24例感染HIV孕产妇的母婴阻断措施应用研究

目的 了解孕产妇艾滋病病毒(HIV)感染状况,探索一条减少HIV母婴传播的有效途径.方法 为孕产妇提供免费咨询及HIV检测,对有生育意愿的HIV阳性孕妇采取综合性HIV母婴阻断措施.结果 为14 833名孕产妇提供免费咨询,咨询率为84.80%;为愿意接受免费检测服务的12 407名孕产妇提供HIV抗体检测,检测率70.93%,发现HIV阳性孕产妇24例,阳性率为0.19%;16名孕妇完成妊娠并产下16名婴儿,经综合性母婴阻断措施,16名婴儿HIV-DNA期诊断结果:15名为阴性,1名为阳性.结论 艾滋病病毒(HIV)可以在妇女妊娠、分娩或产后母乳喂养的过程中由感染孕、产妇传播给胎、婴儿;在儿童的HIV感染中,90%以上的感染是经母婴传播获得;采取综合性母婴阻断措施,能有效预防新生儿HIV感染.     

深圳市孕产妇人群中AIDS流行情况及母婴传播的预防与控制

目的 了解深圳市孕产妇人群中艾滋病(AIDS)流行率及艾滋病病毒(HIV)母婴垂直传播发生率。以及通过采取综合性预防策略降低母婴传播的发生率。方法 对所有产前保健检查的孕妇，在首诊时进行自愿咨询和免费HIV抗体筛查；对HIV抗体阳性的孕产妇实施综合性干预；应用逆转录．聚合酶链式反应(RT-PCR)、套式PCR和基因芯片技术对其新生儿的HIV感染状况进行早期诊断。结果 2001～2003年4月，分别有8021、69976、23413名孕产妇接受了AIDS自愿咨询检测，分别发现2、10、4例HIV感染者，发生率分别为2．49/万、1．43/万、1．71/万。16名HIV感染孕产妇中，经性接触传播占81．3％(13／16)，经血液传播占18．7％；有3人其配偶为HIV抗体阳性。4名孕妇终止妊娠(25．0％)，6名产妇接受产后干预(37．5％)，失访2名，转外地1名。2名接受综合性干预后分娩，1名正接受随访和干预；1例新生儿证实为垂直传播感染(1／8，12．5％)。结论 通过对孕产妇人群提供AIDS自愿咨询检测服务和对该人群中的HIV感染者采取综合性干预措施，可有效防止和降低HIV母婴传播的发生率，提示将健康教育、行为干预和婚前咨询检查与母婴传播预防控制策略相结合，可取得良好的防制效果。     

2009-2020年丽水市孕产妇HIV感染情况调查及母婴传播干预效果分析北大核心CSCD

目的了解丽水市孕产妇HIV感染情况调查,分析艾滋病母婴传播人工阻断干预效果,为母婴HIV感染的防治提供科学依据。方法采用回顾性调查的方法对2009-2020年丽水市孕产妇HIV感染情况及阳性产妇所产婴儿的妊娠结局开展调查,对所有艾滋病阳性孕产妇采取综合性母婴传播阻断措施,并对所生婴儿开展长期随访。结果 2009-2020年孕产妇HIV抗体检测率为99.36%(276791/278560),HIV孕产感染阳性率为0.030%(84/278560)。已分娩孕产妇孕期阻断用药率79.31%(46/58)。活产新生儿人工喂养率91.5%(54/59),预防性抗病毒用药率91.5%(54/59)。40例满18个月儿童HIV抗体检测全部为阴性,长期阻断效果成功率100%。结论丽水市采取的艾滋病母婴传播阻断长期干预措施,简单易操作,效果显著。需加强孕产妇孕早期HIV抗体检测和预防性阻断用药,及早干预和阻断艾滋病母婴传播。     

2009-2020年丽水市孕产妇HIV感染情况调查及母婴传播干预效果分析

目的了解丽水市孕产妇HIV感染情况调查,分析艾滋病母婴传播人工阻断干预效果,为母婴HIV感染的防治提供科学依据。方法采用回顾性调查的方法对2009-2020年丽水市孕产妇HIV感染情况及阳性产妇所产婴儿的妊娠结局开展调查,对所有艾滋病阳性孕产妇采取综合性母婴传播阻断措施,并对所生婴儿开展长期随访。结果 2009-2020年孕产妇HIV抗体检测率为99.36%(276791/278560),HIV孕产感染阳性率为0.030%(84/278560)。已分娩孕产妇孕期阻断用药率79.31%(46/58)。活产新生儿人工喂养率91.5%(54/59),预防性抗病毒用药率91.5%(54/59)。40例满18个月儿童HIV抗体检测全部为阴性,长期阻断效果成功率100%。结论丽水市采取的艾滋病母婴传播阻断长期干预措施,简单易操作,效果显著。需加强孕产妇孕早期HIV抗体检测和预防性阻断用药,及早干预和阻断艾滋病母婴传播。     

临翔区90例接受HIV母婴阻断治疗的孕产妇基本情况分析

目的探讨艾滋病病毒(HIV)感染因素,为阻断艾滋病母婴传播工作提供依据。方法对全区范围内所有孕产妇采取自愿咨询和HIV抗体检测,对每个自愿进行HIV抗体检测的孕产妇进行面对面的咨询调查,并收集整理2003年11月至2007年3月,90例HIV阳性孕产妇的资料。结果HIV阳性孕产妇主要是一些知识层次较低,生活贫困的人。90例阳性孕产妇HIV感染的主要因素是性传播、吸毒及输血。结论建立区、乡、村三级监测网络,对阳性孕产妇实施预防性干预措施,进行艾滋病母婴阻断服务,可以有效地遏制艾滋病的流行和蔓延。     

不同干预措施预防艾滋病母婴传播的效果研究

目的分析河南省对艾滋病病毒(HIV)感染孕产妇,采用不同干预措施预防母婴传播的效果。方法采用随访研究的方法,利用国家预防母婴传播干预(PMTCT)管理信息网络直报系统,以2004年1月至2012年12月确诊报告的863例HIV-1感染孕产妇及其所分娩的婴儿为研究对象,收集和整理孕产妇接受抗反转录病毒药物、安全助产和婴儿喂养指导等预防艾滋病母婴传播干预措施的实施服务情况,收集HIV感染孕产妇定期随访和婴儿的检测信息,掌握婴儿的HIV感染状态,分析干预措施对HIV母婴传播效果的影响。结果 HIV感染孕产妇所生的863名婴幼儿中,有47名感染HIV,艾滋病母婴传播率为5.45%。对不同方案的药物干预措施进行比较,联合、单一和未应用抗病毒药物的孕产妇,其母婴传播率分别为2.02%、3.16%、14.93%。在市、县、乡及以下助产机构分娩的感染孕产妇的母婴传播率分别为2.56%、4.44%和20.31%。孕早期(12孕周)接受艾滋病咨询检测服务的产妇,其母婴传播率低于孕中晚期(≥12孕周)产妇(3.08%、6.47%)(χ2=4.63,P0.01),人工喂养婴儿发生母婴传播率低于非人工喂养婴儿(4.84%、14.04%)(χ2=7.05,P0.01)。多因素分析表明,产妇孕早期接受艾滋病咨询检测服务[比值比(OR)=0.24,95%可信区间(CI):0.02~1.98],产妇孕早期服用抗病毒药物(OR=0.25,95%CI:0.09~0.69)、使用联合用药方案(OR=0.07,95%CI:0.02~0.28)、婴幼儿采取人工喂养(OR=0.16,95%CI:0.07~1.03),是PMTCT的保护因素。结论艾滋病母婴传播的不同干预措施有效降低了艾滋病母婴传播水平。     

HIV母婴传播阻断个性化综合干预措施效果分析

目的探索玉溪市红塔区2005年3月至2007年5月预防艾滋病母婴传播工作的运作模式,实施个性化综合干预措施,降低该地区艾滋病母婴传播发生率。方法在辖区内开展艾滋病自愿咨询检测(VCT)工作,对确认艾滋病病毒(HIV)感染的孕产妇及婚前检查人员实行专人管理,为HIV感染的孕产妇提供母婴阻断服务。结果孕产妇HIV检测率86.41%;孕产妇HIV阳性率为0.31%;对确认HIV感染的38例孕产妇(红塔区25例,外地转入13例)实施了个性化综合干预和阻断。婚前保健人群HIV阳性率0.31%。结论通过妇幼保健、医疗卫生机构、民政等多部门协作模式,早发现、早确诊HIV阳性病例,实施个性化综合干预措施,是降低HIV母婴传播的重要手段。     

河南省2005-2007年孕产妇HIV检测情况分析

目的了解河南省孕产妇艾滋病病毒（HIV）感染状况,为开展预防艾滋病母婴传播工作提供决策依据。方法对2005年1月-2007年5月,河南省艾滋病疫情相对集中的31个县（区）孕产妇的HIV检测结果进行分析。结果共对31个艾滋病重点县720605名孕妇和产妇检测HIV抗体,检测率93.11%;检测出HIV抗体阳性541例,阳性率0.08%。其中364例为阳性孕妇,223例自愿终止妊娠（占61.27%）,5例失访（1.37%）,136例选择继续妊娠待分娩（占37.36%）。3年间选择继续妊娠的HIV阳性孕妇,分别为31.51%（46/146）、36.31%（57/157）、54.10%（33/61）,呈逐年上升趋势。284例分娩阳性产妇中,250例（88%）采取了母婴阻断预防措施。结论加强孕产妇HIV检测和阳性育龄妇女的孕检工作,早期发现、早期管理HIV阳性孕妇,可以进一步提高HIV阳性产妇的药物阻断率。     

广州市2002-2013年HIV母婴传播阻断干预情况分析

目的了解广州市2002-2013年报告的艾滋病病毒(HIV)抗体阳性孕产妇的疫情,以及母婴传播干预情况。方法运用趋势卡方分析,对2002-2013年报告的HIV抗体阳性孕产妇病例的晚发现、接受母婴阻断干预与随访等情况进行分析。结果 2002-2013年,广州市累计报告HIV抗体阳性孕产妇278例,现存活261例。其中常住病例占64.4%(168例),平均年龄为27.6岁,异性传播占85.4%(223例),HIV感染者占70.1%(183例),AIDS病例所占比例呈下降的趋势(趋势χ2=8.46,P=0.004);接受HIV母婴阻断干预措施的病例占66.5%;常住病例中选择继续妊娠者所占比例(51.8%)高于非常住病例(38.7%)(χ2=4.556,P=0.033);已分娩婴儿中失访比例为41.4%。结论应加强孕产妇人群及其配偶的HIV抗体检测工作,孕产妇病例分娩婴儿的随访监测工作,是母婴传播干预工作的重点。     

孕期与产时启动抗病毒治疗阻断艾滋病母婴传播效果评价

目的对比艾滋病病毒(HIV)感染的孕产妇,经孕期与产时不同时期启动抗反转录病毒治疗(ART)后艾滋病母婴阻断的效果,探讨最大程度地减少通过母婴传播导致儿童艾滋病感染的方法。方法以30对临产时才发现HIV感染并采取紧急方案ART的孕产妇及其婴儿为观察组,以90对孕期开始应用ART的HIV感染孕产妇及其婴儿为对照组,两组均结合适宜的助产服务和人工喂养,婴儿进行HIV-1核酸和HIV抗体检测,判断HIV感染情况并进行对比分析。结果观察组有1例婴儿出生3个月死亡,有2例婴儿2次HIV-1脱氧核糖核酸检测结果均阳性,诊断婴儿HIV感染,其余27例满12~18月龄婴儿HIV抗体检测结果阴性,校正后婴儿HIV感染率为8.17%,对照组90例婴儿早期诊断和满12~18月龄HIV抗体检测结果均为阴性,婴儿HIV感染率为0,两组比较差异有统计学意义(χ~2=6.102,P0.05)。结论 HIV感染的孕产妇抗病毒治疗可以降低母婴传播的风险,孕期开始启动ART预防艾滋病母婴传播的效果明显优于产时紧急ART,结合安全分娩和人工喂养可明显降低HIV母婴传播率。     

Glucose and insulin concentration in amniotic fluid and in maternal blood in early and in late pregnancy

Glucose concentration in the amniotic fluid decreases towards the end of gestation, whereas the insulin concentration increases. The ratio between fetal (amniotic fluid) glucose to maternal glucose is reduced by about 50% at the end of pregnancy, whereas the ratio of C peptide is increased four times. The higher glucose concentration in amniotic fluid in early pregnancy could be explained by a lower fetal metabolic rate in the early stage of development and a low insulin activity of the fetus.     

Differentiation pathways in carcinogenesis and in chemo- and radioresistance

Cancer stem cells (CSCs) share many features with embryonic stem cells (ESCs) such as the ability for self-renewal and differentiation. Signaling pathways that are involved in these processes are also involved in chemo- and radioresistance (e.g. Wnt, Notch and Hedgehog pathways). This review is focused on the influence of three important differentiation pathways on carcinogenesis and on chemo- and radioresistance in ESCs and CSCs.     

Nitrite and thiocyanate in the fasting and secreting stomach and in saliva.

The concentrations of nitrite and thiocyanate in fasting and pentagastrin stimulated gastric juice and in saliva have been examined. Nitrite was found in all of 17 samples of fasting gastric juice, mean 4-9 +/- 1-1 muM. Stimulation of gastric secretion with pentagastrin caused no significant change in nitrite concentration. Thiocyanate was detected in all of 21 samples of fasting gastric juice and the difference in concentration between smokers and non-smokers probably reflects similar differences in saliva. In contrast to the nitrite data there was a significant drop in thiocyanate concentration of gastric juice after pentagastrin from 0-9 +/- 0-1 mM to 0-3 +/- 0-04 mM, suggesting a salivary origin for the thiocyanate in gastric juice. Thiocyanate is a powerful catalyst of nitrosation, which, together with small amounts of nitrite and naturally occurring amines could lead to the intragastric formation of carcinogenic nitrosamines and in certain circumstances be a factor in the aetiology of gastric cancer.     

Anti-malarial efficacy of pyronaridine and artesunate in combination in vitro and in vivo

Pyronaridine is a Mannich base anti-malarial with demonstrated efficacy against drug resistant Plasmodium falciparum, P. vivax, P. ovale and P. malariae. However, resistance to pyronaridine can develop quickly when it is used alone but can be considerably delayed when it is administered with artesunate in rodent malaria models. The aim of this study was to evaluate the efficacy of pyronaridine in combination with artesunate against P. falciparum in vitro and in rodent malaria models in vivo to support its clinical application. Pyronaridine showed consistently high levels of in vitro activity against a panel of six P. falciparum drug-sensitive and resistant strains (Geometric Mean IC50=2.24 nM, 95% CI=1.20-3.27). In vitro interactions between pyronaridine and artesunate showed a slight antagonistic trend, but in vivo compared to pyronaridine and artesunate administered alone, the 3:1 ratio of the combination, reduced the ED90 of artesunate by approximately 15.6-fold in a pyronaridine-resistant P. berghei line and by approximately 200-fold in an artesunate-resistant line of P. berghei. Complete cure rates were achieved with doses of the combination above or equal to 8 mg/kg per day against P. chabaudi AS. These results indicate that the combination had an enhanced effect over monotherapy and lower daily doses of artesunate could be used to obtain a curative effect. The data suggest that the combination of pyronaridine and artesunate should have potential in areas of multi-drug resistant malaria.     

Osteoporosis in celiac disease and in endocrine and reproductive disorders

As the increase in lifespan brings to light diseases that were previously not clinically detectable, osteoporosis has become an issue of worldwide significance. The disease is marked by a loss of bone mass; the bones become less dense, fragile and more prone to fracturing. Because it is regulated by endocrine and environmental factors, osteoporosis presents a multifactorial etiopathogenesis, with the genetic component accounting for 70% of an individual variation in bone mass density （BMD）, the principal determinant, with age, of fracture risk. Pathological conditions such as celiac disease （CD） exacerbate the process of bone loss, so that the occurrence of osteoporosis in celiac subjects is of particular note： indeed, the screening of osteoporosis patients for this disease is advisable, since it may be the only sign of undiagnosed CD. An increase in interleukin IL-1β, of the IL-1 system, in the relatives of celiac patients confirms the genetic predisposition to osteoporosis and its presence is evidence of an association between the two conditions. The direct effect on the bones of CD is secondary to poor absorption of calcium and vitamin D. In women osteoporosis is indirectly associated with early menopause and amenorrhea, and it may follow prolonged breast-feeding and frequent pregnancies, while in men it is associated with hypogonadism and GH deficit. These endocrine and non-endocrine factors exert their effects on bones by modulating the RANK/RANK-L/OPG system. An appropriate lifestyle from adolescence onwards, together with early diagnosis of and treatment for CD and primaryand secondary endocrine pathologies are important for the prevention of damage to the bones.     

Salmonellosis in children in developing and developed countries and populations

PURPOSE OF REVIEW: The present review addresses recent developments that relate to the clinical management and prevention of childhood salmonellosis in developed and developing countries. RECENT FINDINGS: Invasive disease due to serovar Typhi as well as nontyphoidal salmonellae (NTS) is common in children younger than 5 years old in developing countries, and multidrug resistance is an increasingly difficult problem to manage. A new conjugate vaccine was found to be very effective in preventing typhoid fever in young Vietnamese children and was well tolerated, showing great promise for the future. Antibiotic use in the food animal industry is an important source of disease with multidrug resistant NTS strains in the developed world. Efforts for prevention are aimed at immunization of animals, control of antibiotic use in the food animal industry and careful monitoring of food-borne outbreaks. On the other hand, although the burden of NTS disease in children is far greater in developing countries, especially in tropical Africa, knowledge of even basic epidemiology is lacking. Importantly, it may be that, as spp. acquire increasing resistance, they also acquire increasing virulence that will lead to even greater morbidity and mortality. SUMMARY: Recent developments include a better knowledge of clinical aspects of invasive salmonellosis, an increasing response to the problem of multiple antibiotic resistance (including quinolones), and excellent results from the use of a recently developed conjugate vaccine for typhoid fever in children as young as 2 years old.