Risks and predictors of mortality among human immunodeficiency virus-infected children receiving highly active antiretroviral therapy in Yunnan Province / 中华传染病杂志

Objective To investigate the influence factors of mortality among human immunodeficiency virus (HIV)-infected children under highly active antiretroviral therapy (HAART).Methods Retrospective cohort study of 652 children initiated HAART from 2005 to 2014 was conducted,and enrolled patients were followed-up until December,2015.Survival data was analyzed using Kaplan-Meier method and Cox regression model was used to identify independent predictors of mortality among these children on HARRT.Chi-square test and Fisher's exact test were used for comparison between groups.Results Overall,26 of the children died over a follow-up period of 3 116.24 child-years,with a mortality rate of 0.83 per 100 child-years.Twelve (46％)of deaths occurred during the first six months after starting HAART.Cox regression analysis of variables showed that the World Health Organization (WHO) clinical stages Ⅲ/Ⅳ (hazard rate [HR] =10.717,95％confidence interal [95％ CI]:4.189-4.749,P =0.000),baseline hemoglobin ＜ 80 g/L (HR =14.768,95 ％ CI:5.721-38.125,P =0.000),tuberculosis co-infection (HR =4.794,95％ CI:2.105-10.918,P =0.000),baseline CD4+T lymphocyte ＜ 50 cells/μL (HR =4.219,95％ CI:1.524-11.680,P =0.006),weight-for-age z-score ＜-2 (HR =2.983,95 ％ CI:1.094-8.135,P =0.033) were independently associated with death,whereas the age ＜ 7 year-old at HAART initiation was protectire (HR =0.293,95％ CI:0.126-0.684,P =0.005).Conclusions The mortality of children receiving HAART is strongly associated with WHO stages Ⅲ/Ⅳ,hemoglobin ＜ 80 g/L,weight-for-age z-score ＜-2,tuberculosis co-infection and older age at treatment.

Amplification and identification of regulatory T cells derived from mice in vitro / 中国医师杂志

Objective@#To establish a method for in vitro expansion of regulatory T cells (Tregs) for clinical study and immunotherapy.@*Methods@#CD4+ T cells were isolated from BALB/c spleens by magnetic activated cell sorting (MACS), then cultured in 24-well plates coated with anti-CD3/CD28 microbeads in the presence of 100 U/ml interleukin-2 (IL-2) and 5 ng/ml recombinant human transforming growth factor-β (rhTGF-β). The purity of the expanded Tregs were tested by flow cytometry. In vitro inhibition of CD4+ CD25-T cells response by expanded Tregs was measured by mixed lymphocyte reaction test. The number and the viability of the expanded Tregs were detemined by trypan blue staining.@*Results@#Tregs were expanded up to 20 folds after 5 days in culture, and the activity was (93±4)%. The purity of expanded Tregs were (79.1±1.5)%, and maintained suppressive ability.@*Conclusions@#We can obtain large numbers of Tregs with highly purity and suppressive ability, thereby providing a solution to the availability of sufficient Tregs in clinical study and immunotherapy.

Amplification and identification of regulatory T cells derived from mice in vitro / 中国医师杂志

Objective To establish a method for in vitro expansion of regulatory T cells (Tregs)for clinical study and immunotherapy.Methods CD4 + T cells were isolated from BALB/c spleens by magnetic activated cell sorting (MACS),then cultured in 24-well plates coated with anti-CD3/CD28 microbeads in the presence of 100 U/ml interleukin-2 (IL-2) and 5 ng/ml recombinant human transforming growth factor-β (rhTGF-β).The purity of the expanded Tregs were tested by flow cytometry.In vitro inhibition of CD4 + CD25-T cells response by expanded Tregs was measured by mixed lymphocyte reaction test.The number and the viability of the expanded Tregs were detemined by trypan blue staining.Results Tregs were expanded up to 20 folds after 5 days in culture,and the activity was (93 ± 4) ％.The purity of expanded Tregs were (79.1 ± 1.5) ％,and maintained suppressive ability.Conclusions We can obtain large numbers of Tregs with highly purity and suppressive ability,thereby providing a solution to the availability of sufficient Tregs in clinical study and immunotherapy.

Analysis of the nearly full-length genome of a novel HIV-1 CRF01_AE/B/C recombinant strain isola-ted in Yunnan Province / 中华微生物学和免疫学杂志

Objective To analyze the genetic structure and recombination characteristics of a new-ly discovered HIV-1 unique recombinant strain in Yunnan Province. Methods During a test for drug-resist-ant HIV genotypes in Yunnan Province in 2016, a recombinant fragment was found in the pol region of a HIV-1 strain isolated from a patient. Two overlapping segments of the HIV-1 genome were amplified by RT-PCR, and then the products were sequenced. Recombination analysis was performed using RIP, jpHMM and SimPlot3. 5 software. A phylogenetic tree was constructed for homology analysis by Neighbor-joining method using MEGA6. 06 software. Results A nearly full-length HIV-1 gene sequence with 8590 bp in length was obtained. Breakpoint analysis indicated that the sequence consisted of CRF01_AE and fragments of B and C subtypes. CRF01_AE was used as the backbone with B and C subtype fragments inserted. The positions were 791 to 1171 for CRF01_AE, 1172 to 2652 for C subtype fragment, 2653 to 2977 for B subtype frag-ment, and 2978 to 9380 for CRF01_AE using HIV-1 HXB2 as the reference strain. Conclusions Some new strains formed by cross-recombination of CRF01_AE and B and C subtypes were discovered in Yunnan Province in recent years. It was found that the recombination pattern of the newly discovered strain was com-plex, suggesting that close attention should be paid to the changes in epidemic trends, which was of great im-portance to understand the current prevalence and epidemic trends of HIV-1.

Long-term efficacy evaluation of antiretroviral therapy and genotypic resistance analysis among human immunodeficiency virus 1-infected children in Yunnan / 中华传染病杂志

Objective To evaluate the long-term efficacy of antiretroviral therapy and drug resistance among human immunodeficiency virus-1(HIV-1)-infected children in Yunnan.Methods In this retrospective study,CD4+T cell counts,HIV viral loads and genetic drug resistance results were obtained from HIV-1-infected children who were treated with antiretroviral treatment between January 2004 to July 2015.Results A total of 1 078 HIV/acquired immune deficiency syndrome(AIDS)children were treated with antiviral therapy.Before treatment,the average CD4+cell number was(466.8 ± 397.2)cells/μL. The percentages of children with CD4+cell count >750 cells/μL after 1-year,3-year,5-year and 8-year treatment were 54.31%,62.87%,68.46% and 74.19%,respectively.Virological failure occurred in 150 HIV/AIDS children(13.9%),and the virological failure rate was 4.3/100 child-years.Among those 150 patients with virological failure,104 cases(69.33%)exhibited genetic resistance to antiretroviral drugs.The prevalent mutations associated with drug resistance were M 184V/I(75.0% [78/104]), K103N(43.3%[45/104]),G190A(29.8%[31/104]),Y181C(22.1%[23/104]),T215Y/F(20.2%[21/104]).Conclusions After long-term antiretroviral treatment,most of the HIV-infected children have restored the immunity and suppressed HIV viral replication successfully.HIV resistance is the main cause of virological failure.Drug resistance mutations mainly occur in nucleoside reverse transcriptase inhibitor and non-nucleoside reverse transcriptase inhibitor,and the resistance rate of proteinase inhibitor is low.Early genetic resistance testing and switch to second-line therapy will improve the treatment outcome.

Analysis of genotype resistance mutations sites among 123 antiretroviral-therapy failure in HIV/AIDS patients in Yunnan province, China / 中华检验医学杂志

Objective To analyze the prevalence and diversity of genotype resistant mutations in 123 HIV/AIDS patients experiencing failure of high antiretroviral therapy (HAART) in Yunnan province.Methods A cross-sectional survey was conducted among 151 HIV/AIDS patients experiencing failure of antiretroviral therapy form January 2011 to January 2012 in Yunnan province.The HIV-1 pol gene was amplified by reverse transcription-polymerase chain reaction (RT-PCR),the sequences were then submitted to the Stanford University HIV drug resistance database to analyze the prevalence of resistant mutations.The resistant mutations were statistically analyzed by gender,ethnic groups,transmission route and subtype,respectively.The chi-square or fisher's exact test was used for statistical test.Results Of the 151 cases,123 plasma samples were amplified successfully for protease PR (codon 1-99) and reverse transcriptase RT (codon 1-272) fragments.The most common mutation was M184 (72.4％),followed by the mutation at position K103 (47.2％),T215 (26.0％),D67 (15.4％),G190 (34.1％),Y181 (29.3％),K101 (17.1％).The frequency of mutations at position V75,A62 and M230 was higher in male population than that in female population (x2 =7.001,6.975,5.446,P ＜ 0.05).The frequency of variants at position Tl215,K70 and T69 was higher in the Han population than in the other ethnic population(x2 =5.290,4.060,3.860,P＜ 0.05).It was interesting that the variant M41L was rare in the other ethnic groups.The significant difference existed at various transmission routes.Frequencies of variants at position T215 and T69 were significantly higher among people infected HIV-I through sexual contact than the intravenous drug users (x2 =10.431,7.952,P ＜ 0.05).Frequencies of variants at position G190 were significantly higher among the intravenous drug users than the population infected HIV-1 through sexual contact(x2 =6.669,P ＜ 0.05),but the variant M230L never occurred in intravenous drug users.The RT mutations V75,T69,M230 were more frequently occurred in patients infected with CRF01_AE than in patients with subtype B (P＜ 0.05).The mutation L74 was never seen in patients infected with CRFOI_AE (P ＜ 0.05).Conclusions The HIV/AIDS patients with failure of high antiretroviral therapy (HAART) were attributed to HIV-1 genotype resistance mutations.The mutation sites among the HAART failure patients from the regions of Dehong,Gejiu,Wenshan and Yuxi were significant difference accordance among the gender,ethnicith,transmission route and subtype,respectively.

Investigation on situation of cervical intraepithelial neoplasia and cervial cancer among rural women in Qianjiang district of Chongqing city / 重庆医学

Objective To investigate the prevalence and the distribution in population of cervical intraepithelial neoplasia (CIN) and cervical cancer among rural women in Qianjiang district of Chongqing city .Methods From April 2010 to April 2012 ,25 128 married rural women in Qianjiang district were performed screening and detection .The individuals with the positive results were performed the colposcopy and cervical biopsy .Results 112 cases were found with the positive results of the pathological examina-tion ,including 58 cases of CINⅠ ,26 cases of CINⅡ ,19 cases of CINⅢ and carcinoma in situ and 9 cases of invasive carcinoma .The incidence rate of CIN and cervical cancer in Tujia nationality women was significantly higher than that in Han nationality women and Miao nationality women .Conclusion The cervical cancer screening is an important way to find early pathological lesions of cer-vical cancer and prevent cervical cancer ,and is the necessary measure to reduce the incidence rate of cervical cancer in rural women .

Investigation of pol gene variation of HIV-1 epidemic strains after treatment with HARRT at Dehong prefecture and Kunming in Yunnan province / 中华检验医学杂志

Objective To investigate the variations in the pol region of HIV-1 strain in treatment failed patients in Yunnan province's Dehong prefecture and Kunming. Methods Blood samples were collected from 139 patients who experienced treatment failure ( HAART treatment ＞ 1 years and HIV-1 RNA Viral load ＞ 1 000 copies/ml). HIV-1 RNA was extracted from plasma, and nested-PCR was performed for amplification of PR and RT genes on the HIV-1 pol region. The PCR products were then sequenced and submitted to Stanford HIV Drug Resistance Database for comparison. The evolution tree was built up with MEGA 4. 1 system, combined with patients' demographics. Results The most prevalent mutation in Kunming patients were T215F/N/Y/I, M41L/M, and T69G/N/I/S/A/D, the mutation rates were 39%(24/62), 27% (17/62) and 27% (17/62) , respectively, which were higher than the corresponding mutations in the Dehong prefecture [16% ( 11/69), 13% (9/69) and 9% (6/69)]. The rate differences were statistically significant ( x2 = 8.646, 4.242 and 7. 909, all P ＜ 0.05 ). The most common HIV-1 pol region subtype in the Dehong patients were CRF01_AE subtype (32%, 22/69), followed by C subtype (25% ,17/69), and B subtype ( 19%, 13/69). Major subtypes in Kunming patients were 08_BC (60%,37/62 ), CRF01_AE subtype(21% , 13/62 ) and 07_BC ( 15% ,9/62). Conclusions Partial differences of the point mutations of the HIV-1 strain pol region and frequency of their occurrences exist among Dehong and Kunming patients, HIV-1 strains in Dehong prefecture for the NNRTIs mutations at the T215 Y/N/T, M41L and T69G/N/I/S/A/D are significantly higher than those in Kunming. Six isoforms are found respectively:CRF01_AE, B, C, BC, 08_BC and 07_BC from the epidemic strains of HIV-1 pol region subtype in Dehong and Kunming areas.

Antidepressants in the treatment of functional dyspepsia / 中华消化杂志

Objective To evaluate the role of antidepressants in the treatment of functional dyspepsia (FD). Methods 90 cases of FD with anxious depressive manifestations were randomizely allocated into antidyspepsia group, antidepressant group and antidyspepsia and antidepressants combination group. All patients were treated for 8 weeks. Results FD scores(upper abdominal distention, satiety, abdominal pain, belching) with Zung depression scale and HAMD scale decreased after treatment in all three groups. Symptoms in combination group improved with a total efficacy rate of 86.7%, and HAMD efficacy rate 86.7%. Both were much higher than those in antidyspepsia group(36.7% and 10.0%, respectively, P

Cardiac affects of esophageal dilatation and stent implantation / 中华消化内镜杂志

Objective To investigate the cardiac affects of esophageal dilatation and stent implantation and its possible pathogenic mechanism. Methods One hundred patients who underwent esophageal dilation or stent implantation had investigeted with Hotter tape recorder, vectorcardiogram, oxygen saturation and cardiac enzymes checked at the time prior to. during and after the procedure respectively. Results During the procedure, incidence of frequent ventricular premature beats was 66%, paroxysmal ventricular tachycardia 9 cases; frequent atrial premature heats 73 cases, paroxysmal supraventricular tachycardia 21 eases, myocardial ischaemia 17 cases and hypoxia 69 eases with significant differences comparing with those prior to the procedure(9 cases; 0 case; 7 cases; 0 case; 0 case and 9 eases respectively) but all above changes as well as cardiac enzymes recorded 24 hours after the procedure had no statistical significance comparing with those prior to the procedure. Conclusion There is a high incidence of cardiac arrhythmia and myocardial ischaemia at the time of dilatation and stent implantation. However, most of these changes can subside without intervention 24 hours after the procedure. Pathogenic mechanisms involved may be related to hypoxia duo to the pain provoked by the procedure suggesting close observation is needed during the operation.