Incidence of extrauterine growth retardation and its risk factors in very preterm infants during hospitalization: a multicenter prospective study / 中国当代儿科杂志

OBJECTIVES@#To investigate the incidence of extrauterine growth retardation (EUGR) and its risk factors in very preterm infants (VPIs) during hospitalization in China.@*METHODS@#A prospective multicenter study was performed on the medical data of 2 514 VPIs who were hospitalized in the department of neonatology in 28 hospitals from 7 areas of China between September 2019 and December 2020. According to the presence or absence of EUGR based on the evaluation of body weight at the corrected gestational age of 36 weeks or at discharge, the VPIs were classified to two groups: EUGR group (n=1 189) and non-EUGR (n=1 325). The clinical features were compared between the two groups, and the incidence of EUGR and risk factors for EUGR were examined.@*RESULTS@#The incidence of EUGR was 47.30% (1 189/2 514) evaluated by weight. The multivariate logistic regression analysis showed that higher weight growth velocity after regaining birth weight and higher cumulative calorie intake during the first week of hospitalization were protective factors against EUGR (P<0.05), while small-for-gestational-age birth, prolonged time to the initiation of total enteral feeding, prolonged cumulative fasting time, lower breast milk intake before starting human milk fortifiers, prolonged time to the initiation of full fortified feeding, and moderate-to-severe bronchopulmonary dysplasia were risk factors for EUGR (P<0.05).@*CONCLUSIONS@#It is crucial to reduce the incidence of EUGR by achieving total enteral feeding as early as possible, strengthening breastfeeding, increasing calorie intake in the first week after birth, improving the velocity of weight gain, and preventing moderate-severe bronchopulmonary dysplasia in VPIs.

Research progress of periodontitis and periodontal dysbiosis / 口腔疾病防治

@#In recent years, the etiology of periodontitis has tended to be based on the theory of flora imbalance. That is, periodontitis is not caused by specific bacteria but by the breakdown of the oral flora balance, which leads to an immune imbalance. Imbalanced bacterial flora cooperate with each other to produce virulent factors that destroy organism tissues and induce immune cells to produce abnormal levels of cytokines, causing greater damage. This article reviews the initiation of a flora imbalance, the interaction between bacteria, the immune damage of the host and the prevention and treatment of the flora imbalance. The literature review shows that peroxidase released by inflammatory reactions, host immune responses to pathogenic microorganisms and some systemic factors, such as diabetes, can trigger flora imbalance. As a result, ion transport, substance synthesis and metabolism of bacteria change; virulence factors increase; and the oral flora balance is disrupted. Red complex bacteria enter gingival epithelial cells, produce adhesin, and selectively inhibit the expression of specific chemokines, which is beneficial for other pathogenic bacteria to enter gingival epithelial cells. Toxicity factors increase throughout the body, directly destroying body tissues and inducing innate and adaptive immune responses, thus causing related immune damage. The dysbacteriosis model of periodontitis provides a new idea for the prevention and treatment of periodontitis, such as using biological factors, bacteriophages, probiotics and other methods to reduce the number of periodontal pathogens to restore the steady state of periodontal flora.

A comparative study on impact of tax incentives and financial subsidies on R&D investment of Chinese materia medica enterprises / 中草药

By comparing the incentive effect of indirect tax incentives and direct financial subsidies on R&D investment of Chinese medicine enterprises, this empirical study aims to provide empirical evidence for the government subsidies to encourage the R&D investment of traditional Chinese medicine industry, and also provide valuable reference for the government to encourage enterprises to carry out innovation activities. Using a total of 301 observations in 62 traditional Chinese medicine enterprises from 2012 to 2016 as the research object, the paper analyzed the impact of tax incentives and financial subsidies on enterprise innovation performance. The results show that tax incentives have a significant incentive effect on R&D investment of traditional Chinese medicine enterprises, for every 1% reduction in tax costs, R&D investment increase by 0.99%, and R&D investment tax elasticity is -0.99; Financial subsidies have a significant positive effect on R&D investment but the estimated coefficient is only 0.24. When tax incentives and financial subsidies exist at the same time, the effect of financial subsidies on R&D investment is not significant. Moreover, the regression results of adding firm size as a moderator variable showed that incentive effects of tax incentives on R&D investment decreased with the increased size of the enterprise. Therefore, government subsidies should be based on tax incentives, supplemented by financial subsidies, and tax incentives should be properly inclined to SMEs.

Prognostic Value of Gai's Plaque Score and Agatston Coronary Artery Calcium Score for Functionally Significant Coronary Artery Stenosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The prognostic values of the coronary computed tomography angiography (CCTA) score for predicting future cardiovascular events have been previously demonstrated in numerous studies. However, few studies have used the rich information available from CCTA to detect functionally significant coronary lesions. We sought to compare the prognostic values of Gai's plaque score and the coronary artery calcium score (CACS) of CCTA for predicting functionally significant coronary lesions, using fractional flow reserve (FFR) as the gold standard.</p><p><b>METHODS</b>We retrospectively analyzed 107 visually assessed significant coronary lesions in 88 patients (mean age, 59.6 ± 10.2 years; 76.14% of males) who underwent CCTA, invasive coronary angiography, and invasive FFR measurement. An FFR <0.80 indicated hemodynamically significant coronary stenosis. Lesions were divided into two groups using an FFR cutoff value of 0.80. We compared Gai's plaque scores and CACS between the two groups and evaluated the correlations of these scores with FFR. The statistical methods included unpaired t-test, Mann-Whitney U-test, and Spearman's correlation coefficients.</p><p><b>RESULTS</b>Coronary lesions with FFR <0.80 had higher Gai's scores than those with FFR ≥0.80. Gai's score had the strongest correlation with FFR (r = -0.48, P < 0.01) and had a greater area under the curve = 0.72 (95% confidence interval: 0.61-0.82; P < 0.01) than the CACS of whole arteries and a single artery.</p><p><b>CONCLUSIONS</b>Both CACS in a single artery and Gai's plaque score demonstrated a good capacity to assess functionally significant coronary artery stenosis when compared to the gold standard FFR. However, Gai's plaque score was more predictive of FFR <0.80. Gai's score can be easily calculated in daily clinical practice and could be used when considering revascularization.</p>

Mutation analysis of HOXD13 gene in a Chinese family affected with autosomal dominant synpolydactyly / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To detect potential mutation in a Chinese family affected with autosomal-dominant synpolydactyly and to provide the basis for prenatal diagnosis.</p><p><b>METHODS</b>Inheritance pattern was determined by clinical examination and pedigree analysis. Blood samples were obtained from members of the family. Genomic DNA was extracted and sequenced following PCR amplification. Suspected mutation was confirmed by subclone sequencing and agarose gel electrophoresis.</p><p><b>RESULTS</b>A 27 bp expansion mutation in exon 1 of HOXD13 was identified in all affected individuals from the family but not in unaffected members and normal controls. The mutation has caused insertion of 9 alanines in the polyalanine-expansion region of HOXD13 protein.</p><p><b>CONCLUSION</b>A polyalanine-expansion within the HOXD13 probably underlies the disease in this family.</p>

Cost-effectiveness analysis of HIV testing strategy in hospitals from 2006 to 2010 in Guangzhou / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the cost effectiveness of HIV testing strategy in hospitals from 2006 to 2010 in Guangzhou.</p><p><b>METHODS</b>According to the HIV test strategy costs and the number of HIV patients found in Guangzhou, following aspects were calculated as the total cost of HIV testing strategy in hospitals from 2006 to 2010 of Guangzhou, the cost of finding each HIV patient, and the cost of obtaining one quality adjusted life year (QALY) using Markov model.</p><p><b>RESULTS</b>The total HIV test strategy costs increased from 11 106.98 thousand Yuan to 25 105.58 thousand Yuan, and 4599 HIV positive patients were found due to this strategy. The cost-effectiveness of HIV testing were different in hospitals from 2006 to 2010 in Guangzhou. The lowest cost-effectiveness ratio of HIV testing strategy was 11 810 Yuan per HIV positive patient, the highest was 23 510 Yuan, and the average was 16 070 Yuan. According to the Markov model result, 7.2855 QALYs could be gained per HIV patient on average via HIV testing strategy in 113 hospitals in Guangzhou, and the cost of obtaining one QALY was 2210 Yuan.</p><p><b>CONCLUSION</b>The cost effectiveness ratio of HIV testing strategy in hospitals in Guangzhou was significantly lower than the standard of WHO recommended, and it was cost-effective to carry out the HIV testing strategy in Guangzhou.</p>

Acceptability status of early antiretroviral therapy among HIV-positive men who have sex with men / 中华预防医学杂志

<p><b>OBJECTIVE</b>To assess the acceptability and influence factors of early antiretroviral therapy (ART) among HIV-positive men who have sex with men (MSM) .</p><p><b>METHODS</b>From June to August 2012, through convenience sampling, HIV-positive MSM who were willing to cooperate with the survey were selected from the Hangzhou and Ningbo AIDS prevention and control database. A total of 280 HIV-positive MSM who did not receive ART participated in the study.Using self-designed questionnaire, general demographic information, awareness of AIDS knowledge, sexual behavior, use of condom, current physical condition, awareness and attitude towards early ART were investigated.Excluding 60 HIV-infected MSM whose CD4(+)T count didn't meet the inclusion criteria, a total of 220 subjects were included in the analysis. Chi-square was used to compare the difference of early ART acceptance among subjects with different characteristics.Non-conditional logistic regression was used to analyze the influence factors of the acceptability of early ART.</p><p><b>RESULTS</b>The acceptance rate of early ART among HIV-infected MSM was 62.7% (138/220). Delaying the disease development, preventing partners from infection, not worrying others to suspect them of having HIV, and partners unknowing the HIV-infected status were the factors which had a relatively higher acceptance rate of early ART. Correspondingly, the acceptance rate was 68.8% (130/189), 68.7% (103/150), 78.4% (69/88) and 72.5% (74/102) respectively and the acceptance rate among subjects with opposite opinions or characteristics was 24.1% (7/29) , 50.0% (30/60), 52.7% (68/129) and 45.8% (58/107) respectively (chi-square values were 21.46, 6.43, 14.84 7.55, all P values <0.05).Logistic regression analysis showed that delaying the disease development (OR = 11.50, 95%CI:3.29-40.22) and preventing partners from infection (OR = 3.72, 95%CI:1.53-9.03) were inclined to the acceptance of early ATR.While concerning others' suspection of them having HIV (OR = 0.19, 95%CI:0.08-0.48) and partners knowing the HIV-infected status were inclined to unacceptance of ART(OR = 0.31, 95%CI:0.13-0.70).</p><p><b>CONCLUSION</b>The acceptability of early ART among HIV-positive MSM is high. The recognition of early ART and concern of privacy leak are the major influence factors which can stimulate the acceptance of early ART.</p>

Novel deletion of SPAST in a Chinese family with hereditary spastic paraplegia

<p><b>INTRODUCTION</b>Hereditary spastic paraplegia (HSP) belongs to a large, heterogeneous group of progressive neurodegenerative diseases characterised by progressive lower extremity weakness and spasticity, which is caused by developmental failure or degeneration of motor axons in the corticospinal tract. Classical genetic studies have identified at least 46 genetic loci responsible for HSP.</p><p><b>METHODS</b>A genetic study was conducted on a four-generation Chinese family with autosomal dominant HSP. The SPAST gene was investigated using linkage analysis and direct sequencing. Findings were compared with unaffected family members and 50 normal, unaffected individuals who were matched for geographical ancestry.</p><p><b>RESULTS</b>We identified a novel 14-bp heterozygous deletion that induced a frameshift mutation in exon 15 of SPAST (SPG4). This mutation is predicted to have functional impact and found to cosegregate with the disease phenotype.</p><p><b>CONCLUSION</b>Our results have expanded the mutation spectrum of the SPAST gene. These findings could help clinicians provide prenatal diagnosis of affected foetuses in families with a known history of such neurodegenerative diseases.</p>

Serum cystatin C concentration as an independent marker for hypertensive left ventricular hypertrophy / 老年心脏病学杂志（英文版）

Background Serum cystatin C levels can be used to predict morbidity and mortality in patients with cardiovascular disease. However, the clinical relevance of serum cystatin C levels in patients with hypertensive left ventricular hypertrophy (LVH) has rarely been investigated. We designed the present study to investigate whether serum cystatin C levels are associated with cardiac structural and functional alterations in hypertensive patients. Methods We enrolled 823 hypertensive patients and classified them into two groups:those with LVH (n=287) and those without LVH (n=536). All patients underwent echocardiography and serum cystatin C testing. We analyzed the relationship be-tween serum cystatin C levels and LVH. Results Serum cystatin C levels were higher in hypertensive patients with LVH than in those without LVH (P＜0.05). Using linear correlation analysis, we found a positive correlation between serum cystatin C levels and interven-tricular septal thickness (r=0.247, P＜0.01), posterior wall thickness (r=0.216, P＜0.01), and left ventricular weight index (r=0.347, P＜0.01). When analyzed by multiple linear regression, the positive correlations remained between serum cystatin C and interventricular septal thickness (β=0.167, P＜0.05), posterior wall thickness (β=0.187, P＜0.05), and left ventricular weight index (β=0.245, P＜0.01). Con-clusion Serum cystatin C concentration is an independent marker for hypertensive LVH.

Magnetic resonance imaging: a valuable method for diagnosing chronic lumbago caused by lumbar muscle strain and monitoring healing process / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Magnetic resonance imaging (MRI) is the most sensitive technique for evaluating the healing process and should be performed before the patients return to their exercise routines. The aim of this research was to diagnose chronic lumbago associated with lumbar muscle strain and to monitor healing process by MRI.</p><p><b>METHODS</b>Sixty-fve symptomatic cases of chronic lumbago caused by lumbar muscle strain were collected from March 2009 to October 2011. MRI was used to examine, diagnose and monitor the healing process. The control group included 65 random cases of asymptomatic volunteers. MRI methods included routine sequences of GRE T1WI, TSE T2WI and special sequences of T2-STIR-FS, combined with DWI. We compared the MRI characteristics of symptomatic cases before and after healing and with asymptomatic controls.</p><p><b>RESULTS</b>The important MRI characteristics of chronic lumbago with lumbar muscle strain included: (1) The low back muscle showed edema. (2) The low back intermuscular spaces showed edema and/or fluid. (3) The low back spaces beside the spinous process showed edema and/or fluid. (4) The low back vertebral articular process fossae or transverse process fossae showed fluid. Of these image characteristics, the intermuscular space edema provided the best diagnostic sensitivity, Se = 83%, with YI = 0.63, p = 74%. The low back muscle edema provided the best diagnostic specificity, Sp = 100%, with YI = 0.66, Π = 83%. And the spaces edema beside the spinous process provided the best diangnostic accuracy, Π = 86%, with YI = 0.71, Se = 80%, Sp = 91%. The diagnosis accurate could be improved by combining multiple MRI characteristics. The diagnostic accuracy could achieve Π = 93%, with YI = 0.86, Se = 100% and Sp = 86% when two characteristics were combined. After rehabilitation care, the edema disappeared on the repeated MRI.</p><p><b>CONCLUSIONS</b>MRI may well be a useful diagnostic method for lumbago with lumbar muscle strain. Combining routine sequences with T2-STIR-FS and DWI sequences could demonstrate the pathological changes of lumbar muscle strain and monitor the healing.</p>

Gender and its impact on condom use among HIV male serodiscordant couples / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the gender-based factors which influence the condom use among the HIV serodiscordant couples in selected regions of China.</p><p><b>METHODS</b>Based on the analysis of the existing case reporting database and convenient sampling in the cross-sectional study, a total of 481 female HIV-negative spouses completed an interviewer-administered questionnaire regarding demographic characters, the knowledge, behaviors and the gender-based factors in five sites of four provinces Sichuan (Zhaojue), Yunnan (Dali), Henan (Weishi) and Guangxi (Lingshan and Luzhai), during June-September 2011. χ(2) analysis and logistic regression were used to study the gender-based factors influencing condom use among the participants.</p><p><b>RESULTS</b>Among the 481 female HIV-negative spouses, the average age was (35.1 ± 6.7) years, and the proportion of Han and Yi nationality were high, 43.5% (209/481) and 41.8% (201/481), respectively. The awareness of knowledge related to HIV spousal transmission was high (≥ 79.6%). A total of 86.9% (418/481) used condom more frequently after informed the status of HIV infection of their spouses, and the condom use consistency was 56.6% (272/481). A total of 57.6% (277/481) reported low sexual relationship power; 34.5% (166/481) experienced forced sex in the past 1 year. And the proportion of condom use self-efficacy from 0 to 3 scores were 12.7% (61/481), 23.9% (115/481), 8.7% (42/481) and 54.7% (263/481), respectively (median = 3). Han and other nationality were significantly more likely to use condom consistently than Yi, with odds ratio (95%CI) of 0.01 (0.00 - 0.03) and 0.01 (0.00 - 0.04), and the female spouses with higher condom use self-efficacy used condom more consistently than the lower ones, with odds ratio (95%CI) of 0.20(0.11 - 0.34).</p><p><b>CONCLUSION</b>The female spouses with higher condom use self-efficacy were more likely to use condom consistently after excluding the confounding effect of nationality.</p>

Association of two SNPs in 3'UTR of ETS1 gene with systemic lupus erythematosus in a northern Chinese Han population / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To assess the association between 2 single nucleotide polymorphisms (SNPs) of ETS1 gene and susceptibility to systemic lupus erythematosus (SLE) in a northern Chinese Han population.</p><p><b>METHODS</b>Two SNPs within the ETS1 gene mapped to 11q23 were selected based on HapMap data. Genotyping was conducted with Taqman method in 231 patients with SLE and 474 healthy controls from Qilu Hospital, Shandong and analyzed with PLINK1.07 software. Haplotypes were analyzed with SHEsis software.</p><p><b>RESULTS</b>A statistically significant difference was detected in the distribution of rs1128334 and rs4937333 genotypes between the two groups (all P< 0.01). For rs1128334, the frequency of the minor allele was 0.291 and 0.428 in controls and cases, respectively. For rs4937333, the minor allele frequency was 0.381 and 0.476 in controls and cases respectively. An A-C haplotype was found to be strongly associated with increased risk for SLE, while another haplotype G-C may reduce this risk.</p><p><b>CONCLUSION</b>Our study has suggested that rs1128334 and rs4937333 are strongly associated with the risk for SLE in northern Chinese Han population.</p>

Adjuvant treatment with Shengmai injection for chronic heart failure combined with coronary heart disease: A clinical observation / 第二军医大学学报

Objective To explore the treatment effect of Shengmai injection on patients with chronic heart failure combined with coronary heart disease. Methods From 2009 to 2011, 56 patients with coronary heart disease combined with chronic heart failure were equally divided into two groups randomly. Patients in the control group received conventional treatment and the observation group was also given Shengmai injection (40 ml Shengmai injection in 250 ml glucose, once daily for 7 days). The following parameters were examined and compared before and one week after treatment; left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD),left ventricular end-diastolic diameter (LVEDD), stroke volume (SV) and left ventricular fractional shortening (FS). Results All the above five parameters were significantly improved after treatment in both groups (P<0. 05), and the improvement in the observation group was significantly greater than that in the control group (P<0. 01). The total effective rate in the observation group was 82. 1%, which was significantly higher than that in the control group (75. 0%, P < 0. 05). No obvious adverse reaction was noticed in the two groups. Conclusion Shengmai injection can definitely improve the systolic function of heart in patients with heart failure.