Clinical Characteristics of 26 Human Cases of Highly Pathogenic Avian Influenza A (H5N1) Virus Infection in China

BACKGROUND: While human cases of highly pathogenic avian influenza A (H5N1) virus infection continue to increase globally, available clinical data on H5N1 cases are limited. We conducted a retrospective study of 26 confirmed human H5N1 cases identified through surveillance in China from October 2005 through April 2008. METHODOLOGY/PRINCIPAL FINDINGS: Data were collected from hospital medical records of H5N1 cases and analyzed. The median age was 29 years (range 6-62) and 58% were female. Many H5N1 cases reported fever (92%) and cough (58%) at illness onset, and had lower respiratory findings of tachypnea and dyspnea at admission. All cases progressed rapidly to bilateral pneumonia. Clinical complications included acute respiratory distress syndrome (ARDS, 81%), cardiac failure (50%), elevated aminotransaminases (43%), and renal dysfunction (17%). Fatal cases had a lower median nadir platelet count (64.5 x 10(9) cells/L vs 93.0 x 10(9) cells/L, p = 0.02), higher median peak lactic dehydrogenase (LDH) level (1982.5 U/L vs 1230.0 U/L, p = 0.001), higher percentage of ARDS (94% [n = 16] vs 56% [n = 5], p = 0.034) and more frequent cardiac failure (71% [n = 12] vs 11% [n = 1], p = 0.011) than nonfatal cases. A higher proportion of patients who received antiviral drugs survived compared to untreated (67% [8/12] vs 7% [1/14], p = 0.003). CONCLUSIONS/SIGNIFICANCE: The clinical course of Chinese H5N1 cases is characterized by fever and cough initially, with rapid progression to lower respiratory disease. Decreased platelet count, elevated LDH level, ARDS and cardiac failure were associated with fatal outcomes. Clinical management of H5N1 cases should be standardized in China to include early antiviral treatment for suspected H5N1 cases

Dietary Patterns and Obesity among Chinese Adults: Results from a Household-Based Cross-Sectional Study

The key dietary pattern other than dietary factors influencing obesity has been reported by several large epidemiological studies. This study was carried out between 2010 and 2012 including 1613 adult residents in Zhejiang Province. Dietary patterns were extracted by factor analysis based on 24-h dietary recall. Associations with dietary patterns and obesity were examined and adjusted for age and gender by logistic regression. Five dietary patterns were identified by factor analysis with their eigenvalues greater than 1: ‘cereal, animal, and plant food’, ‘high protein food’, ‘plant food’, ‘poultry’, and ‘beverage’. After adjustment for age and gender, the ‘cereal, animal, and plant food’ and ‘beverage’ pattern was associated with obesity (OR = 2.924, 3.257; 95% CI = 1.147–7.463, 1.372–7.692). In conclusion, ‘cereal, animal, and plant food’ and ‘beverage’ dietary patterns may be associated with increased risk of obesity. ‘Cereal, animal, and plant food’ dietary patterns may be associated with increased risk of obesity resulting from increased total energy intake by increased protein and fat intake; while a ‘beverage’ dietary pattern may be associated with increased risk of obesity resulting from increased total energy intake by increased carbohydrate intake. The findings are valuable in targeting future nutrition education

Synthetic CsCEP3 Peptide Attenuates Salinity Stress via ROS and ABA Signaling in Cucumber Primary Root

Salinity stress prominently limits cucumber growth and productivity. However, the mechanism underlying salinity response mediated by the C-TERMINALLY ENCODED PEPTIDE (CEP) peptide in cucumber primary root remains largely unclear. In this study, we show that salinity prominently inhibits cucumber primary root growth, and CsCEP gene expression is differentially induced by salinity. We further demonstrate that the exogenous application of synthetic CsCEP3 peptide partially suppresses salinity-triggered growth inhibition in cucumber primary root, although CsCEP3 peptide itself shows no obvious effect on cucumber primary root growth under normal conditions. Our transcriptomic and qRT-PCR data further reveal that CsCEP3 peptide may modulate gene expression related to abscisic acid (ABA) signaling pathway, reactive oxygen species (ROS) production, and slat-responsive transcription factors to attenuate the inhibitory effect of salinity on cucumber primary root growth. Taken together, our work provides a fundamental insight into CEP peptide-mediated cucumber salinity adaptation

HIV testing uptake and yield among sexual partners of HIV-positive men who have sex with men in Zhejiang Province, China, 2014-2016: A cross-sectional pilot study of a choice-based partner tracing and testing package.

BACKGROUND:Measures to effectively expand tracing and testing to identify undiagnosed HIV infections are significant for the control of HIV/AIDS epidemic among men who have sex with men (MSM). We piloted a choice-based tracing and testing package aimed at improving partner tracing, uptake, and yield of HIV testing for sexual partners of newly diagnosed HIV-positive MSM. METHODS:This package was piloted in the cities of Hangzhou and Ningbo, Zhejiang province, China from June 2014 to June 2016. The package adopted four modes: couples' HIV counseling and testing (CHCT), information assisted partner notification (IAPN), assisted HIV self-testing (HIVST) and patient referral. Data regarding sociodemographic factors and sexual behaviors between HIV-positive MSM and their sexual partners, as well as tracing and testing outcomes of each mode, were collected. RESULTS:Among 2,495 newly diagnosed HIV-positive MSM, 446(18%) were enrolled as index cases (ICs) through two rounds of contact tracing. The ICs disclosed a total of 4,716 sexual partners, of whom 548 (12%) were reachable. The pilot study resulted in a testing uptake of 87% (478/548), and a yield of 16% (74/478) among sexual partners. The generalized linear mixed model showed that the odds of a reachable sexual partner enrolled via IAPN taking an HIV test were 290% greater than that of a partner traced via CHCT (95% CI: 1.6, 9.3). CONCLUSIONS:A choice-based tracing and testing package can feasibly expand HIV testing uptake and case finding among sexual partners of HIV-positive MSM. IAPN may be an acceptable option to reach sexual partners for whom limited contact information is available

Outbreak of HIV Infection Linked to Nosocomial Transmission, China, 2016–2017

On January 25, 2017, a physician from ZC Hospital in Hangzhou, China, reported to the Zhejiang Provincial Center for Disease Control and Prevention that a potential HIV outbreak might have occurred during lymphocyte immunotherapy (LIT) performed at the hospital on December 30, 2016. We immediately began investigating and identified the index case-patient as an LIT patient’s husband who donated lymphocytes for his wife’s LIT and later screened HIV-reactive. Subsequent contamination by a technician resulted in the potential exposure of 34 LIT patients. Acute HIV infection was diagnosed in 5 persons. Phylogenetic analysis confirmed that the HIV-1 gag, pol, and env gene sequences from the index and outbreak-related cases had >99.5% similarity. Rapid investigation and implementation of effective control measures successfully controlled the outbreak. This incident provides evidence of a lapse in infection control causing HIV transmission, highlighting the need for stronger measures to protect patients from infectious disease exposure