Interpreting declines in HIV test positivity: an analysis of routine data from Zimbabwe's national sex work programme, 2009–2019

IntroductionEarly diagnosis of HIV is critical for epidemic control. To achieve this, successful testing programmes are essential and test positivity is often used as a marker of their performance. The aim of this study was to analyse trends and predictors of HIV test positivity over time and explore how an understanding of seroconversion rates could build on our interpretation of this indicator among female sex workers in Zimbabwe.MethodsWe analysed HIV test data from Zimbabwe''s nationally scaled sex work programme between 2009 and 2019. We defined test positivity as the proportion of all tests that were HIV positive and measured new diagnoses by estimating seroconversion rates among women with repeat tests, defined as an HIV‐positive test after at least one HIV‐negative test in the programme. We used logistic regression to analyse test positivity over three time‐periods: 2009–2013, 2014–2017 and 2018–2019, adjusting for potential confounding by demographic factors and the mediating effects of time since last HIV test. We calculated the seroconversion rates for the same time‐periods.ResultsDuring the 10‐year study period, 54,503 tests were recorded in 39,462 women. Between 2009 and 2013, 18% of tests were among women who reported testing in the previous 6 months. By 2018–2019, this had increased to 57%. Between 2018 and 2019, test positivity was 9.6%, compared to 47.9% for 2009–2013 (aOR 6.08 95% CI 5.52–6.70) and 18.8% for 2014–2017 (aOR 2.17 95% CI 2.06–2.28). Adjusting for time since last test reduced effect estimates for 2009–2013 (aOR 4.03 95% CI 3.64–4.45) and 2014–2017 (aOR 1.97 95% CI 1.86–2.09) compared to 2018–2019. Among 7573 women with an initial HIV‐negative test in the programme and at least one subsequent test, 464 tested HIV positive at a rate of 3.9 per 100 pyar (95% CI 3.5–4.2).ConclusionsTest positivity decreased among women testing through the programme over time, while seroconversion rates remained high. These declines were partly driven by changes in individual testing history, reflecting comprehensive coverage of testing services and greater knowledge of HIV status, but not necessarily declining rates of seroconversion. Understanding testing history and monitoring new HIV infections from repeat tests could strengthen the interpretation of test positivity and provide a better understanding of programme performance.     

Arthroscopic Modified Double‐Row Biceps Tenodesis versus Labral Repair for the Treatment of Isolated Type II SLAP Lesions in Non‐Overhead Athletes

ObjectiveTo evaluate the postoperative efficacy and the clinical outcomes of arthroscopic modified double‐row biceps tenodesis versus labral repair.MethodsA retrospective study was conducted in 56 patients with isolated type II superior labrum anterior and posterior (SLAP) lesions from March 2015 to November 2018. Thirty patients (male:female = 17:13) were treated with labral repair, and 26 patients (male:female = 15:11) were treated with modified double‐row biceps tenodesis. The average age of the labral repair group and the modified double‐row biceps tenodesis group were 42.8 ± 10.6 and 40.9 ± 10.2 years, respectively. Pre‐ and postoperative assessments with the visual analog scale (VAS), University of California Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores were compared between the two treatment groups. Additional outcome measures included patient satisfaction, the time to return to previous activities, workers'' compensation status, and postoperative complications.ResultsAt a 2‐year follow‐up, the tenodesis group showed significant differences in postoperative VAS (1.5 to 1.8, respectively; p = 0.008), patient satisfaction (92.3% vs. 46.7%, p < 0.001), and recovery time to return to their previous activities (6.8 ± 1.8 vs. 8.1 ± 1.5, p = 0.007) compared to the labral repair group; however, there was no significant difference in postoperative ASES and UCLA scores between the two groups. Additionally, one patient in the tenodesis group developed persistent postoperative stiffness, which was resolved by conservative treatment. In the labral repair group, two patients presented with persistent postoperative night pain, three developed persistent postoperative stiffness, and two required a subsequent capsular release.ConclusionsCompared with the labral repair group, the arthroscopic modified double‐row biceps tenodesis showed more encouraging postoperative pain reduction, earlier recovery to previous activities, and higher patient satisfaction.     

Comparative study on the gastrointestinal- and immune- regulation functions of Hedysari Radix Paeparata Cum Melle and Astragali Radix Praeparata cum Melle in rats with spleen-qi deficiency,based on fuzzy matter-element analysis

ContextHedysari Radix Praeparata Cum Melle (HRPCM) and Astragali Radix Praeparata Cum Melle (ARPCM) are used interchangeably in clinics to treat spleen-qi deficiency (SQD) symptom mainly including gastrointestinal dysfunction and decreased immunity, which has unknown differences in efficacy.ObjectiveTo investigate the differences between HRPCM and ARPCM on intervening gastrointestinal- and immune-function with SQD syndrome.Materials and methodsAfter the SQD model was established, the Sprague–Dawley (SD) rats were randomly divided into nine groups (n = 10): normal; model; Bu-Zhong-Yi-Qi Pills; 18.9, 12.6 and 6.3 g/kg dose groups of HRPCM and ARPCM. Gastrointestinal function including d-xylose, gastrin, amylase vasoactive intestinal peptide, motilin, pepsin, H⁺/K⁺-ATPase, Na⁺/K⁺-ATPase, sodium-glucose cotransporter 1 (SGLT1), glucose transporter 2 (GLUT2) and immune function including spleen and thymus index, blood routine, interleukin (IL)-2, IL-6, interferon-γ (IFN-γ), tumour necrosis factor-α (TNF-α), immunoglobulin (Ig) M, IgA, IgG and delayed-type hypersensitivity (DTH) were detected. Finally, the efficacy differences were analysed comprehensively by the fuzzy matter-element method.ResultsIn regulating immune, the doses differences in efficacy between HRPCM and ARPCM showed in the high-dose (18.9 g/kg), but there were no differences in the middle- and low- dose (12.6 and 6.3 g/kg); the efficacy differences were primarily reflected in levels of IL-6, IFN-γ, TNF-α and IgM in serum, and the mRNA expression of IL-6 and IFN-γ in the spleen. In regulating gastrointestinal, the efficacy differences were primarily reflected in the levels of D-xylose, MTL, and GAS in serum, and the mRNA and protein expression of SGLT1 and GLUT2 in jejunum and ileum.Discussion and conclusionsHRPCM is more effective than ARPCM on regulating gastrointestinal function and immune function with SQD syndrome. Therefore, we propose that HRPCM should be mainly used to treat SQD syndrome in the future.     

长链非编码RNA核富集转录体1促进喉鳞状细胞癌细胞迁移和侵袭的机制研究

目的 探究长链非编码RNA(lncRNA)核富集转录体1(NEAT1)NEAT1对喉鳞状细胞癌(LSCC)细胞迁移和侵袭的影响,并进一步分析miR-429/锌指E-盒结合同源异形盒1(ZEB1)轴在其中发挥的作用。方法 慢病毒转染建立稳定敲减lncRNA NEAT1的LSCC细胞,通过RT-qPCR检测细胞lncRNA NEAT1表达以验证转染效率,通过Transwell实验检测细胞迁移和侵袭能力,通过Western blot检测细胞上皮-间充质转化(EMT)相关蛋白N-cadherin、Vimentin、Slug和Snail表达。通过生物信息学分析miR-429与lncRNA NEAT1和ZEB1 mRNA间的潜在结合位点,并通过双荧光素酶报告基因实验验证miR-429与lncRNA NEAT1以及miR-429与ZEB1 mRNA结合。将miR-429抑制剂转染敲减lncRNA NEAT1的LSCC细胞,通过Western blot检测细胞ZEB1表达。进一步检查敲减ZEB1对抑制miR-429的敲减lncRNA NEAT1的LSCC细胞迁移、侵袭和EMT的影响。结果 敲减lncRNA NEAT1降低LSCC细胞lncRNA NEAT1表达,抑制细胞迁移和侵袭并下调细胞N-cadherin、Vimentin、Slug和Snail表达。miR-429与lncRNA NEAT1和ZEB1 mRNA间存在潜在结合位点,且miR-429与lncRNA NEAT1以及miR-429与ZEB1 mRNA结合。抑制miR-429逆转了敲减lncRNA NEAT1对LSCC细胞ZEB1表达的抑制作用。此外,敲减ZEB1逆转了抑制miR-429对敲减lncRNA NEAT1的LSCC细胞迁移和侵袭的促进作用及EMT相关蛋白N-cadherin、Vimentin、Slug和Snail表达的上调作用。结论 lncRNA NEAT1促进LSCC细胞迁移和侵袭,其机制可能与海绵化miR-429上调ZEB1表达促进LSCC细胞EMT有关。     

转移相关蛋白2在头颈部恶性肿瘤中的作用

转移相关蛋白2(MTA2)是近年来被发现的与肿瘤侵袭进展、转移相关的转录调控家族成员,在肿瘤的增殖、侵袭以及远处转移中起着非常重要的作用。其在多种头颈部恶性肿瘤如鼻咽癌、口腔癌、喉癌、食管癌、甲状腺癌中呈高表达,并且MTA2的高表达与这些恶性肿瘤的不良预后相关。MTA2与头颈部恶性肿瘤的侵袭、进展及预后的关系研究成为了头颈肿瘤研究中的新热点。本文对MTA2的结构与功能、其在不同头颈肿瘤中的表达以及意义、其可能的调节机制以及其研究展望作一个小结,希望对MTA2的后续研究以及头颈肿瘤的综合诊治提供帮助。     

Rotenone,an environmental toxin,causes abnormal methylation of the mouse brain organoid's genome and ferroptosis

More and more reports have pointed out that rotenone, as an insecticide, has high neurotoxicity and reproductive toxicity to livestock and mammals. As a highly physiological correlation system of internal organs, quasi-organs have great potential in the fields of drug toxicity and efficacy test, toxicology research, developmental biology and so on. In this study, brain organs (mBOs) derived from mouse neural stem cells were used to investigate the effects of rotenone on the physiological activity and epigenetic modification of mBOs. At the same time, Rotenone could significantly stimulate the increase of the concentration of LPO, lactic acid and hydroxyl radical in mBOs, and inhibit the expression of neuronal marker Tuj1, CHAT, PAX6 and so on. Further analysis showed that Rotenonem could induce mitochondrial damage in mBOs. The results of qPCR and Western blot showed that Rotenone could up-regulate the expressions of ferroptosis promoting protein p53, Cox2 and so on, while inhibit the expressions of negative regulatory protein of ferroptosis GPX4, FTH1, SLC7A11. In addition, the results of RRBS-Seq sequencing showed that the methylation modification at DMR level in Rotenone-treated mBOs group was significantly higher than that in Ctrl group. The results of KEGG analysis showed that compared with Ctrl, the genes with hypermethylation of promoter and Genebody in Rotenone-treated mBOs were mainly located in the Neuro active ligand-receptor interaction signal transduction pathway. In summary, rotenone can significantly lead to abnormal methylation of mouse brain organs, and lead to the loss of normal physiological function of neurons by inducing ferroptosis.     

对接大健康产业发展的康复治疗学人才培养体系的构建

在大健康产业发展背景下,康复服务产业发展模式和服务理念逐步转变。康复人力资源是康复服务产业发展的基石,文章基于《国际功能、残疾和健康分类》(international classification of functioning,disability and health,ICF)康复科学理论体系,切合康复服务产业化和专业化需求,重构康复治疗学专业人才培养的课程体系,强化实践教学,探讨构建康复治疗学专业人才培养新模式。     

三全育人视角下中医临床课程思政建设的探索

课程思政建设是立足“培养什么样的人、如何培养人以及为谁培养人”这个根本问题,实现课程教学与思政课教学同向同行,形成协同效应,有利于“全面发展的人”的培养。深入发掘医学专业课程的育人元素,充分发挥中医临床课程的育人功能,以培养学生学习能力、实践能力、创新能力为核心,推进医学院校全员、全过程、全方位打造德智体美劳全面发展的应用型人才是时代所需、发展之要。我们从“梳理思政教育元素、课程设计、课程反馈”三方面构建了中医临床课程思政育人路径,实现了专业课知识传递与德育相融合,以期在医学临床教学的课程思政建设提供一定思路。     

基于“一动力三循环”管理模式的“3S”方法在临床研究生导师队伍建设中的应用

研究生教育是国家高水平教育的代表,也是医院发展的体现,在一定程度上可以看出医院的医疗、教学、科研、学术地位。研究生导师是高层次和高水平师资的主要代表,是一个医院提升自身教学实力、影响力、竞争力的关键。本文针对专科医院研究生导师队伍建设存在以下问题进行阐述：对外交流培训不足,师资队伍评价体系不科学,师资队伍结构不合理。基于“一动力三循环”管理模式,探索提出“3S”研究生导师队伍建设模式：加强对外交流与培训,建立科学的评价体系,建立结构合理的导师队伍,以优化研究生导师队伍建设为目标,打造一支业务能力专业、评价体系科学、师资结构合理的导师队伍,不断提升医院研究生导师队伍建设水平,是每个研究生培养单位的重要任务。同时概括了现阶段研究生导师队伍建设的成效和不足,并给予了反馈与意见。     

产儿科住院医师整合培养模式探讨

随着医学教学模式的更新,整合医学教育及围产医学理念的不断强化,产科与儿科的人才培养模式有了新的定位。临床案例中多学科合作抢救的模式的频频成功,产科与儿科的合作交流促进有了新的需求。分析产科与儿科目前住院医师规范化培训的特点,总结阐述整合培养不仅可以增强产儿科医师的自信力和职业归属感,提升围产保健的质量和救治力,而且可以培养出“高精尖”的产儿科储备人才以及缓和产儿科特殊的医患关系。从实际出发,针对具体的整合培训时长,可优化的带教形式,模拟训练的模式,反馈及奖惩制度等各方面进行探讨研究,以使整合培养的模式能落到实处,真正实现“高精尖”人才的培养,最终更好的服务于孕产妇及新生儿,提高我国围产医学领域的影响力。