Development of COVID-19 pandemic prevention and control policies in China / 复旦学报（医学版）

Since the World Health Organization(WHO)officially announced COVID-19 as a global pandemic in 2020,114 countries or regions in the world have been affected to varying degrees.The arrival of the post-epidemic era requires countries to take new epidemic prevention and control measures to deal with the problems and challenges that may arise in the future.In order to help China consolidate its epidemic prevention achievements over the years and gain a larger development window in the post-epidemic era,this study explored the changes in the global epidemic situation and the major national prevention and control policies in different countries,summarized the development and changes of China's epidemic prevention and control policies,and proposed new family-centered precision prevention and control measures that adapt to China's national conditions.

Nanomaterial-based Therapeutics for Biofilm-generated Bacterial Infections / 生物化学与生物物理进展

Bacterial biofilms gave rise to persistent infections and multi-organ failure, thereby posing a serious threat to human health. Biofilms were formed by cross-linking of hydrophobic extracellular polymeric substances (EPS), such as proteins, polysaccharides, and eDNA, which were synthesized by bacteria themselves after adhesion and colonization on biological surfaces. They had the characteristics of dense structure, high adhesiveness and low drug permeability, and had been found in many human organs or tissues, such as the brain, heart, liver, spleen, lungs, kidneys, gastrointestinal tract, and skeleton. By releasing pro-inflammatory bacterial metabolites including endotoxins, exotoxins and interleukin, biofilms stimulated the body’s immune system to secrete inflammatory factors. These factors triggered local inflammation and chronic infections. Those were the key reason for the failure of traditional clinical drug therapy for infectious diseases.In order to cope with the increasingly severe drug-resistant infections, it was urgent to develop new therapeutic strategies for bacterial-biofilm eradication and anti-bacterial infections. Based on the nanoscale structure and biocompatible activity, nanobiomaterials had the advantages of specific targeting, intelligent delivery, high drug loading and low toxicity, which could realize efficient intervention and precise treatment of drug-resistant bacterial biofilms. This paper highlighted multiple strategies of biofilms eradication based on nanobiomaterials. For example, nanobiomaterials combined with EPS degrading enzymes could be used for targeted hydrolysis of bacterial biofilms, and effectively increased the drug enrichment within biofilms. By loading quorum sensing inhibitors, nanotechnology was also an effective strategy for eradicating bacterial biofilms and recovering the infectious symptoms. Nanobiomaterials could intervene the bacterial metabolism and break the bacterial survival homeostasis by blocking the uptake of nutrients. Moreover, energy-driven micro-nano robotics had shown excellent performance in active delivery and biofilm eradication. Micro-nano robots could penetrate physiological barriers by exogenous or endogenous driving modes such as by biological or chemical methods, ultrasound, and magnetic field, and deliver drugs to the infection sites accurately. Achieving this using conventional drugs was difficult. Overall, the paper described the biological properties and drug-resistant molecular mechanisms of bacterial biofilms, and highlighted therapeutic strategies from different perspectives by nanobiomaterials, such as dispersing bacterial mature biofilms, blocking quorum sensing, inhibiting bacterial metabolism, and energy driving penetration. In addition, we presented the key challenges still faced by nanobiomaterials in combating bacterial biofilm infections. Firstly, the dense structure of EPS caused biofilms spatial heterogeneity and metabolic heterogeneity, which created exacting requirements for the design, construction and preparation process of nanobiomaterials. Secondly, biofilm disruption carried the risk of spread and infection the pathogenic bacteria, which might lead to other infections. Finally, we emphasized the role of nanobiomaterials in the development trends and translational prospects in biofilm treatment.

Chinese expert consensus on diagnosis and treatment strategies for SARS-CoV-2 infection in immunocompromised populations(2023 edition-2) / 中国感染控制杂志

Since the end of 2019,severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection has swept the world,bringing great harm to human society and significantly increasing the health burden.Due to stron-ger infectivity,faster transmission,and higher reinfection rate of the Omicron variant,it has now replaced the Delta variant as the main epidemic strain for both imported and local outbreaks in China.Chinese Diagnosis and treatment protocol for SARS-CoV-2 infection(10th trial version)emphasizes"strengthening the protection of key popula-tions,"which includes the increasing number of immunocompromised population.These people have a high inci-dence of severe diseases and a high fatality rate after infected with SARS-CoV-2,and belong to the high-risk popula-tions of severe or critical diseases.Moreover,due to underlying diseases,these people take immunosuppressants and other related drugs chronically.The interactions between anti-SARS-CoV-2 infection treatment drugs and origi-nal drugs are complicated,thus bring significant challenges to the treatment after the SARS-CoV-2 infection.Cur-rently,there is a lack of guidelines or consensus on the diagnosis and treatment of SARS-CoV-2 infection among im-munocompromised population.Therefore,the Guangzhou Institute of Respiratory Health and National Center for Respiratory Medicine organized experts from multiple disciplines(respiratory and critical care medicine,organ transplantation,rheumatology and immunology,hematology,infection,critical care medicine,etc.)in China.Af-ter multiple rounds of discussions,13 items of recommendations are made as the reference for peers based on evi-dence-based medical evidence,so as to provide a theoretical and practical reference for the diagnosis and treatment strategies of this population.

Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients / 中华医学杂志(英文版)

Background@#A patient’s infectivity is determined by the presence of the virus in different body fluids, secretions, and excreta. The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease (COVID-19) remain unclear. This study analyzed the clearance time and factors influencing 2019 novel coronavirus (2019-nCoV) RNA in different samples from patients with COVID-19, providing further evidence to improve the management of patients during convalescence.@*Methods@#The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20, 2020 to February 10, 2020 were collected retrospectively. The reverse transcription polymerase chain reaction (RT-PCR) results for patients’ oropharyngeal swab, stool, urine, and serum samples were collected and analyzed. Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive (minimum 24 h sampling interval) negative RT-PCR results for viral RNA from oropharyngeal swabs. The effects of cluster of differentiation 4 (CD4)+ T lymphocytes, inflammatory indicators, and glucocorticoid treatment on viral nucleic acid clearance were analyzed.@*Results@#In the 292 confirmed cases, 66 patients recovered after treatment and were included in our study. In total, 28 (42.4%) women and 38 men (57.6%) with a median age of 44.0 (34.0–62.0) years were analyzed. After in-hospital treatment, patients’ inflammatory indicators decreased with improved clinical condition. The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5 (6.0–11.0) days. By February 10, 2020, 11 convalescent patients (16.7%) still tested positive for viral RNA from stool specimens and the other 55 patients’ stool specimens were negative for 2019-nCoV following a median duration of 11.0 (9.0–16.0) days after symptom onset. Among these 55 patients, 43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs, with a median delay of 2.0 (1.0–4.0) days. Results for only four (6.9%) urine samples were positive for viral nucleic acid out of 58 cases; viral RNA was still present in three patients’ urine specimens after throat swabs were negative. Using a multiple linear regression model (F=2.669, P=0.044, and adjusted R2=0.122), the analysis showed that the CD4+ T lymphocyte count may help predict the duration of viral RNA detection in patients’ stools (t=-2.699, P=0.010). The duration of viral RNA detection from oropharyngeal swabs and fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (15 days vs 8.0 days, respectively; t=2.550, P=0.013) and the duration of viral RNA detection in fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (20 days vs 11 days, respectively; t=4.631, P <0.001). There was no statistically significant difference in inflammatory indicators between patients with positive fecal viral RNA test results and those with negative results (P >0.05).@*Conclusions@#In brief, as the clearance of viral RNA in patients’ stools was delayed compared to that in oropharyngeal swabs, it is important to identify viral RNA in feces during convalescence. Because of the delayed clearance of viral RNA in the glucocorticoid treatment group, glucocorticoids are not recommended in the treatment of COVID-19, especially for mild disease. The duration of RNA detection may relate to host cell immunity.

Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients / 中华医学杂志(英文版)

BACKGROUND@#A patient's infectivity is determined by the presence of the virus in different body fluids, secretions, and excreta. The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease (COVID-19) remain unclear. This study analyzed the clearance time and factors influencing 2019 novel coronavirus (2019-nCoV) RNA in different samples from patients with COVID-19, providing further evidence to improve the management of patients during convalescence.@*METHODS@#The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20, 2020 to February 10, 2020 were collected retrospectively. The reverse transcription polymerase chain reaction (RT-PCR) results for patients' oropharyngeal swab, stool, urine, and serum samples were collected and analyzed. Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive (minimum 24 h sampling interval) negative RT-PCR results for viral RNA from oropharyngeal swabs. The effects of cluster of differentiation 4 (CD4)+ T lymphocytes, inflammatory indicators, and glucocorticoid treatment on viral nucleic acid clearance were analyzed.@*RESULTS@#In the 292 confirmed cases, 66 patients recovered after treatment and were included in our study. In total, 28 (42.4%) women and 38 men (57.6%) with a median age of 44.0 (34.0-62.0) years were analyzed. After in-hospital treatment, patients' inflammatory indicators decreased with improved clinical condition. The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5 (6.0-11.0) days. By February 10, 2020, 11 convalescent patients (16.7%) still tested positive for viral RNA from stool specimens and the other 55 patients' stool specimens were negative for 2019-nCoV following a median duration of 11.0 (9.0-16.0) days after symptom onset. Among these 55 patients, 43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs, with a median delay of 2.0 (1.0-4.0) days. Results for only four (6.9%) urine samples were positive for viral nucleic acid out of 58 cases; viral RNA was still present in three patients' urine specimens after throat swabs were negative. Using a multiple linear regression model (F = 2.669, P = 0.044, and adjusted R = 0.122), the analysis showed that the CD4+ T lymphocyte count may help predict the duration of viral RNA detection in patients' stools (t = -2.699, P = 0.010). The duration of viral RNA detection from oropharyngeal swabs and fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (15 days vs. 8.0 days, respectively; t = 2.550, P = 0.013) and the duration of viral RNA detection in fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (20 days vs. 11 days, respectively; t = 4.631, P  0.05).@*CONCLUSIONS@#In brief, as the clearance of viral RNA in patients' stools was delayed compared to that in oropharyngeal swabs, it is important to identify viral RNA in feces during convalescence. Because of the delayed clearance of viral RNA in the glucocorticoid treatment group, glucocorticoids are not recommended in the treatment of COVID-19, especially for mild disease. The duration of RNA detection may relate to host cell immunity.

Efficacy and safety of the long-acting fusion inhibitor albuvirtide in antiretroviral-experienced adults with human immunodeficiency virus-1: interim analysis of the randomized, controlled, phase 3, non-inferiority TALENT study / 中华医学杂志(英文版)

BACKGROUND@#Albuvirtide is a once-weekly injectable human immunodeficiency virus (HIV)-1 fusion inhibitor. We present interim data for a phase 3 trial assessing the safety and efficacy of albuvirtide plus lopinavir-ritonavir in HIV-1-infected adults already treated with antiretroviral drugs.@*METHODS@#We carried out a 48-week, randomized, controlled, open-label non-inferiority trial at 12 sites in China. Adults on the World Health Organization (WHO)-recommended first-line treatment for >6 months with a plasma viral load >1000 copies/mL were enrolled and randomly assigned (1:1) to receive albuvirtide (once weekly) plus ritonavir-boosted lopinavir (ABT group) or the WHO-recommended second-line treatment (NRTI group). The primary endpoint was the proportion of patients with a plasma viral load below 50 copies/mL at 48 weeks. Non-inferiority was prespecified with a margin of 12%.@*RESULTS@#At the time of analysis, week 24 data were available for 83 and 92 patients, and week 48 data were available for 46 and 50 patients in the albuvirtide and NRTI groups, respectively. At 48 weeks, 80.4% of patients in the ABT group and 66.0% of those in the NRTI group had HIV-1 RNA levels below 50 copies/mL, meeting the criteria for non-inferiority. For the per-protocol population, the superiority of albuvirtide over NRTI was demonstrated. The frequency of grade 3 to 4 adverse events was similar in the two groups; the most common adverse events were diarrhea, upper respiratory tract infections, and grade 3 to 4 increases in triglyceride concentration. Renal function was significantly more impaired at 12 weeks in the patients of the NRTI group who received tenofovir disoproxil fumarate than in those of the ABT group.@*CONCLUSIONS@#The TALENT study is the first phase 3 trial of an injectable long-acting HIV drug. This interim analysis indicates that once-weekly albuvirtide in combination with ritonavir-boosted lopinavir is well tolerated and non-inferior to the WHO-recommended second-line regimen in patients with first-line treatment failure.@*TRIAL REGISTRATION@#ClinicalTrials.gov Identifier: NCT02369965; https://www.clinicaltrials.gov.Chinese Clinical Trial Registry No. ChiCTR-TRC-14004276; http://www.chictr.org.cn/enindex.aspx.

Clinical features and treatment outcomes of human immunodeficiency virus-associated cryptococcal meningitis: a 2-year retrospective analysis / 中华医学杂志(英文版)

BACKGROUND@#Cryptococcal meningitis (CM) is one of the most common opportunistic infections caused by Cryptococcus neoformans in human immunodeficiency virus (HIV)-infected patients, and is complicated with significant morbidity and mortality. This study retrospectively analyzed the clinical features, characteristics, treatment, and outcomes of first-diagnosed HIV-associated CM after 2-years of follow-up.@*METHODS@#Data from all patients (n = 101) of HIV-associated CM hospitalized in Shanghai Public Health Clinical Center from September 2013 to December 2016 were collected and analyzed using logistic regression to identify clinical and microbiological factors associated with mortality.@*RESULTS@#Of the 101 patients, 86/99 (86.9%) of patients had CD4 count <50 cells/mm, 57/101 (56.4%) were diagnosed at ≥14 days from the onset to diagnosis, 42/99 (42.4%) had normal cerebrospinal fluid (CSF) cell counts and biochemical examination, 30/101 (29.7%) had concomitant Pneumocystis (carinii) jiroveci pneumonia (PCP) on admission and 37/92 (40.2%) were complicated with cryptococcal pneumonia, 50/74 (67.6%) had abnormalities shown on intracranial imaging, amongst whom 24/50 (48.0%) had more than one lesion. The median time to negative CSF Indian ink staining was 8.50 months (interquartile range, 3.25-12.00 months). Patients who initiated antiretroviral therapy (ART) before admission had a shorter time to negative CSF Indian ink compared with ART-naïve patients (7 vs. 12 months, χ = 15.53, P < 0.001). All-cause mortality at 2 weeks, 8 weeks, and 2 years was 10.1% (10/99), 18.9% (18/95), and 20.7% (19/92), respectively. Coinfection with PCP on admission (adjusted odds ratio [AOR], 3.933; 95% confidence interval [CI], 1.166-13.269, P = 0.027) and altered mental status (AOR, 9.574; 95% CI, 2.548-35.974, P = 0.001) were associated with higher mortality at 8 weeks.@*CONCLUSION@#This study described the clinical features and outcomes of first diagnosed HIV-associated CM with 2-year follow-up data. Altered mental status and coinfection with PCP predicted mortality in HIV-associated CM.

Highlights of the third edition of Chinese guidelines for AIDS diagnosis and treatment(2015) / 浙江大学学报·医学版

The third edition of Chinese guidelines for AIDS diagnosis and treatment was launched in 2015 by AIDS Professional Group, Society of Infectious Diseases, Chinese Medical Association. New edition emphasizes the importance of timely initiation of anti-retroviral therapy(ART). Like other guidelines, this edition recommends that once the HIV infection is confirmed, the ART should be initiated timely. For patients with HIV and opportunistic infections, once the infections are under control, the ART should be initiated without delay. For AIDS patients complicated with tuberculosis whose CD4 cell counts are less than 200/μL, the ART should start within 2 weeks after the initiation of anti-tuberculosis treatment. In this guideline, the drugs with severe toxicities and poor tolerance are excluded, and new drugs are added such as rilpivrine (RPV) and atazanavir (ATV) because of less toxicity and higher HIV depression effect; and 3TC+TDF+EFV is recommended as the first line regimen. As for children with HIV infection, especially for those less than 5 years, once the infection is confirmed the ART should be initiated immediately. For the prevention of HIV mother to children transmission, new edition recommends that HIV-infected pregnant women start ART early and keep on ART all their lives.

Evaluating patients' perception of service quality at hospitals in nine Chinese cities by use of the ServQual scale

Objective: To investigate patients' perception of service quality at hospitals in nine Chinese cities and propose some measures for improvement. Methods: The ServQual scale method was used in a survey involving patients at outpatient and in-patient facilities in Shanghai, Chongqing, Chengdu, Nanning, Guilin and Laibin of Guangxi, Honghezhou of Yunnan, Wulumuqi of Xinjiang and Zhongshan of Guangdong. The data collected were entered and analyzed using SPSS 20.0. Statistical analyses included descriptive statistics, factor analyses, reliability analyses, productmoment correlations, independent-sample t-tests, One-way ANOVA and regression analyses. Results: The Kaiser-Meyer-Olkin value for the factor analysis of the scale was 0.979. The Cronbach's α for the reliability analysis was 0.978. All the Pearson correlation coefficients were positive and statistically significant. Visitors to out-patient facilities reported more positive perception than visitors to in-patient facilities on tangibles (t = 4.168, P < 0.001) and reliability (t = 1.979, P < 0.05). Patients of 60 years of age and above reported more positive perception than those between 40 and 49 on reliability (F = 3.311, P = 0.010), assurances (F = 2.751, P < 0.05) and empathy (F = 4.009, P = 0.003). For the five dimensions of the scale, patients in Laibin, Guangxi reported the most positive perceived service quality, followed by patients in Shanghai. On the other hand, patients in Chongqing and Nanning and Guilin of Guangxi reported relatively poor perceptions of service quality. Standardized regression coefficients showed statistically significant (P < 0.001) positive values for all ServQual dimensions. Empathy (β = 0.267) and reliability (β = 0.239) most strongly predicted perception of service quality. Conclusions: Chinese patients perceived service quality as satisfactory. Hospitals in various regions of China should enhance their awareness and ability to serve their patients.

Proteomic study on effect of tangcao pill on microsome CYP450 / 中国中药杂志

Tangcao pill is commonly applied in adjuvant and even alternative therapy for patients with AIDS. However, the herb contains complex ingredients, but with unknown effect against anti-HIV drug and unknown function. Because CYP450 emzyme is the main metabolic enzymes of the drug, it is of important significance to study the regulation of CYP450 enzymes before and after the combined administration of Tangcao pill and EFV. Proteomics, due to its high throughout and high sensitivity, has been widely applied in CYP450 enzyme study. In this paper, liver microsomes were separated through differential centrifugation. Their proteins were separated through SDS-PAGE. The three protein bands that CYP450 enzymes were located were cut and identified by liquid chromatography tandem mass spectrometry. Totally 16 CYP450 isoenzymes were identified. Furthermore, in order to make a quantitative analysis on the effect of tang herb on CYP450 emzyme, the multiple reaction monitoring (MRM) technology based on MS was adopted. The CYP2C11 was selected based on the results of the mass spectrum identification of proteins. The characteristic polypeptides were obtained through searching Expasy blast database. The m/z of the fragment ions was less than 800. In the paper, the m/z of ion pairs of CYP2C11 were 711.5/232.1, 711.5/319.2, 711.5/466.2 and 711.5/595.3, and the m/z of ESAT-6 (internal standard, IS) were 735.5/215.3, 735.5/389.3, 735.5/460.3 and 735.5/524.3. The relative peak (analyte/IS) area was adopted for the relative quantitative analysis. Compared with the EFV single administration group, the EFV and Tangcao pill combined administration group showed a 1.6-fold increase in CYP2C11. The results of the paper indicated that Tangcao pill may affect drug metabolism by regulating metabolic enzymes such as CYP2C11, but the specific mechanism still unknown.

Epidemiological and clinical features of occult hepatitis B in HIV infection without antiretroviral treatment / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate and analyze the differential prevalence, as well as the risk factors and clinical features, of occult hepatitis B virus (HBV) infection in the human immunodeficiency virus (HIV)-infected population without antiretroviral therapy (ART) as compared to the general (non-HIV-infected) population.</p><p><b>METHODS</b>Two-hundred-and-forty-eight individuals with confirmed HIV infection but ART naive (males: 220, females: 28; 15-82 years old) were enrolled in the study, along with 121 healthy individuals (confirmed HIV antibody-negative; males: 53, females: 68; 20-88 years old). HBV markers (hepatitis B surface antigen (HBsAg); hepatitis B e antigen (HBeAg); anti-HBs, anti-HBe and anti-hepatitis B core (HBc) antibodies) were detected by microparticle enzyme-linked immunosorbent assay (AxSYM immunology analyzer manufactured by Abbott Laboratories); all cases and controls were confirmed negative for hepatitis B surface antigen (HBsAg). Then, the HBV DNA level in serum was detected using nucleic acid amplification assay (COBAS AmpliPrep/COBAS TaqMan HBV test, version 2.0 manufactured by Roche). CD4+ T lymphocytes were measured by flow cytometry, and alanine aminotransferase (ALT, marker of liver function) was measured by enzymatic assay.</p><p><b>RESULTS</b>Twenty-four of the HIV cases (9.7%) and four of the healthy controls (3.3%) tested positive for HBV DNA; the amount of individuals with HBV DNA-positivity was significantly higher in the HIV-infected group (P = 0.035). Among the 24 cases of HBV DNA(+) HIV-infected individuals, the lowest HBV DNA load was < 20 IU/ml and the highest was 3.22 x 10s IU/ml; nine of the individuals (37.5%) had HBV DNA load > 100 IU/ml, four (16.7%) had 20-99 IU/ ml, and 11 (45.8%) had < 20 IU/ml. Among the total HIV-infected cases with HBV DNA-positivity, 7.3% (8/110) were anti-HBc(+)/anti-HBs(+), 20.8% (11/53) were anti-HBc(+)/anti-HBs(-), 14.3% (3/21) were anti-HBc(-)/anti-HBs(+), and 3.1% (2/64) were anti-HBc(-)/anti-HBs(-). The amount of individuals with HBV DNA-positivity in the anti-HBc(+)/anti-HBs(-) group was significantly different from those in the anti-HBc(+)/anti-HBs(+) group (P = 0.018) and the anti-HBc(-)/anti-HBs(-) group (P = 0.003). However, multiple comparison of HBV DNA loads detected between the four groups of HBV marker status revealed no significant difference (P = 0.805). Furthermore, statistical analysis provided no evidence to support that occult hepatitis B infection in HIV-infected individuals had any impact on CD4+ T lymphocytes count (Z = 1.902, P = 0.059) or ALT levels (Z =1.401, P = 0.161).</p><p><b>CONCLUSION</b>HIV-infected individuals who are ART naive and HBsAg(-) have a higher incidence of HBV DNA-positivity than individuals in the general (non-HIV-infected) population. In addition, the highest rate of occult hepatitis B among the HIV-infected cases occurred among individuals who were anti-HBc(+)/anti-HBs(-).</p>

Computed tomography in predicting smear-negative pulmonary tuberculosis in AIDS patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The correct diagnosis of sputum smear-negative pulmonary tuberculosis in AIDS patients is very important to their therapy. We aimed to assess the value of the computed tomography (CT) and clinical findings in predicting smear-negative pulmonary tuberculosis in AIDS patients.</p><p><b>METHODS</b>A total of 121 AIDS patients suspected of smear-negative pulmonary tuberculosis by clinical and radiographic findings were recruited. Pulmonary tuberculosis was diagnosed in 57 (47.1%) patients. The CT and clinical predictors were selected to diagnose AIDS-related pulmonary tuberculosis through univariate and multivariate Logistic analysis.</p><p><b>RESULTS</b>Multivariate analysis showed that five variables, including weight loss, presence of miliary nodules, necrotic lymph node, lobular consolidation, tree-in-bud sign, were independent predictors of pulmonary tuberculosis in AIDS patients. Predicted scores based on the five variables were used to identify pulmonary tuberculosis. If the predicted score of 3 was taken as the ideal cut-off point in the diagnosis of AIDS-related smear-negative pulmonary tuberculosis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.2%, 81.2%, 80.0%, 85.2%, and 82.6%, respectively.</p><p><b>CONCLUSION</b>The prediction method based on five key factors of clinical and CT findings are useful in guiding the diagnosis of smear-negative pulmonary tuberculosis in AIDS patients.</p>

Sixty-two severe and critical patients with 2009 influenza A (H1N1) in Shanghai, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pandemic influenza A (H1N1) emerged rapidly in China in May 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A (H1N1) disproportionately affects younger ages and causes generally mild disease. To characterize disease progress, comorbidities, and treatment outcomes among consecutive severe and critically ill patients in a hospital served as a reference center for the care of patients with H1N1 in Shanghai, China.</p><p><b>METHODS</b>A retrospective study on 62 severe and critically ill patients with 2009 influenza A (H1N1) was conducted in Shanghai Public Health Clinical Center. Demographic data, symptoms, comorbidities, disease progression, treatments, and clinical outcomes were collected for analysis.</p><p><b>RESULTS</b>Sixty-two severe or critically ill patients were admitted to the hospital with confirmed 2009 influenza A (H1N1) infection. The median age of the study cohort was 40 years old with a range from 18 years to 75 years, and 67.7% were males. All patients presented with fever and respiratory symptoms. At presentation, 34 patients (54.8%) had comorbidities such as smoking (29.0%), hypertension (29.0%) and hepatitis B virus infection (9.7%). The median time from symptom onset to hospital admission was 6 days (interquartile-range 3 - 14 days) and 23 critically ill patients were admitted to Intensive Care Unit after admission. All the patients received neuraminidase inhibitors (oseltaminir), while 60 patients (96.7%) were treated with antibiotics, and 39 (62.9%) with corticosteroids. Twenty-three critical cases received noninvasive mechanical ventilation on the first day of admission, and 3 of them ultimately required invasive ventilation. Four death reports (6.5%) were filed within the first 14 days from the onset of critical illness with the primary causes of severe acute respiratory distress syndrome, hypoxemia, or complications, secondary infection and sepsis, pyopneumothorax and stroke.</p><p><b>CONCLUSIONS</b>Severe illness from 2009 influenza A (H1N1) infection in Shanghai occurred among young individuals. Critical cases were associated with severe hypoxemia, multisystem organ failure, and a requirement for mechanical ventilation. Most patients had a good prognosis.</p>

LC-MS/MS method for simultaneous quantification of lopinavir and ritonavir in human plasma / 药学学报

A liquid chromatographic-tandem mass spectrometric (LC-MS/MS) method was developed for the determination of lopinavir and ritonavir in human plasma. Analytes were separated from plasma by a combination of alkalinized protein precipitation and liquid-liquid extraction with ethyl acetate. Chromatographic separation was performed on a Agilent ZORBAX Eclipse XDB-C18 column with the mobile phase consisted of methanol-0.1% formic acid in water (80:20). A tandem mass spectrometer equipped with electrospray ionization source was used as detector and operated in the positive ion mode. Quantification was performed using multiple reaction monitoring (MRM) of the transitions m/z 629.6 --> 155.2, m/z 721.4 --> 268.2, and m/z 515.2 --> 276.2 for lopinavir, ritonavir and telmisartan (internal standard), respectively. The method showed a good linearity in a concentration range of 62.5 - 10000 ng mL(-1) for lopinavir, and 12.5 - 2000 ng mL(-1) for ritonavir. The lower limits of quantification were 15 pg mL(-1) and 8 pg mL(-1) for lopinavir and ritonavir, respectively. The intra- and inter-day precision was less than 15% and the absolute recovery was above 75%. This method was selective and rapid, sensitive for investigating blood drug concentrations in clinics.

Clinical features and prognosis of the mild cases of pandemic influenza H1N1 virus infection / 中华预防医学杂志

<p><b>OBJECTIVE</b>Analyze the clinical characteristics of the mild cases of pandemic influenza H1N1 virus infection, as well as the relationship of clinical characteristics and patient genders.</p><p><b>METHODS</b>A total of 245 influenza A (H1N1) patients confirmed by viral nucleic acid detection were included in the study. The patients' personal information, signs and symptoms, lab and iconography data, disease course, negative seroconversion duration of new influenza A (H1N1) viral nucleic acid after antiviral treatment and hospitalization stay were analyzed. Measurement data were analyzed using one-way analysis of variance (ANOVA) by software SPSS 11.5. P < 0.05 was defined as statistically significant.</p><p><b>RESULTS</b>(1) Among the 245 patients, 130 were males and 115 were females, yielding a sex ratio of 1.13:1. Almost 52.0% (127/245) of the patients came from Australia, and 64.5% (158/245) were between 18 and 40 years old. (2) Clinical manifestations included fever (98.4%, 241/245), cough (80.8%, 198/245) and throat congestion (95.9%, 235/245), and lab findings were characterized by elevated C-reaction protein (CRP, 71.0%, 174/245) and neutrophil (52.2%, 128/245). (3) Female patients had significantly lower serum Prealbumin (pre-A) levels than male patients [(245.04 ± 75.3) vs (273.34 ± 92.18) mg/L, F = 5.55, P = 0.019]. (4) The patients' serum CRF levels significantly decreased after the treatment [(4.06 ± 3.47) vs (14.54 ± 14.68) mg/L, F = 6.18, P = 0.016], while the levels of CD3, CD4 and CD8 were significantly increased after treatment [(1451.23 ± 443.97) vs (819.97 ± 375.75) cell/µl, F = 32.61, P = 0.000; (771.33 ± 251.92) vs (435.36 ± 215.35) cell/µl, F = 44.43, P = 0.000; (593.16 ± 237.19) vs (342.47 ± 180.12) cell/µl, F = 28.518, P = 0.000, respectively]. (5) Approximately 30.6% (75/245) of the patients had abnormal signs on chest CT iconography, and 22.0% (54/245) had obvious signs indicating pneumonia. The average disease course was (3.9 ± 1.2) days, the average hospitalization stay was (5.0 ± 1.4) days, and the negative seroconversion duration of the mRNA after antiviral treatment was (3.8 ± 1.4) days.</p><p><b>CONCLUSION</b>The influenza A (H1N1) virus was characterized by fever, cough and throat congestion, with elevated CRP and neutrophil being the most significant lab findings. The influenza A (H1N1) strain was able to affect multiple organs, including being able to affect hepatic synthesis of pre-A as well as immune functioning. The influenza A (H1N1) influenza virus strain was mild clinically, with short disease course and good prognosis.</p>

Effect of moxibustion on immunological function in the patient of AIDS of spleen-kidney yang-deficiency / 中国针灸

<p><b>OBJECTIVE</b>To observe the therapeutic effect of moxibustion on AIDS patients of spleen-kidney yang-deficiency.</p><p><b>METHODS</b>Sixty-six cases of AIDS were divided into a treatment group and a control group, 33 cases in each group. All of the patients were treated with HAART, with moxibustion at Tianshu (ST 25), Shenque (CV 8), Zhongwan (CV 12), Guanyuan (CV 4) added in the treatment group for 3 months. Clinical symptoms and cell immunity were recorded before and after treatment.</p><p><b>RESULTS</b>After treatment, the effective rate was 90.9% in the treatment group, which was better than 66.7% in the control group (P < 0.05). The improvement of the score for clinical symptoms in the treatment group was superior to that in the control group (P < 0.01). After treatment, the CD4 lymphocyte counts increased in the two groups, with no significant difference between the two groups (P > 0.05). Additionally, increase of total lymphocyte count in the treatment group was superior to that in the control group (P < 0.05).</p><p><b>CONCLUSION</b>Moxibustion can increase the therapeutic effect of HAART on AIDS patients and increase the total lymphocyte count.</p>

Differences in Variation of Human Immunodeficiency Virus Type 1 Sequences from Henan and Shanghai Regions of China / 中国病毒学

Illegally paid blood donation was a risk factor for HIV acquisition exclusively in Henan and Hubei Provinces of China, and not in Shanghai. Nucleotide sequences in the gag and env genes of HIV-1 were compared between isolates from Henan and Shanghai regions of China to test whether an expected higher degree of a common source of infections from this unique blood donation transmission risk would be evident as decreased variation among Henan isolates in an exploratory cross-sectional analysis. Among 38 isolates studied, 23 of 23 (100%) from Henan and 8 of 15 (54%) from Shanghai were subtype B. In addition, fewer sequence differences were found in gp41 of subtype B isolates from Henan than from Shanghai isolates. Further studies with additional controls are therefore warranted to confirm the role of the degree of a common source of infections in differences in HIV variation across populations.

Forty two cases infected with swine streptococcosis / 中华传染病杂志

Objective To investigate the clinical characteristics,diagnosis,treatment and prognosis of human swine streptococcosis occurred in some areas of Jiangsu Province from late summer to autumn since 1998.Methods The epidemiologic and clinical features of 42 cases were collected and analyzed.The bio- chemical features of strains isolated from patient's blood or cerebrospinal fluid(CSF) were tested,and the homogeneity were compared among 15 Streptococcus suisⅡ.Results All patients had acute infection toxe- mic symptoms such as chill,fever,headache and malaise etc.Toxic shock syndrome or meningitis syndrome were the major clinical manifestations.Forty two cases of human swine streptococosis were classified into 3 types:the rates of general,shock and meningitis type were 7.1% (3/42),38.1% (16/42) and 54.7%(23/42),respectively.Ten patients were died of shock type,32 were cured.Strain isolated from patients was identified as Streptococcus suisⅡby API-Strep,the biochemical reactional code was 0641473,and appraised result was 99.9%.There was highly homogeneity in the strains of Streptococcus suisⅡisolated from patients and sick pigs identified by genomic fingerprinting.Com- bined therapy of large doses of penicillin G and ceftriaxone was effective in these patients.Conclusions Human swine streptococosis is zoonosis caused by Streptococcus suisⅡand the clinical manifesta- tions are variable.In the cases of shock type,the onset of disease is stormy and the fatality rate is very high.While the prognosis of general and meningitis type is good and the majority of the cases are cured by effective antibiotic therapy.

Peg-interferon alfa-2a and highly active antiretroviral drug therapy on hepatitis C patients with AIDS / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate the clinical effect and side-effect of peg-interferon alfa-2a (PEG-IFN alfa-2a) and highly active antiretroviral therapy (HAART) for patients infected with hepatitis C virus (HCV) and co-infected with human immunodeficiency virus (HIV).</p><p><b>METHODS</b>Twenty-two patients with HCV/HIV co-infection received highly active antiretroviral therapy initially; after their CD4 lymphocyte counts rose to over 0.20x10(9)/L, they were separated into two groups: one group with CD4 lymphocytes over 0.35x10(9)/L (high group) and one group with CD4 lymphocytes below 0.35x10(9)/L (low group). Both groups were given 180 microg of PEG-IFN alfa-2a every week intramuscularly. HCV RNA and HIV RNA loads, blood cell and CD4 lymphocyte counts, and liver functions were routinely examined.</p><p><b>RESULTS</b>After 12, 24 and 48 weeks of PEG-IFN alfa-2a therapy, mean HCV RNA loads reduced 2.0650 log10 copies/ml (t=3.8733), 2.9146 log10 copies/ml (t=7.6741) and 2.4315 log10 copies/ml (t=5.8202) from the baseline at week 0 in the 13 patients in the high group, and reduced 1.1522 log10 copies/ml (t = 2.8937), 1.4189 log10 copies/ml (t=2.4422) and 1.1167 log10 (t=1.1261) in the 8 patients of the low group. However, there was no significant difference between the early viral response rate (EVR) and the end of treatment viral response rate (ETVR) of the two groups. In the high group, the white blood cell count was lower at 24 weeks than the base line (t=2.4700), and the blood platelet count was lower both at 24 and 48 weeks than the base line (t=2.3273 and t=3.6149).</p><p><b>CONCLUSIONS</b>PEG-IFN alfa-2a can effectively reduce HCV RNA loads in patients with HCV-/HIV co-infection, and the inhibition rate in patients with higher CD4 lymphocyte counts is better. The EVR and ETVR of the two groups of patients show similar results after the treatment. PEG-IFN alfa-2a can reduce the white blood cell counts and the blood platelet counts in the peripheral blood.</p>