The relationship between high-normal blood pressure in the first half of pregnancy and the risk of hypertensive disease of pregnancy.

Early warning of hypertensive disorder in pregnancy (HDP) can improve maternal and infant outcomes. However, few studies had evaluated the warning value of high-normal blood pressure (BP) before the onset of HDP. This was a prospective cohort study to investigate the relationship between high-normal BP in the first half of pregnancy and the risk of HDP. According to the maximum BP measured before 20+6  weeks of gestation, the cohort was divided into three groups: optimal BP (SBP < 120 mmHg and DBP < 80 mmHg), normal BP (120 mmHg ≤ SBP < 130 mmHg or 80 mmHg ≤ DBP < 85 mmHg), and high-normal BP (130 mmHg ≤ SBP < 140 mmHg or 85 mmHg ≤ DBP < 90 mmHg). The relationship between different BP levels in the first half of pregnancy and HDP risk was assessed by general linear models. Ten thousand one hundred and ninety-three normotensive pregnant women with complete information were finally included for data analysis. Among them, 532 pregnant women were diagnosed with HDP, with a total HDP incidence of 5.2%. The incidences in the optimal, normal, and high-normal BP groups were 2.4%, 6.0%, and 21.8%, respectively. Compared to women with optimal BP in the first half of pregnancy, women with high-normal BP had a 445% increased risk of HDP (aRR: 5.45, 95% CI: 4.24-7.00), and even women with normal BP had a 107% increased risk of HDP (aRR: 2.07, 95% CI: 1.68-2.56). This study demonstrated that among low-risk healthy women, women with high-normal BP in the first half of pregnancy had a significantly higher risk of HDP.

Prehypertension prior to pregnancy is associated with hypertensive disorders of pregnancy and postpartum metabolic syndrome in Chinese women.

Objective: To examined whether prehypertension prior to pregnancy increased the risk of hypertensive disorders of pregnancy (HDP) and postpartum metabolic syndrome.Methods:1060 singleton pregnancy women with physical examination data before pregnancy were enrolled through the Kailuan study. Women with pre-pregnancy hypertension, metabolic syndrome, or no postpartum follow-up data were excluded. Pre-pregnancy prehypertension was defined as elevated blood pressure (130-139/85-89 mmHg) at the last physical examination before pregnancy. Multivariable Logistic and Cox Regression were used to examine the association between pre-pregnancy prehypertension and outcomes. Kaplan-Meier survival curve was used to analyze the cumulative incidence of postpartum metabolic syndrome.Results: Among the 801 women enrolled at baseline, 173 (21.6%) had prehypertension. Overall, 61 women (7.6%) developed HDP. Kaplan-Meier survival curve showed that the incidence of postpartum metabolic syndrome was significantly higher in prehypertensive women. After adjusting for confounders, women with pre-pregnancy prehypertension were 2.09 (95% CI 1.19-3.70) and 1.91 (95% CI 1.23-2.97) times as likely to develop HDP and postpartum metabolic syndrome, compared to normotensive women.Conclusion: Women with pre-pregnancy prehypertension may benefit from the more intensive monitor for HDP and postpartum metabolic syndrome.

Postoperative prognostic model for patients with clear cell renal cell carcinoma in a Chinese population.

OBJECTIVES: To develop a predictive model for the oncological outcomes of clear cell renal cell carcinoma in a Chinese population. METHODS: A retrospective study of 1108 patients with clear cell renal cell carcinoma who underwent nephrectomy or partial nephrectomy between January 2006 and December 2013 was carried out. Recurrence-free survival was calculated using Kaplan-Meier analysis. Differences between the groups were compared using the log-rank test. Cox proportional hazard regression was used to test associations between features and outcomes. The discriminative ability of the models was validated using Harrell's concordance index and bootstrapping. RESULTS: Overall, 942 patients who met the inclusion criteria had been followed. The median follow-up period was 72 months (range 1-143 months). Multivariate analysis showed that age, Eastern Cooperative Oncology Group performance status, preoperative platelet count, neutrophil-to-lymphocyte ratio, tumor size, 2010 tumor stage (pT3 and pT4) and Fuhrman nuclear grade were independent risk factors affecting recurrence-free survival in clear cell renal cell carcinoma patients (P < 0.05). These factors were assigned to develop a new model. The patients were divided into three groups based on the risk of recurrence. The difference among the prognoses of patients in the three groups was statistically significant (P < 0.05). The concordance index for our new model and that for Leibovich's 2018 model were 0.791 and 0.750, respectively. CONCLUSIONS: In the present study, the new model has a higher concordance index than does Leibovich's 2018 model of clear cell renal cell carcinoma in the Asian population, with no added pain for patients. This new model might be an appropriate risk stratification tool for clinical work.

Dynamic Changes in Clinical Characteristics During an Outbreak of Human Adenovirus Serotype 55 in China.

OBJECTIVE: To determine dynamic changes in clinical characteristics by examining an outbreak of adenovirus infection that occurred from December 20, 2012, to February 25, 2013, in Tianjin, China. METHODS: Active surveillance for febrile respiratory illnesses was conducted, and medical records of patients were collected. Real-time quantitative polymerase chain reaction and sequencing were used for pathogen identification and viral genome study, respectively. Student's t-test was used to compare the mean values of normally distributed continuous variables. Mann-Whitney U or Kruskal-Wallis tests were used if continuous variables were not normally distributed. Pearson's chi-square test or Fisher's exact test was used to compare categorical variables. RESULTS: The outbreak was sourced from the index case diagnosed as the common cold on December 20, 2012; a total of 856 cases were reported in the following 66 days. The pathogen was identified as human adenovirus (HAdV) 55. The symptoms manifested differently in severe and mild cases. Routine blood examinations, liver function indexes, and heart function indexes showed different dynamic patterns over time in hospitalized patients. CONCLUSIONS: Clinical characteristics and laboratory examinations may reveal unique patterns over the course of HAdV-55 infection. (Disaster Med Public Health Preparedness. 2018;12:464-469).

Acupuncture lowering blood pressure for secondary prevention of stroke: a study protocol for a multicenter randomized controlled trial.

BACKGROUND: Stroke is the prime cause of morbidity and mortality in the general population, and hypertension will increase the recurrence and mortality of stroke. We report a protocol of a pragmatic randomized controlled trial (RCT) using blood pressure (BP)-lowering acupuncture add-on treatment to treat patients with hypertension and stroke. METHODS: This is a large-scale, multicenter, subject-, assessor- and analyst-blinded, pragmatic RCT. A total of 480 patients with hypertension and ischemic stroke will be randomly assigned to two groups: an experimental group and a control group. The experimental group will receive "HuoXueSanFeng" acupuncture combined with one antihypertensive medication in addition to routine ischemic stroke treatment. The control group will only receive one antihypertensive medication and basic treatments for ischemic stroke. HuoXueSanFeng acupuncture will be given for six sessions weekly for the first 6 weeks and three times weekly for the next 6 weeks. A 9-month follow-up will, thereafter, be conducted. Antihypertensive medication will be adjusted based on BP levels. The primary outcome will be the recurrence of stroke. The secondary outcomes including 24-h ambulatory BP, the TCM syndrome score, the Short Form 36-item Health Survey (SF-36), the National Institute of Health Stroke Scale (NIHSS), as well as the Barthel Index (BI) scale will be assessed at baseline, 6 weeks and 12 weeks post initiating treatments; cardiac ultrasound, carotid artery ultrasound, transcranial Doppler, and lower extremity ultrasound will be evaluated at baseline and 12 weeks after treatment. The safety of acupuncture will also be assessed. DISCUSSION: We aim to determine the clinical effects of controlling BP for secondary prevention of stroke with acupuncture add-on treatment. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02967484 . Registered on 13 February 2017; last updated on 27 June 2017.

Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China.

Human enterovirus 68 (HEV-68) is an enterovirus associated with respiratory illness. In China, no information about HEV-68 is available for children yet. This study aimed to investigate the presence of HEV-68 in mainland China between 2009 and 2012 and to explore the migration events of HEV-68 across the world. Among 1565 samples tested from children, 41 (2.6%) were positive for HEV and 223 (14.3%) for human rhinovirus (HRV). Seven (17.1%) of 41 HEVs were HEV-68. Two HEV-68- and five HRV-positive samples were detected in 585 adult samples. HEV-68 is the predominant type of enterovirus in children with acute respiratory tract infection (ARTI), followed by HEV-71 and coxsackievirus A6. Three HEV-68-infected children presented with severe pneumonia and one presented with a severe asthma attack. The viruses were attributed to two novel distinct sublineages of HEV-68 based on phylogenetic analysis of partial VP1 gene sequences. Migration events analysis showed that the USA and the Netherlands were possible geographical sources of HEV-68, from where three strains migrated to China. In conclusion, HEV-68 may play a predominant role among the enteroviruses associated with ARTI in children. Additional surveillance is needed to clarify the reason why HEV-68 causes such a wide spectrum of disease, from asymptomatic to severe respiratory disease and even death.

[Correlation analysis between the exposure levels and the serum protein fingerprints in population exposure to silica].

OBJECTIVE: To explore the correlation between the exposure levels and serum protein fingerprints in population exposed to silica. METHODS: Liquid chip time-of-flight mass spectrometry technology was used to investigate the serum profiles in control group (30 cases), group exposed to silica (30 cases), silicosis group (I stage, 25 cases) and suspected silicosis group (30 cases), and screen the differential expression proteins. The correlation between the levels of the differential expression proteins and the exposure levels was performed. RESULTS: Five differential expression proteins were found among 4 groups, the expression of 5081 and 5066 proteins was upregulated, and the expression of 3954, 2021 and 1777 proteins was downregulated. There was no the correlation between the exposure levels and the peak with M/Z among those proteins. CONCLUSION: the results of present investigation indicated there was no correlation between the exposure levels and protein/peptide peak.

[The effects of complement C3f segment on expression and secretion of collagen I, III and transforming growth factor-beta1 in human embryonic lung fibroblast].

OBJECTIVE: To observe the effects of complement fragment C3f on expression and secretion of collagen I, III and transforming growth factor( TGF)-beta1 in human embryonic lung fibroblast (MRC-5) cells. METHODS: MRC-5 cells were cultured with C3f (the synthetic 17 peptides fragments of complement C3). The extracellular and intracellular expression levels of type I, III collagens and TGF-beta1 in MRC-5 cultures were detected by ELISA and immunohistochemistry, respectively. RESULTS: The expression levels of type I, III collagen and TGF-beta1 in the supernatant of MRC-5 cultures decreased significantly with the concentrations of C3f as compared with controls (P < 0.05). Also the expression level of TGF-beta1 in MRC-5 cytoplasm reduced significantly as compared with controls (P < 0.05). CONCLUSION: The results of present in vitro study showed that the complement fragment C3f could reduce the formation of TGF-beta1 and type I, III collagens in MRC-5 cells, and inhibit the lung tissue fibrosis.

Seroprevalence and genetic characteristics of five subtypes of influenza A viruses in the Chinese pig population: a pooled data analysis.

A literature review and pooled data analysis were carried out to examine the prevalence of antibodies against five influenza virus subtypes in pigs in China over a 10-year period (1999-2009). The average seropositive frequencies of subtypes H1, H3, H5, H7 and H9 were 3478/11,168 (31.1%), 2900/10,139 (28.6%), 77/5945 (1.3%), 0/1440 (0%) and 86/3619 (2.4%), respectively. There was a geographical variation in the seroprevalence of subtype H1, with the highest seroprevalence in pigs in South and East China. BLAST analysis of genetic sequences revealed that genome segments with moderate homology to the 2009 pandemic influenza A (H1N1) virus were present among swine influenza viruses isolated in China, especially in South and East China. It was concluded from both serological and genetic studies that subtypes H1, H3, H5 and H9 are currently co-circulating in pigs in China, with the H1 subtype most commonly detected, followed by H3.

Clinical and immunological characteristics of patients with 2009 pandemic influenza A (H1N1) virus infection after vaccination.

BACKGROUND: We followed a cohort of 773 individuals who received a monovalent vaccine against 2009 pandemic influenza A (H1N1). Approximately 6 weeks after vaccination, 12 persons developed the disease. METHODS: Three groups of subjects were studied (12 patients who had or had not received previous monovalent vaccine and 1 group of 49 control subjects who had previously been immunized with the same vaccine). For all patients, clinical features were characterized and the causative viruses sequenced for possible mutations. Nasopharyngeal swabs, serum specimens, and peripheral blood monocyte cells (PBMCs) were collected at different time points up to 11 weeks after symptom onset to measure the virus load and humoral and cellular immune responses. Serum samples and PBMCs were also collected from 49 and 16 vaccinated control subjects, respectively. RESULTS: Both patient groups had similar clinical manifestations. No substantial viral mutations were detected. Compared with unvaccinated patients, viral loads in vaccinated patients were initially higher, but the levels decreased faster to undetectable levels. However, the virus became detectable again for 6 of them. Two weeks after infection, vaccinated and unvaccinated patients had similar neutralizing antibody levels as the vaccinated control subjects. Thereafter, the neutralizing antibody levels decreased markedly in vaccinated patients. During the acute phase, memory T cell counts and tumor necrosis factor-α levels were significantly higher in vaccinated than in unvaccinated patients. CONCLUSIONS: Although the clinical consequences of infection are comparable between vaccinated and unvaccinated patients, humoral and cellular immune responses in vaccinated patients are boosted for some weeks, indicating an additional benefit of vaccination against 2009 pandemic influenza A (H1N1) virus.

Community transmission of pandemic influenza A (H1N1) in China.

Prophylaxis and treatment with oseltamivir effectively controlled a community outbreak of pandemic influenza A (H1N1) in China. The genetic makeup of strains of different generations seemed to be stable. Travel in confined settings might accelerate the transmission of pandemic influenza in a community outbreak.

Mixed infections of pandemic H1N1 and seasonal H3N2 viruses in 1 outbreak.

BACKGROUND: In early September 2009, an outbreak of influenza occurred at a college campus in Beijing, China, in which both pandemic H1N1 and seasonal H3N2 viruses were detected. METHODS: Outbreak investigation was performed in the campus. Epidemiologic, clinical data were collected by interviewing patients and retrieving medical records. Individual contact tracing was performed for detailed contact information. Viruses were identified by reverse-transcription polymerase chain reaction assays followed by sequence analysis. The hemagglutination inhibition test was used to detect antibodies to both viruses for paired serum samples. RESULTS: Forty of 45 people with influenza-like illness had laboratory-confirmed influenza A infection; 22 of these 40 people were infected with pandemic H1N1 virus, 12 were infected with seasonal H3N2 virus, and 6 were coinfected with both viruses. In the subsequent generation of cases with mixed infection, we detected pandemic H1N1 virus infection more often than seasonal H3N2 virus infection. The clinical patterns were essentially similar for patients with different virus infections. No substantial differences in sequences were observed in either pandemic H1N1 or seasonal H3N2 virus between patients with mixed and single infection. Sequence analyses revealed that all of the detected viruses were susceptible to oseltamivir but resistant to adamantane. Hemagglutination inhibition tests of paired serum samples confirmed mixed infection in the outbreak. CONCLUSIONS: Cocirculation of pandemic H1N1 virus and seasonal H3N2 virus led to a mixed infection in patients. Pandemic H1N1 virus, however, took prevalence over seasonal influenza virus in the course of transmission. Therefore, competitive circulation of seasonal influenza A virus with the pandemic H1N1 virus seems less likely.

The SARS outbreak in a general hospital in Tianjin, China: clinical aspects and risk factors for disease outcome.

OBJECTIVES: To describe clinical characteristics of severe acute respiratory syndrome (SARS) patients in a hospital in Tianjin, China, thereby comparing probable and suspected cases; to study risk factors associated with the death of cases; to describe the implementation of preventive interventions during the hospital outbreak. METHODS: Physical and haematological information was obtained from clinical records. White blood cell counts, and percentages of neutrophilic granulocytes and neutrophilic lymphocytes were measured. The service department of the hospital provided information about daily use of protective materials. Differences in clinical symptoms between probable and suspected SARS cases were tested by Fisher's exact test. Non-linear mixed modelling was used to test for differences between the haematological patterns for probable and suspected cases. Risk factors for dying among probable SARS cases were tested by logistic regression. RESULTS: The SARS outbreak started with a patient from Beijing on 15 April 2003, and spread quickly among the healthcare workers and in-patients in the hospital. In total 90 probable and 21 suspected cases were reported, with 17 deaths among them (case fatality rate 15%). Haematological patterns were significantly different between probable and suspected cases, whereas the percentages with certain clinical symptoms showed no apparent difference. Death of probable SARS cases was only significantly associated with high age and use of a respiratory machine (mainly for the most severe cases), whereas e.g. co-morbidity and steroid treatment showed no impact in multivariate analysis. Stringent control measures, including distribution of huge numbers of protective materials, started on 20 April, which soon lead to a strong decrease in the incidence of new cases. After the last SARS case left the hospital on 6 June, protective materials were dispensed at substantially lower rates, but not to zero, as was the case during the first days of the outbreak. CONCLUSION: The working definition of probable SARS used during the epidemic appeared to have been fairly accurate. Many valuable lessons were learned regarding prevention of hospital spread of infection, especially the need to have sufficient protective supplies available and to implement these rigidly and at an early stage of an (threatening) epidemic.

Transmission of SARS in three Chinese hospitals.

OBJECTIVE: To quantify the transmissibility of severe acute respiratory syndrome (SARS) in hospitals in mainland China and to assess the effectiveness of control measures. METHODS: We report key epidemiological details of three major hospital outbreaks of SARS in mainland China, and estimate the evolution of the effective reproduction number in each of the three hospitals during the course of the outbreaks. RESULTS: The three successive hospital outbreaks infected 41, 99 and 91 people of whom 37%, 60% and 70% were hospital staff. These cases resulted in 33 deaths, five of which occurred in hospital staff. In a multivariate logistic regression, age and whether or not the case was a healthcare worker (HCW) were found to be significant predictors of mortality. The estimated effective reproduction numbers (95% CI) for the three epidemics peaked at 8 (5, 11), 9 (4, 14) and 12 (7, 17). In all three hospitals the epidemics were rapidly controlled, bringing the reproduction number below one within 25, 10 and 5 days respectively. CONCLUSIONS: This work shows that in three major hospital epidemics in Beijing and Tianjin substantially higher rates of transmission were initially observed than those seen in the community. In all three cases the hospital epidemics were rapidly brought under control, with the time to successful control becoming shorter in each successive outbreak.

[Differential analysis of two-dimensional gel electrophoresis profiles in lung tissue of rats exposed to silica early].

OBJECTIVE: To analyze the differences of lung tissue proteins in rats exposed to silica early by using comparative proteomics method and investigate the related mechanism with the occurrence and development of silicosis. METHODS: Adult male Wistar rats were randomly divided into control group and silica-treated group. The animal model was established by intratracheal (IT) instillation with silica suspension. On the 14th day after establishment of animal model, rats were sacrificed and lung tissues were collected. The total proteins were separated by means of two-dimensional gel electrophoresis (2-DE) and the differentially expressed proteins were identified by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). In addition, Western blotting was performed to verify the expression of certain candidate protein. RESULTS: Eleven differential expression protein spots were tested by MALDI-TOF-MS, and six proteins were identified. The levels of cathepsin D precursor, peroxiredoxin-1 (Prx-1), heat shock cognate 71 000 protein (HSP7C), heterogeneous nuclear ribonucleoprotein A3 (hnRNPA3) and fatty acid-binding protein (epidermal, E-FABP) were up-regulated in silica-treated group with the optical density (A) values. These values were 116.50+/-12.56, 148.75+/-22.40; 40.00+/-1.63, 66.00+/-13.93; 51.25+/-7.37, 92.75+/-8.69; 83.00+/-6.48, 122.75+/-24.62; 50.75+/-6.50, 93.50+/-23.10 and 100.25+/-19.99, 142.50+/-21.21 respectively. The statistical difference was observed as compared with control group (t=-2.51, -3.71, -7.28, -3.12, -3.56 and -2.90, P<0.05). However, SEC14-like protein 3 with the A values 153.00+/-11.28, 109.75+/-18.32 was down-regulated (t=4.02, P<0.01). Western blotting showed that in the expression of Prx-1 was higher in silica-treated group (0.61+/-0.05) than that in the control (0.35+/-0.05) (t=-7.24, P<0.01) when calculating the semi-quantification of this protein using ratio of optical density. CONCLUSION: 2-DE pattern of lung tissue from rats exposed to silica has been established and six differentially expressed proteins have been identified. Our study is of help for further research of the mechanisms of silicosis.

[Epidemiological characteristics of 420 influenza A (H1N1) cases confirmed in the early stage of the epidemic in mainland China].

OBJECTIVE: To describe the epidemical characteristics of A (H1N1) influenza identified in the early stage (from May 11 to June 22, 2009) of the epidemic, in mainland China. METHODS: Epidemical characteristics of 420 confirmed A (H1N1) influenza cases reported from May 11 to June 22, 2009 were analyzed descriptively, including the distribution of age, sex, source of infection, main symptoms and incubation period. RESULTS: A total of 77.8% early cases in mainland China were imported from other countries. Three countries including America, Canada and Australia were attributed to 90% of the imported cases. Most of the cases were from 6 months to 73 years old, with 94% of them under 50 years. Most of the symptoms would include fever (81%), cough (40%) and sore throat (35%). The mean incubation period of second-generation cases was 4.3 (4.2 +/- 1.5) days. CONCLUSION: Imported cases dominated the total cases in the early stage of the epidemic had similar gender distribution of those from exporting countries. Fever, cough and sore throat were the three main symptoms manifested in influenza cases. 2.5 +/- 1.9 (1 - 11) days was found in imported cases between the day of off-board and the onset of symptoms. The incubation period was 4.3 +/- 1.7 (1 - 8) days among the secondary cases.

[The study on differential gene expression profiling in pulmonary tissue of rats exposed to silica early].

OBJECTIVE: To study the differential gene expression profiling of rats exposed to silica using the normal rats as control. METHODS: Animal models were established using intratracheal injection of the lung and 22 107 genes were screened in the differential expression profiling of silicosis by using oligonucleotide bead array. Differential expression profiling data were analyzed by using DAVID bioinformation software. RESULTS: Totally 1567 differentially expressed genes were identified in lungs of silica exposed rats including 765 up-regulated genes and 802 down-regulated genes as compared to the normal controls. Among 406 annotated genes in KEGG pathways, 204 genes and 11 pathways were up-regulated as well as 202 genes and 3 pathways were down-regulated in silica exposed rats. CONCLUSION: All 1567 genes are involved in the formation of silicosis. The differential gene expression profile of silicosis describes the general changes in the gene expressions in silicosis at transcriptional level. Further analysis of the identified genes might help reveal the molecular mechanism of pulmonary fibrosis induced by silica.

[The proteomics research on relational expressed serum proteins among the recovered SARS patients complicating avascular necrosis of femoral head].

OBJECTIVE: To seek differentially expressed serum proteins in recovered SARS patients complicating avascular necrosis of femoral head (AVNFH). METHODS: 2-DE and MALDI-TOF MS were used to study the comparative serum proteomics among female SARS AVNFH group, female SARS non-AVNFH group and female healthy group. ELISA method was used to detect serum amyloid P component in individual serum; specificity and sensitivity of serum amyloid P component were analyzed. RESULTS: Average protein points on 2-DE of 3 groups were 632 +/- 28, 671 +/- 55, 688 +/- 42 respectively, and the matching rate of protein points was ranged from 85% to 95%; eighteen differentially expressed proteins were discovered including transthyretin, serpin peptidase inhibitor, alpha-1-antitrypsin precursor, serum amyloid P components, etc. Compared to healthy group and SARS non-AVNFH group, transthyretin, C4B3, fibrinogen gamma, apolipoprotein L, apolipoprotein A-IV precursor, albumin and prealbumin showed lower expression, inversely serpin peptidase inhibitor, alpha-1-antitrypsin precursor and serum amyloid P components showed higher expression in serum in the SARS AVNFH necrosis group. The serum amyloid P component in 3 groups were 0.54 +/- 0.30 ng/ml, 0.83 +/- 0.39 ng/ml, 1.21 +/- 0.29 ng/ml respectively. The areas under the ROC curve on serum amyloid P component was 0.854, the specificity was 77.8% and the sensitivity was 85.2%. CONCLUSION: There were differentially expressed serum proteins in three groups. Serum amyloid P components might be one of the potential biomarkers in serum of recovered SARS patients complicating avascular necrosis of femoral head.