dose of the HPV vaccine at the Melbourne Sexual Health Centre, Australia. More than half (56.5%) had any high-risk HPV genotypes detected in the anus. Almost half (43.1%) had at least one quadrivalent HPV vaccine-preventable genotype (6, 11, 16 or 18) and one-fifth (21.0%) had HPV 16 detected in the anus. These findings suggest that a targeted catch-up HPV vaccination program for MSM is still beneficial to protect against high-risk HPV genotypes associated with anal cancer, as well as low-risk HPV genotypes.     

细粒棘球蚴AgB亚单位基因的联合表达和血清学评价

目的为进一步提高AgB抗原在诊断中的敏感性和特异性,将细粒棘球蚴AgB1和AgB2两个亚单位基因在同一载体中进行联合表达,并对联合表达的重组抗原和单基因表达的AgB1、AgB2在血清抗体检测中的差异进行比较研究。方法在表达载体PET32a中构建AgB1＋AgB2（AgBs）联合基因的重组质粒,用ELISA检测重组抗原与病人血清的反应性。结果构建了AgBs重组质粒,经测序证实插入的联合基因片段序列正确。AgBs重组质粒表达的融合蛋白分子量为38kDa,为不溶性蛋白。联合表达抗原AgBs对细粒棘球蚴病（CE）血清的敏感性为84．4％,特异性为80．5％;单基因表达的AgB1和AgB2的敏感性分别为75．6％和57．8％,特异性分别为72．6％和91．2％。结论成功构建了AgB亚单位联合表达基因,联合表达的AgBs抗原对CE血清的诊断价值优于单基因表达的AgB1或AgB2抗原。     

Influenza and pneumococcal vaccination as a model to assess C-reactive protein response to mild inflammation

This study was set up to examine whether an influenza vaccine or an influenza vaccine in combination with pneumococcal vaccine can be used as a model to study responses to mild stimulation of the inflammatory system.In this study, 19 subjects received the influenza vaccine, 20 subjects the combination of influenza and pneumococcal vaccine. CRP and prothrombin fragment 1 and 2 (F1 + 2) were measured at baseline, and two times after vaccination. Influenza vaccination increased CRP by 0.20 mg/L, and influenza in combination with pneumococcal vaccine increased CRP by 0.60 mg/L. F1 + 2 increased 0.15 nmol/L after the combined vaccination; an increase in response to the influenza vaccination was not statistically significant.Our findings show that the influenza vaccine alone as well as the combination of the influenza and pneumococcal vaccine increases CRP-levels with a peak 2 days after vaccination.     

用合成多肽分析细粒棘球蚴AgB抗原亚单位的反应性表位

目的通过合成多肽分析细粒棘球蚴AgB1、AgB2和AgB4等3个亚单位抗原的主要反应性表位区域。方法用ELISA法分析来源于细粒棘球蚴AgB1、AgB2和AgB4亚单位基因序列的5个人工合成多肽KK36、RK30、B4-1、B4-2和B4-3,及上述3个亚单位重组抗原在血清抗体检测中的反应性,共检测细粒棘球蚴病(115例)、多房棘球蚴病(54例)、囊尾蚴病(22例)患者和健康人(18例)血清209份。用受试者工作特征(ROC)曲线分析合成多肽和重组抗原在血清检测中的诊断效率。结果多肽KK36和RK30诊断细粒棘球蚴病的敏感性分别为89.2%和85.0%,特异性为62.5%和59.4%,诊断效率分别为84.8%和80.4%,与AgB1(84.5%)和AgB2(81.2%)抗原诊断效率相近,拟合AgB1和AgB2重组抗原的ROC曲线。来源于AgB4抗原的3个多肽B4-1、B4-2和B4-3检测细粒棘球蚴病患者血清的诊断效率分别为49.4%、57.9%和77.4%。其中,B4-3的反应性最佳,B4-2也有一定的反应性。结论 KK36和RK30完整地包含了AgB1和AgB2抗原的反应性表位区域。B4-2和B4-3多肽...     

棘球蚴AgB抗原家族基因的克隆及抗原表位的预测分析

目的对棘球蚴AgB抗原家族的不同亚单位基因进行克隆,并对序列进行生物信息学分析和抗原表位预测分析。方法根据GenBank中的参考序列设计特异性引物,以我国新疆、甘肃和四川来源的细粒棘球蚴(Eg)和多房棘球蚴(Em)虫体DNA为模板扩增目的基因,将PCR产物克隆到TA载体中测序。用Bioedit分析软件和Blastn、NPS@和IEDB等在线分析系统对序列进行分析。结果分别从细粒棘球蚴和多房棘球蚴中克隆获得AgB抗原的全部5个亚单位基因,经测序确定为正确的目的序列;序列比对分析表明,EmAgB的5个亚单位基因序列高度保守,而EgAgB的亚单位基因变异性较大。细粒棘球蚴和多房棘球蚴种间差异分析显示,相同亚单位基因的序列一致性为87.69%～100%。AgB各亚单位抗原主要的二级结构包括α-螺旋、β-折叠和无规卷曲等3个类型。其中,AgB1、AgB2和AgB4等3个亚单位抗原中无规卷曲所占比例较高。AgB各亚单位抗原预测表位区共10个,分别是AgB1:1～7和21～27,AgB2:1～7和29～36,AgB3:1～11和18～28,AgB4:1～13、27～37和39～60,AgB5:1～11。结论 EgAgB和EmAgB亚单位抗原表位区的大部分序列一致或相似,预测的10个表位区主要位于序列N端。在5个亚单位抗原中,AgB1、AgB2和AgB4的抗原性较高。     

细粒棘球蚴AgB亚单位基因的联合表达和血清学评价

目的为进一步提高AgB抗原在诊断中的敏感性和特异性,将细粒棘球蚴AgB1和AgB2两个亚单位基因在同一载体中进行联合表达,并对联合表达的重组抗原和单基因表达的AgB1、AgB2在血清抗体检测中的差异进行比较研究。方法在表达载体PET32a中构建AgB1+AgB2(AgBs)联合基因的重组质粒,用ELISA检测重组抗原与病人血清的反应性。结果构建了AgBs重组质粒,经测序证实插入的联合基因片段序列正确。AgBs重组质粒表达的融合蛋白分子量为38kDa,为不溶性蛋白。联合表达抗原AgBs对细粒棘球蚴病(CE)血清的敏感性为84.4%,特异性为80.5%;单基因表达的AgB1和AgB2的敏感性分别为75.6%和57.8%,特异性分别为72.6%和91.2%。结论成功构建了AgB亚单位联合表达基因,联合表达的AgBs抗原对CE血清的诊断价值优于单基因表达的AgB1或AgB2抗原。     

Trends in maternal mortality in the United States

Maternal mortality is a major global concern. Although a notable decline in maternal mortality in the United States occurred during the mid-20th century, this progress stalled during the late 20th century. Furthermore, maternal mortality rates have increased during the early 21st century. Around the year 2000 the maternal mortality rate began to rise and has since nearly doubled. Given that at least half of maternal deaths in the U.S. are preventable, the rise in maternal deaths in the U.S. is historic and worrisome. This overview will try to provide a context for understanding the problem of this rise in maternal mortality in the U.S. by briefly discussing how maternal mortality rates are reported from National Vital Statistics data and from a National Surveillance system. Trends and causes of maternal deaths and the difficulty with interpreting these trends will be discussed.     

Response to hepatitis B vaccination is co-determined by HLA-DPA1 and -DPB1

Background and aimsNo report explored the combined effects of HLA-DPA1 and -DPB1 with long-term response to hepatitis B (HB) vaccination (HBVac). The specific aims of the study were to assess the combined effects and relative contributions of DPA1 and DPB1 genes.MethodsThe cases were 152 adolescents who had undetectable (<1.0 mIU/mL) post-booster anti-HBs titers and the controls were adolescents who had residual anti-HBs ≥ 10 mIU/mL at aged 16 years (n = 207) or had detectable (≥1.0 mIU/mL) anti-HBs titers after booster HBVac (n = 481). HLA-DPA1 and -DPB1 genotypes were determined by sequence-based typing.ResultsHLA-DPA1*01:03:01 was correlated with lower ORs of undetectable anti-HBs titers, while -DPA1*02:02:02 and -DPB1*05:01:01 were correlated with higher ORs. The ORs for HLA-DPA1*01:03:01-DPB1*05:01:01 and DPA1*02:02:02-DPB1*protective combinatory types were significantly less than 1.0. As compared with subjects who had no protective allele, the adjusted ORs (95% CI) were 0.545 (0.328–0.906), 0.350 (0.174–0.702), and 0.122 (0.058–0.257), for subjects who had protective alleles on DPA1only, DPB1 only, and both genes, respectively. Analyses of amino acid polymorphisms showed that subjects who carried Arg81-Pro158-Val191-Pro259α + Met234β and Gln62-Arg82α + Met234β combinations had 4.3-to-4.6 folds of risks.ConclusionBoth DPA1 and DPB1 genes contribute to the persistence of immunological response to primary infantile HBVac. The effects of HLA-DP risk alleles were dominated by the protective alleles and there were significant gene-gene interactions. Our findings provide evidences for the design of more potent HB vaccine.     

上海市成年人健康期望寿命测算研究

目的 评价上海市居民健康状况,测算健康期望寿命,分析影响居民健康相关因素,为卫生决策提供有力的信息和依据。方法 采用多阶段分层随机抽样方法随机抽取上海市≥18岁户籍居民作为调查对象,采用WHO在世界健康调查中使用的自评健康调查问卷,进行居民自评健康状况调查。应用CHOHT模型校正自评健康调查数据,获得人群自报伤残测度,结合上海市居民出生、死亡和人口资料编制人口寿命表计算期望寿命,采用Sullivan法测算居民健康期望寿命。结果 2017年上海市≥18岁成年人自评伤残测度为0.25,女性（0.28）高于男性（0.23）;≥18岁成年人期望寿命为65.76岁,女性（68.22岁）高于男性（63.39岁）;≥18岁成年人健康期望寿命为47.99岁,男性（49.05岁）高于女性（47.14岁）;健康期望寿命在期望寿命中的比例随年龄增加逐渐降低,18岁组居民健康期望寿命占期望寿命比例为72.97%,至85岁组仅为39.00%。结论 上海市成年人男性健康水平高于女性,随着年龄增加健康期望寿命损失占期望寿命的比例越来越高。应重视提高女性、老龄等人群的生存质量,提升对影响居民寿命质量的慢性病等重大疾病防控,加强重点人群的长期照护及健康支持体系,提升居民健康水平和生活质量。