2012年 · 第125卷第03期

Abstract：Background Six provinces in China accounted for 70％-80％ of all reported HIV/AIDS cases in the country in 2009 and five provinces accounted for 78％ of all reported mother-to-child transmission (MTCT) of HIV cases.Because Guangxi belonged to both groups,the Prevention of Mother-to-Child Transmission (PMTCT) Plus program was established there to understand better low birth weight (LBW) and preterm delivery (PD) birth outcomes and their associated risk factors better.Methods Pregnancy outcomes were examined among HIV-infected pregnant women who enrolled in the PMTCT Plus program from June 2006 to February 2009 in Guangxi,China.Multivariate Logistic regression analysis was used to explore the risk factors associated with LBW (＜2500 g) and PD (gestational age ＜37 weeks).Results The prevalence of LBW and PD among 194 HIV-positive mothers was 19.6％ (38/194) and 9.8％ (19/194),respectively.Multivariate Logistic regression analysis showed that CD4 cell count ＜100 cell/μI (multivariate-adjusted odds ratio (AOR) 5.52; 95％ CI 1.11-25.55) and CD4 cell count 100-199 cells/μl (AOR 3.40; 95％ Cl 1.03-11.25,compared to CD4 cell count ≥350 cells/μl),gestational age ＜37 weeks (AOR 4.38; 95％ CI 1.29-14.82,compared to ≥37 weeks),maternal weight ＜45 kg (AOR 5.64; 95％ Cl 1.09-29.07) and maternal weight 45-54 kg (AOR 3.55; 95％ Cl 1.31-9.60,compared to ≥55 kg) at enrollment,and HIV RNA ≥100 000 copies/ml at enrollment (AOR 4.22; 95％ Cl 1.24-14.32) and 20 000-99 999 (AOR 2.77; 95％ CI 1.01-7.77,compared to ＜20 000 copies/ml) were associated with a higher risk of LBW.For PD,only maternal injection drug use as the route of HIV transmission (AOR 5.30; 95％ CI 1.33-21.14,compared to those infected with HIV through sexual transmission) was significantly associated with a higher risk of PD.Conclusions Lower CD4 cell count and higher HIV RNA viral load at enrollment were associated with LBW.Optimal antenatal care,including earlier antenatal screening and HIV diagnosis,is critical to earlier PMTCT prophylaxis and/or HIV treatent to prevent transmission of HIV to the infant and also to prevent LBW pregnancy outcomes。

Abstract：Background Phenotypic and genotypic heterogeneity is a known feature of many cancers.Whether serum tumor marker kinds vary and change following chemotherapy is still unclear.The aim of this study was to investigate whether there is a change in the expression of serum tumor markers following chemotherapy,and the potential clinical significance in patients with epithelial ovarian carcinoma (EOC) or primary serous peritoneal carcinoma (PSPC).Methods Samples were collected before surgery,during chemotherapy and during follow-up for enzyme-linked immunosorbent assay (ELISA)-based evaluation of serum CA-125,CA19-9 and CP2 levels in patients with EOC or PSPC who had received primary debulking surgery followed by adjuvant chemotherapy.In total,72 patients were examined,including 37 patients with recurrent lesions and 35 patients receiving first-line chemotherapy.Results In 35 de novo patients,20％ (7/35) demonstrated a significant changed serum tumor marker kinds among whom the patients with mucinous carcinoma (57.1％,4/7) showed resistance to chemotherapy.In the 37 recurrent patients,51.4％ (19/37) had changed serum tumor markers,of whom 57.9％ (11/19) presented with serous carcinoma.There was no significant difference in median progression-free survival or overall survival in patients with drug-sensitive or drug-resistant recurrence in patients with changed tumor marker kinds relative to those with unchanged markers.However,for patients with changed serum tumor markers there was a trend towards prolonged survival compared with the unchanged serum tumor marker group.In the 17 patients with secondary recurrence,37.5％ (6/17) had changed tumor marker levels.The ratios of CA-125/CP2 and CA-125/CA19-9 were significantly different after either chemotherapy or recurrence.Conclusions Serum tumor marker expression in patients with EOC or PSPC may change after chemotherapy or recurrence,indicating that in addition to the markers that are abnormal before surgery,those markers that are normalshould also be monitored during chemotherapy and follow-up。

Abstract：Background Endometrial carcinoma is one of the most common gynecological malignancies among women.Early diagnosis and correct preoperative evaluation of myometrial invasion are necessary to improve the prognosis.This study aimed to determine whether features and time-intensity curves (TIC) of transvaginal contrast-enhanced ultrasound (CEUS) differ from those of conventional ultrasound for endometrial carcinoma,and to further explore the clinical role of transvaginal CEUS in the early diagnosis of endometrial carcinoma.Methods Forty women with a normal uterus and seventy-nine patients with endometrial carcinoma were examinedby the transvaginal CEUS with SonoVue (Bracco,Imaging B.V,Switzerland).The enhancement patterns and TIC of lesions were analyzed.The results of CEUS were compared with those of conventional ultrasound and pathology.Results In the early and late enhanced stages,the intensity of enhancement of the normal endometrium was always lower than that in the myometrium,and the boundary between normal endometrium and myometrium was clear.A total of 65.8％ (52/79) of lesions presented with inhomogeneous enhancement,34.2％ (27/79) presented with homogeneous enhancement; 60.8％ (48/79) presented with hyperechoic enhancement,27.8％ (22/79) presented with isoechoic enhancement,and 11.4％ (9/79) presented with hypoechoic enhancement.The average arrival time,time to peak,rise time,half-wash out time of lesions were shorter than of normal endometrium (P ＜0.05).The average peak intensity,relative rise in intensity,half-wash out intensity of lesions were higher than of normal endometrium (P＜0.05).There were 49 (must be and may be present) cases of endometrial carcinoma by ultrasound (US); 24 cases were consistent with pathology results,16 cases were underestimated and 9 cases were overestimated.There were 72 (must be and may be present) cases of endometrial carcinoma by CEUS; 53 cases were consistent with pathology results,12 cases were underestimated and 7 cases were overestimated.The qualitative diagnosis of endometrial carcinoma by CEUS was more accurate and definite than that by US (P ＜0.01).Conclusions By evaluating contrast-enhanced patterns and analyzing TIC,we found that CEUS can increase the accuracy of ultrasound qualitative diagnosis of endometrial carcinoma.CEUS shows lesions more clearly than conventional ultrasound,which is an advantage in evaluating the encroachment of endometrial carcinoma。

Abstract：Background Hepatitis B virus (HBV) infection remains a global public health problem and it is an important cause of acute,chronic and fulminant hepatitis,liver cirrhosis and hepatocellular carcinoma.The prevalence of HBV infection in Hong Kong over the past decade remained unchanged at 10％,despite the implementation of universal neonatal and availability of adult vaccination.We suspect that the current state of affairs is attributable to inadequate awareness and knowledge of HBV transmission and prevention in the general population,resulting in a low rate of uptake of HBV vaccination by the lay public.Therefore,we have embarked in this study to evaluate the awareness and knowledge on HBV infection in our local Chinese population,their attitude on the prevention of horizontal transmission of HBV,and the use of HBV vaccination,especially in those who were born before the era of universal neonatal vaccination.Methods The factors associated with HBV screening,vaccination uptake,and knowledge were examined in a face-to-face questionnaire survey on a group of adult Chinese in Hong Kong.Results Within this group,14％ was considered to have good knowledge for HBV infection,and 26％ had HBV vaccination.Age,occupation,having children,and family monthly income,are independent factors associated with vaccination.Conclusion This study suggests insufficient public awareness of HBV infection in the Hong Kong Adult Chinese population。

Abstract：Background Cardiac resynchronization therapy (CRT) with biventricular pacing improves cardiac function,functional capacity and quality of life in selected patients with heart failure.The current study aimed to evaluate the efficacy of the intracardiac electrogram (IEGM)-based optimization method,QuickOptTM,in Chinese patients treated with CRT.Methods Aortic time velocity integrals (AVTI) achieved at the sensed atrioventricular (AV),paced AV and interventricular (VV) interval settings recommended by both QuickOptTM and standard echocardiographic optimization were measured in 101 patients.Consistency and the strength of the relationship between the two timing cycle optimization methods were assessed by intra-class correlation coefficient (ICC).Results The ICC showed good agreement and correlation with what the AVTI achieved at the optimal sensed AV (ICC=0.9683 (0.9535-0.9785)),paced AV (ICC=0.9642 (0.9475-0.9757)) and VV (ICC=0.9730 (0.9602-0.9817)) interval settings determined by the two optimization methods.The average time required by echocardiographic optimization and by QuickOptTM were (78.32±32.40) minutes and (1.98±1.64) minutes respectively (P ＜0.0001).Conclusion The QuickOptTM algorithm provides a quicker,simpler and reliable alternative to the standard method for timing cycle optimization.(ClinicaITrial.gov Reference Number:NCT00918294)

Abstract：Background Some leukemia patients before hematopoietic stem cell transplantation (HSCT) have nutritional risk or undernutrition,which was one of the main reasons that caused series of complications during transplantation.The aim of this study was to find out some appropriate methods to learn about the nutritional status of leukemia patients before HSCT.Methods Nutritional status of patients with leukemia was assessed with three common methods of nutritional assessment (nutritional risk screening 2002 (NRS2002),mini nutritional assessment (MNA) and subjective global assessment (SGA)) before HSCT.The assessment results of NRS2002 and MNA were compared by paired x2 test.The consistency was analyzed by Kappa test.Results In this study,13 of 50 patients (26.0％) with leukemia had nutritional risk before HSCT assessed by NRS2002,including 7 patients (14.0％) with undernutrition.Of 50 patients assessed by SGA,only 1 case (2.0％) was mild or moderate undernutrition,and the remaining 49 patients (98.0％) were well-nutrition.Assessed by MNA,1 case (2.0％)was undernutrition,11 cases (22.0％) were potential undernutrition,and 38 cases (76.0％) were well-nutrition.Paired x2 test results showed that the difference between NRS2002 and MNA was statistically significant (x2=13.64,P ＜0.05);Kappa test results showed that they were consistent between NRS2002 and MNA (Kappa=0.62,P＜0.05).Conclusions It is important to know the nutritional status of patients with leukemia before HSCT,and NRS2002 should be the first choice of nutritional assessment for patients with leukemia.If NRS2002 and MNA used at the same time,the accuracy and comprehensiveness of the assessment can be improved。

Abstract：Background Genetic factors contribute to the development of coronary artery disease (CAD).Recently,a missense mutation in the low density lipoprotein receptor related protein 6 (LRP6) gene,encoding low density lipoprotein receptor related protein 6,has been implicated in an autosomal dominant form of early-onset CAD.The aim of this study was to determine whether the common variants in LRP6 are associated with sporadic CAD in Chinese.Methods A total of 766 CAD patients and 806 healthy controls were included in this study.The presence of angiographic CAD was determined by coronary angiographic analysis.Six signal nucleotide polymorphisms (SNPs) were genotyped using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique.Results A significant association was detected between rs11054731 in LRP6 intron 2 and CAD in our cohort (P=0.001).The CC genotype and C allele frequency in the case group were 52％ and 72％.Using a dominant model of inheritance,the C allele of rs11054731 was shown to be an independent risk factor for CAD with an OR of 1.45 (95％ CI:1.19-1.77,P=0.0002).With the stratification according to the number of affected coronary arteries,an association was observed between rs11054731 and CAD (P=0.0002).No significant association was observed between any other SNPs and the risk of CAD.Conclusion The C allele of the rs11054731 within the LRP6 gene was associated with increased risk and extent of CAD in Chinese。

Abstract：Background Esophageal squamous cell carcinoma (ESCC) is one of the most frequent malignancies in China and epidermal growth factor receptor (EGFR) is widely distributed in human epithelial cell membrane.The aim of this study was to investigate the protein overexpression and gene copy number of EGFR in ESCC,and help to identify patients who may benefit from EGFR targeted therapies.Methods Immunohistochemistry (IHC) was performed to analyze the expression of EGFR in 105 cases of ESCC,16 cases of squamous epithelial atypical hyperplasia,and 11 cases of normal esophageal tissue.Fluorescence in situ hybridization (FISH) was performed to analyze the gene copy number in 80 cases of ESCC,eight cases of squamous epithelial atypical hyperplasia,and eight samples of normal esophageal tissue.Results The IHC-positive rates of EGFR in 105 cases of ESCC,16 cases of squamous epithelial atypical hyperplasia,and 11 normal esophageal tissues were 97％ (102/105),44％ (7/16),and 18％ (2/11) respectively.The difference in the expression of EGFR among different esophageal tissue groups had statistically significance (P ＜0.05).Among the 105 cases of ESCC,overexpression of EGFR was found in 90 cases (86％),of which 55 cases scored 3+ for EGFR staining and 35 cases scored 2+.In ESCC,the expression of EGFR was significantly correlated with depth of invasion and TNM stage (P＜0.05),but not with other parameters.The FISH-positive rates of EGFR in 80 cases of ESCC,the eight cases of squamous epithelial atypical hyperplasia,and eight samples of normal esophageal tissue were 31.3％ (25/80),0 (0/8) and 0 (0/8) respectively.In ESCC,EGFR gene amplification was found in 17 (21％) cases,high polysomy in 8 (10％) cases,disomy in 34 cases,low trisomy in 17 cases,and high trisomy in four cases.EGFR FISH-positive was significantly correlated with depth of invasion and lymph node metastasis (P ＜0.05).EGFR FISH-positive was significantly associated with overexpression of EGFR.Conclusion Protein overexpression and/or increased gene copy number of EGFR is common in ESCC,and EGFR targeted therapy may be appropriate for ESCC patients。

Abstract：Background Typhoid/paratyphoid fever (TPF) is endemic in Guizhou.We conducted wavelet analysis and Spearman's rank correlation analysis to explore the impact of meteorological variations on TPF infection in Guizhou,in an attempt to assess the risk factors associated with TPF epidemics.Methods We examined the association between TPF incidence in Guizhou and temperature,precipitation and relative humidity using 24 years of data from 1984 to 2007.Periodicities of TPF incidence and the impact of climate factors on the TPF were detected by Spearman's rank correlation and wavelet analysis,Results Temperature and precipitation with a 1-month lag were positively correlated with the monthly incidence of TPF.The multiyear incidence pattern of TPF in Guizhou was explicitly periodic.Moreover,the association and driving effect of precipitation on TPF were observed,and the results showed that the incidence of TPF in Guizhou had a closer correlation with precipitation than with temperature.Conclusions Safe water supply is the key issue for TPF control in Guizhou.Moreover,climate variation might impact the enteric infections,which may inform policy assessment for TPF control in Guizhou。

Abstract：Background Marginal renal grafts may alleviate the shortage of suitable organs to meet an increasing demand of kidney transplantation,especially when live donors are currently limited to relatives of patients in China.The aim of this study was to investigate how to increase the available donors pool,evaluation,and treatment of marginal donors.Methods We had performed 121 kidney transplantation cases with living relative donors.Five out of these cases applied marginal grafts with surgical diseases,including one renal stone,one duplex kidney,one renal leiomyoma and two cases of simple renal cysts.In each case,particular surgical interventions were exerted on the graft prior to standard engrafting procedures.Results All recipients recovered with functioning transplants given that their serum creatinine levels declined to a normal range within one week after operation.These recipients were subsequently followed up for 10 months on average and their kidney functions remained stable.Conclusions Marginal renal grafts with surgical diseases,which can be treated surgically before engrafting,may provide satisfying transplantation outcomes.Positive and cautious consideration of these grafts may increase renal donorpool。

Abstract：Background Completely video-assisted thoracoscopic Iobectomy is a reasonable treatment for early-stage non-small-cell lung cancer (NSCLC).At present,the indication for this procedure is stage la and Ib peripheral lung cancer ((<-)5 cm); however,for larger tumors,it remains controversial whether this surgical technique is comparable to open Iobectomy.This study aimed to evaluate the safety,completeness,and efficacy of thoracoscopic Iobectomy,and to compare this technique with open Iobectomy for the treatment of non-small-cell lung cancer when the tumor's diameter was greater than 5 cm.Methods From May 2001 to April 2011,802 patients underwent a Iobectomy for treatment of non-small-cell lung cancer at our center.In 133 patients,the tumor was ＞ 5 cm.There were 98 men and 35 women,median age 63 years (range:29-81 years).We divided the patients into two groups,group V (completely video-assisted thoracoscopic surgery),and group T (open Iobectomy),and evaluated the two groups for age,gender,tumor size,pathological type,location,duration of surgery,blood loss,lymph node dissection,pathological stage,time of drainage,hospitalization,complications,overall survival and recurrence.Results There were 46 cases in group V and 87 cases in group T.Age,gender,tumor size,location,pathological type and stage were similar between the two groups.Group V had shorter operative duration ((186.5±62.8) minutes vs.(256.7±67.5) minutes,P ＜0.001) and reduced bleeding ((218.5±174.6) ml vs.(556.9±187.2) ml,P ＜0.001).There were no significant differences between the two groups in complications,lymph node dissection,time of drainage and hospitalization.The recurrence between the two groups was equivalent (2.4％ vs.3.8％,P=0.670).The overall survival at 1,2 and 3 years was 95.1％,81.6％ and 69.6％ for group V and 88.3％,78.8％ and 64.0％ for group T.Kaplan-Meier survival curves showed that there was no significant differences between the two groups (P=0.129).Conclusions Completely video-assisted thoracoscopic lobectomy was similar to open lobectomy in safety,completeness,and efficacy,but had a shorter operative duration,and reduced bleeding.This is a minimally invasive procedure that is feasible for a subset of non-small-cell lung cancer patients with tumor size > 5 cm。

Abstract：Background The key components of metabolic syndrome (MS) are waist circumference,blood pressure,fast blood glucose,high density lipoprotein cholesterol (HDL-c) and triglycerides (TG).These components have,separately and jointly,been associated with an increased risk of cardiovascular diseases.In this study,we aimed to explore the association between MS components and cancer risk in a population-based cohort in China.Methods We established a population-based cohort with 17 779 individuals aged 35 and above at baseline in 2004 and 2005 in Changzhou,Jiangsu Province,China.All participants were face-to-face interviewed to complete a questionnaire and were accepted physical examinations including blood tests for glucose and lipids and physical measurements for obesity and blood pressure.In 2009,a total of 16 284 subjects (6886 men and 9398 women,91.6％) attended the flow-up interviews and the participants or their family members reported all the hospitalizations and diseases including cancer occurred during the follow-up period.Multivariate Cox regression was used to estimate the hazard ratios (HRs) of metabolic syndrome components and cancer incidence.Results There was a dose-response association between cancer risk and the number of MS components presented at baseline (P for trend=0.012) and the HR (95％ confidence interval (CI)) was 2.63 (1.27-5.45) for subjects carrying 3 or more metabolic syndrome components after adjustment for possible confounding factors.Specifically,the multivariate-adjusted HRs (95％ CIs) for cancer risk in subjects with central obesity,high fasting glucose,low HDL-c were 1.94 (1.01-3.74),2.04 (1.10-3.77) and 2.05 (1.09-3.88),respectively.Conclusions In this population-based,prospective cohort study in China,we found MS components,e.g.,central obesity,high fasting glucose,low HDL-c were risk factors for cancer development.Early intervention of MS components may be also beneficial to reduce cancer burden。

Abstract：Horseshoe kidney and retrocaval ureter are uncommon congenital anomalies of the genitourinary system that are easily diagnosed by typical imaging features.Both anomalies presenting in one patient is a rare disease characterized by isthmus of horseshoe kidney between the abdominal aorta and inferior vena cava.The clinical diagnosis and treatment of horseshoe kidney with retrocaval ureter remain a challenge.Here,we reported a case of a 44-year-old man with the two anomalies who was preoperatively diagnosed by unenhanced computed tomography scanning immediately after retrograde pyelography.The literatures on such combined anomalies are reviewed and the diagnostic evaluation and surgical management of this rare entity are discussed。

Congenital rubella syndrome (CRS) is characterized by the triad of deafness,cataract and cardiovascular malformations.1 The great majority of the cases in the literature have been usually diagnosed in infancy and childhood because of various defects at birth.However,we report a rare case of suspected CRS in an adult with unilateral pulmonary artery stenosis and late-onset cataract。

Welder's siderosis or pneumoconiosis siderotica is an occupational lung disease which is usually seen after chronic exposure to iron dust,especially in welders.It was first described by Doig and McLaughlin1 in 1936 and occurs in about 7％ of arc welders.Despite striking radiological and histopathological features, it has traditionally been classified as a “benign pneumoconiosis” because of the absence of associated symptoms,functional impairment or pulmonary fibrosis in general.1,2 Although several authors have reported evidence of fibrosis in the lungs of welders,3,4 siderosis with local massive fibrosis described from pathology or occupying lesion on chest CT scans is very rare.5 Here we present a case of Welder's siderosis with local massive fibrosis mimicking lung cancer。

Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae,which primarily affects the skin and peripheral nerves.In this article,we present a 45-year-old man and a 39-year-old women who suffered fróm asymptomatic irregular erythemas on their trunk and extremities.Since both patients denied the history of exposure to leprosy patients and were absent clinical signs of superficial sensation dysfunction and enlarged peripheral nerves,they were diagnosed of mycosis fungoides and livedo reticularis clinically.Nevertheless the biopsies of erythemas showed perineural and periadnexal foamy-cell granulomas in the dermis and Fite staining revealed a large number of acid-fast bacilli.A diagnosis of multibacillary leprosy was made finally.These cases revealed that since leprosy is still epidemic in some remote area in China and in other developing countries and its clinical manifestations may be very weird sometimes,the dermatologists should be alert of it and skin biopsy could confirm the diagnosis。