Unprotected Sex with Casual Partners: A Neglected Source of HIV Transmission among Members of the Yi Minority in Southwestern China

The Yi are the largest and most disadvantaged ethnic minority population in southwestern China. This region contains over eight million Yi, with approximately 2.4 million living in the Liangshan Yi Autonomous Prefecture （Liangshan） in Sichuan Province. Liangshan is located along one of the main drug trafficking routes from the ＇Golden Triangle＇ to northwest and central China, making it one of the largest illicit drug production and distribution centers in China.

Percutaneous treatment of <i>de novo</i>unprotected left main stenosis in unselected consecutive patients: Experience of a high volume center

Background: Percutaneous coronary intervention (PCI) has been increasingly employed to treat unprotected left main (ULM) stenosis, with hard endpoints similar to by-pass surgery, in patients selected by a Heart Team. Methods: From January 2008 to December 2011, 317 unselected and consecutive patients with de novo ULM stenosis underwent PCI with both bare metal (BMS) and drug-eluting (DES) stents. Major adverse cardiovascular events, target lesion (TLR) and vessel (TVR) revascularization were evaluated over a mean period of 590 ± 371 days. Results: Our population was characterized by a mean age 72 ± 10 years, high rate of acute coronary syndrome (ACS) (either with ST or non-ST elevation myocardial infarction, 15.5% and 35% respectively), severe comorbidity 16%, mean Euroscore 7 ± 3, mean Syntax Score 25 ± 9. In-hospital mortality was 6%. During the follow-up period, all-cause mortality was 16.7%, falling to 7% at the end of the follow-up, excluding patients presenting with ACS. TLR was observed and treated in 15% of patients. BMS utilization, age >75 years, ACS indication, Syntax Score >32 and associated peripheral artery disease were independent predictors of mortality at multivariate analysis. Conclusions: Stenting of ULM stenosis appears to be associated with a favorable mid-term outcome, even in an unselected population.

Intervention Value of Unprotected Midwifery Nursing in Natural Delivery of Primipara

Objective:This paper mainly explores the application value of unprotected midwifery care for primipara natural childbirth.Methods:120 primiparas in our hospital from January 2017 to February 2019 were divided into routine group and Research Group,60 cases in each group.The routine group was given routine perineal protection midwifery,and the Research Group was given routine midwifery nursing.The nursing intervention effects of the two groups were compared statistically.Results:After statistics,VAS score and bleeding volume of perineal pain in the Research Group were lower than those in the conventional group,and the length of hospital stay in the Research Group was less than that in the conventional group,P<0.05;There was no significant difference in the time of the first stage of labor,the second stage of labor and the third stage of labor between the Research Group and the conventional group(P>0.05);The incidence of complications in the Research Group was lower than that in the conventional group(P<0.05).Conclusion:The application value of unprotected midwifery nursing intervention in primipara natural childbirth is significant.

Ir-Catalyzed Asymmetric Hydrogenation of Unprotected Indoles:Scope Investigations and Mechanistic Studies

Transition metal-catalyzed asymmetric hydrogenation(AH)of unprotected indoles has mainly been applied to alkyl substituted unprotected indoles.However,the challenging aryl substituted unprotected indoles with poor reactivity and enantioselectivity(≤42%ee)could not be hydrogenated well.In this work,a highly efficient Ir/bisphosphine-thiourea ligand ZhaoPhos catalytic system for the AH of challenging aryl substituted unprotected indoles has been successfully developed for the first time with high reactivity and excellent stereoselective control.Moreover,a series of 2-alkyl-substituted and 2,3-disubstituted unprotected indoles were also well tolerated in this catalytic system.A wide variety of chiral indoline derivatives were obtained in good to high yields with excellent stereoselectivities(75–99%yields,>20:1 dr,and 86–99%ee).The anion-binding activation strategy played an important role in accessing both high reactivity and excellent stereoselectivity,which was formed between the catalyst and unprotected indoles in situ-generating iminium ion with the assistance of Brønsted acid.A possible catalytic mechanism was proposed for this Ir-catalyzed AH according to density functional theory calculations and control experiment results.Readily available substrates,a broad range of substrate tolerance,an efficient chiral catalytic system,and a gram-scale protocol further demonstrated the potential practicality of this methodology.

Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease

Background： There are limited data on longer-term outcomes （〉5 years） for patients with unprotected left main coronary artery （ULMCA） disease who underwent percutaneous coronary intervention （PCI） in the drug-eluting stents （DES） era. This study aimed at comparing the long-term （〉5 years） outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting （CABG） and the predictors of adverse events. Methods： All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups. Results： Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses （DES = 465 vs. CABG = 457）. During the median follow-up of 7.1 years （interquartile range 5.3-8.2 years）, no difference was found between PCI and CABG in the occurrence of death （P = 0.282） and the composite endpoint of cardiac death, myocardial infarction （MI） and stroke （P = 0.294）. Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group （P = 0.014） in large part because of the significantly higher rate of repeat revascularization （P 〈 0.001）. PC/was correlated with the lower occurrence of stroke （P = 0.004）. Multivariate analysis showed ejection fraction （EF） （P = 0.012）, creatinine （P = 0.016）, and prior stroke （P = 0.03 l） were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age （P = 0.026） and EF （P = 0.002） were independent predictors in the CABG group. Conclusions： During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group.

Clinical outcome after management of unprotected left main in-stent restenosis after bare metal or drug-eluting stents

Background Implantation of either bare metal stent （BMS） or drug-eluting stent （DES） has been used in every day practice for patients with unprotected left main stenosis （UPLMS）. There are still a lack of data regading the subsequent results of UPLMS in-stent restenosis （ISR）. The present study aimed at determing the clinical outcome of UPLMS ISR patients after implantation of either BMS or DES.Methods Patients with UPLMS ISR after stenting were included. The primary endpoint was the cumulative major adverse cardiac events （MACE）, including cardiac death, myocardial infarction （Ml）, and target vessel revascularization （TVR）.Results UPLMS ISR rate was 14.8% （n=73, 15.7% after BMS, 14.5% for DES） after average of （3.89±2.01） years （range from 1 to 10.5 years） follow-up. Angiographic follow-up between 6-8 months was available in 85.3%. Of these,repeat percutaneous coronary intervention （PCI） was used in 62 （84.9%） patients, with medicine only in 9 （12.4%） and coronary artery bypass graft （CABG） in 2 （2.7%）. Most repeat PCI patients were with unstable angina （87.0%）, and had decreased left ventricular ejection fraction （（42.58±5.12）%）, fewer focal/ostial left circumflex branch （LCX） lesions, in relative to medicine only group. After （31.9±23.3） months, the MACE, Ml, TVR and cardiac death were 31.5%, 1.4%, 24.1% and 8.2%, respectively. Definite and possible stent thrombosis occurred in 1 （1.4%） patient.Conclusions Medical therapy for asymptomatic isolated ostial LCX was safe. Repeat PCI for UPLMS ISR was associated with acceptable early and short-term clinical outcome. Further study was needed to elucidate the role of CABG in treating UPLMS ISR.

Facile access to chiral 1-pyrrolines through Rh-catalyzed enantioselective partial hydrogenation of unprotected simple pyrroles

Highly enantioselective Rh-catalyzed partial hydrogenation of unprotected simple 2-alkyl-5-aryl-disubstituted pyrroles has been successfully developed,generating a series of chiral 1-pyrroline derivatives generally with excellent results(95%-99%yields,91%-96%ee).Moreover,2,5-aryl-1H-pyrroles were hydrogenated well in high yields and good enantioselectivities.This efficient protocol features easily accessible substrates,wide substrate scope,well functional group compatibility,commercially available rhodium precursor and chiral ligand.It provides a versatile route to access chiral 1-pyrroline derivatives that are of great importance in organic synthesis and pharmaceutical chemistry.

Catalyst-free Photochemical Bromination of Unprotected Aromatic Amino Acid Derivatives by Using a Rotating Ultraviolet Photoreactor

Aromatic amino acid halides are valuable amino acid derivatives and fundamental building blocks that are used to various coupling reaction^1-3!,such as Heck,Suzuki and Ullmann reaction[4-7],and also important precursors of active natural products,pharmaceuticals and chiral auxiliaries[8-9].

In-situ Protection Management and Conservation Study of Some Medicinal Plants

In-situ study on eleven commercially important species viz; Adiantum capillus-veneris L, Bergenia ciliata (Haw) Sternb, Colchicum luteum Baker, Polygonum amplexicaule D.Den, Cuminum cyminum L, Dioscorea deltoidea Wall Kunth,L Morchella esculenta L, Paeonia emodi Wall ex H Kf, Podophyllum hexandrum (Royle) Chatt & Mukh, Valeriana wallichii DC and Viola serpens Wall ex Roxb was conducted in four locations viz; Malam (1 400 to 2 000?m),Bargin (1 700 to 2 300?m),Biakand (1 500 to 2 100?m) and Shinko (2 100 to 2 700?m).The data was recorded from both protected and unprotected sites of each site.Each site had 3 altitudinal sampling point.The density, herbage coverage and fresh biomass were determined in each locations for every species.All the investigated parameters generally showed an increase of 3 to 6 times over unprotected sites in each locations. Morchella esculenta,Dioscorea deltoidea,Colchicum luteum and Podophyllum hexandrum were absent in all unprotected sites while other species had low values in these sites.The investigated parameters of Colchicum luteum,Bergenia ciliata,Paeonioa emodi,Dioscorea deltoidea and Podophyllum hexandrum generally increased with the increasing elevation.Soil analysis,soil and air temperatures were recorded for each site.The air and soil temperature were slightly higher in open areas than in the protected site and showed decrease with increasing elevation.While the soil fertility was relatively high in protected sites as compared to unprotected area.The study shows that protection promotes the growth, distribution and occurrence of medicinal plants.It is possible with the participation of local communities to conserve these resources.

Evaluation of Condom Use among University Undergraduates in Port Harcourt, Nigeria

Background: Barrier contraception has the beauty of dual protection—against pregnancy and sexually transmitted infections. Following the persisting burden of unsafe abortion and human immunodeficiency virus (HIV), much sensitization/campaign has been ongoing in the past few decades by government and non-governmental organisations (NGOs) in Nigeria against unprotected sexual intercourse. The youth are generally assumed to have high risk sexual behaviour, hence this study on Port Harcourt university undergraduates. Objectives: To determine the awareness and use of condom among University undergraduates in Port Harcourt. Methods: The study was a prospective descriptive cross-sectional study of 636 undergraduate students of the University of Port Harcourt and Rivers state University, South-south Nigeria. The multistage sampling technique was used to randomly select participants and data collected using a pretested structured self administered questionnaire. Data was analyzed using version 23.0 SPSS and reported in means, frequencies and percentages. Probability value was set at 5% (p χ2 = 200.602). Only 5.5% of the respondents in this study were willing to know their HIV status. Conclusion: There is a high level of condom awareness among Port Harcourt University undergraduates. Surprisingly, their practice of unprotected sexual intercourse is still high.

Plant Species Composition and Distribution in Relation to Land Use Patterns in Serengeti Ecosystem Tanzania

Serengeti is the largest ecosystem in Tanzania endowed with high level of biodiversity in protected and unprotected areas. Serengeti National Park is the only protected area in a matrix of unprotected areas characterized with a wide range of human activities which threaten biodiversity conservation. It was assessed plant species composition, diversity, distribution and vegetation structure in both the protected and unprotected areas of the ecosystem. Two transects with twenty plots each were established in each vegetation type in which data was collected. A significantly higher species composition (262) and diversity (2.39 ± 0.03) was observed in unprotected areas than in the protected area (163 and 2.06 ± 0.04 respectively). The DCA ordination of the species data from the two management regimes formed four clusters based on similarity in plant species composition, where three clusters were from unprotected areas and one from protected area. The variations in plant species composition ranged from 35.69% to 65.92% for the first four DCA axes. There was no significant difference in stem density between protected and unprotected areas of the ecosystem. Although high density of trees at 10 - 14 cm DBH sizes was observed in both sides of the conservation management regimes, individuals with DBH above 65 cm existed in the protected area but were absent in unprotected areas. It can be concluded that the decrease of plant species diversity and density in unprotected area is because of habitat degradation associated with exploitation pressure, livestock grazing and other forms of disturbance related with anthropogenic activities. Because of high demand for plant resources, the local community needs to establish woodlots to cater for wood resource needs outside the protected areas of Serengeti. Also, pastoralists need to diversify livestock keeping systems compatible with limited grazing land in unprotected area of the Serengeti ecosystem.

Sexuality and Emergency Contraceptive Practice among Female Undergraduates in Lagos, Nigeria

Background: Young people, especially those in tertiary institutions are vulnerable to unplanned and unprotected sexual intercourse which predisposes them to unintended pregnancies and subsequently unsafe abortions. One of the key interventions for reduction of unwanted pregnancies and unsafe abortions is effective use of emergency contraceptives. Objectives: To assess the sexuality, perception, attitude towards and determinants of usage of emergency contraception among female undergraduates in Lagos, Nigeria. Methods: Cross-sectional survey conducted in June 2016 among 805 female students of the Lagos State University. Data were collected through structured self-administered questionnaire by obtaining information on demography, sexual and contraceptive history, perception, attitude towards and use of emergency contraceptives. Data obtained were analyzed using SPSS version 16. Chi-square and logistic regression models were applied to variables to test for significance that predicts the use of emergency contraceptives. Results: Of the 725 (90%) completed questionnaires, 334 (46%) of the respondents were sexually active with 115 (34%) having previous history of pregnancy. Eighty-two percent of those pregnancies were unintended. Eighty-eight percent of those with unintended pregnancy had them terminated by induced abortions, 54% of which was carried out by untrained persons. Only 29% of those who had unprotected sexual intercourse used emergency contraceptives. Lack of knowledge and promotion of sexual promiscuity were identified as the main reasons for not using emergency contraceptives. Previous use of contraceptives, married status, increasing age and year of study were positive predictors for the use of emergency contraceptives while poor knowledge was a significant predictor of non-use. Conclusion: There was poor knowledge and low utilization of emergency contraceptives among respondents. Information on contraceptives should be introduced in secondary schools and in general studies courses in tertiary institutions while parents and caregivers should discuss issues relating to sex and contraceptives with adolescents.

Enzyme-like C-H Oxidation of Glucosides Promoted by Visible Light

To match nature’s prowess at using enzymes to make desired motifs in a regioselective fashion,we explore the use of visible light for the selective oxidation of the hydroxyl group to afford the corresponding ketosaccharide.This highly admirable approach offers several advantages over the enzymatic approach in terms of yields and the scope of substrates.Herein,we report the development of a simple visiblelight-promoted selective oxidation of unprotected glucosides that allows for inexpensive access to valuable keto-saccharide building blocks.The method is employed on a variety of different natural and artificial glucosides,is operationally simple and scalable,and can be used to access keto-saccharides rapidly and inexpensively.

Effect of Final Kissing Balloon Dilatation after One-stent Technique at Left-main Bifurcation： A Single Center Data

Background:Whether final kissing balloon (FKB) dilatation after one-stent implantation at left-main (LM) bifurcation site remains unclear.Therefore,this large sample and long-term follow-up study comparatively assessed the impact of FKB in patients with unprotected LM disease treated with one-stent strategy.Methods:Total 1528 consecutive patients underwent LM percutaneous coronary intervention in one center from January 2004 to December 2010 were enrolled; among them,790 patients treated with one drug-eluting stent crossover LM to left anterior descending (LAD) with FKB (n =230) or no FKB (n =560) were comparatively analyzed.Primary outcome was the rate of major adverse cardiovascular events,defined as a composite of death,myocardial infarction (MI) and target vessel revascularization (TVR).Results:Overall,The prevalence of true bifurcation lesions,which included Medina classification (1,1,1),(1,0,1),or (0,1,1),was similar between-groups (non-FKB:37.0％ vs.FKB:39.6％,P =0.49).At mean 4 years follow-up,rates of major adverse cardiovascular events (non-FKB:10.0％ vs.FKB:7.8％,P =0.33),death,MI and TVR were not significantly different between-groups.In multivariate propensity-matched regression analysis,FKB was not an independent predictor of adverse outcomes.Conclusions:For patients treated with one-stent crossover LM to LAD,clinical outcomes appear similar between FKB and non-FKB strategy.

Chemoselective Dual Functionalization of Phenols via Relay Catalysis of Borane with Different Forms

A highly efficient and chemoselective dual functionalization of unprotected phenols withα-orβ-hydroxyl acids is presented.A variety of valuable benzofuranones and dihydrocoumarins are delivered in moderate to high yields.Density functional theory(DFT)calculations and control experiments indicate that an untypical Friedel–Crafts alkylation and the subsequent lactonization are catalyzed by the Lewis acid form and the Brønsted acid form of borane,respectively.Gram-scale experiments and late-stage functionalization of complex molecules have been performed to highlight the utility of this reaction.