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Objective:To investigate the clinical and pathological characteristics of acquired immunodeficiency syndrome (AIDS) patients with intestinal Talaromycosis marneffei (TM) infection. Methods:A total of 64 AIDS patients who underwent colonoscopy in Guangzhou Eighth People′s Hospital from January, 2010 to December, 2018 were retrospectively collected. Among them, 32 patients were co-infected with TM (AIDS with intestinal TM infection group) and 32 patients were not (AIDS without intestinal TM infection group) according to the colonic mucosa pathology. The clinical manifestations and pathological differences were compared between the two groups. Nonparametric rank sum test and Fisher exact probability method were used for statistical analysis.Results:The proportions of patients presented with fever, cough, retroperitoneal lymph nodes tume faction, nausea and vomiting, abdominal muscle tension, abdominal tenderness and rebound pain in AIDS with intestinal TM infection group were 28 (87.5%), 16 (50.0%), 13 (40.6%), 9 (28.1%), 8 (25.0%), 20 (62.5%) and 12 (37.5%), respectively, which were all significantly higher than those in AIDS without intestinal TM infection group 11 (34.4%), 6 (18.8%), 3 (9.4%), 2 (6.2%), 1 (3.1%), 8 (25.0%) and 1 (3.1%), respectively, the differences were statistically significant (Fisher exact test, all P<0.05). The median counts of peripheral blood CD4 + T lymphocyte, lymphocytes, monocytes, hemoglobin, platelet and albumin in AIDS with intestinal TM infection group were 13.5/μL, 0.30×10 9/L, 0.16×10 9/L, 88 g/L, 122×10 9/L and 23.5 g/L, respectively, which were all significantly lower than those in AIDS without intestinal TM infection group 207.0/ μL, 1.35×10 9/L, 0.35×10 9/L, 128 g/L, 201×10 9/L and 37.5 g/L, respectively, the differences were all statistically significant ( Z=-6.111, -6.191, -4.273, -5.353, -2.974 and-6.666, respectively, all P<0.05). Multivariate logistic regression analysis showed that CD4 + T lymphocytes <50/μL, hemoglobin <90 g/L and fecal occult blood positive were independent risk factors for AIDS with intestinal TM infection. The main manifestations of colonoscopy in AIDS with intestinal TM infection group were discontinuous ulcers (31.2%(10/32)), erosion (31.2%(10/32)) or co-exitance of ulcer and erosion (21.9%(7/32)), while suspected tumor-like eminence lesions were less common (15.6%(5/32)). The pathological features of colon mucosa were ulcer and/or erosion (53.1%(17/32)), chronic inflammation (46.9%(15/32)) and inflammatory granuloma (43.8%(14/32)). Oval or round spore with apparent septum could be seen by special staining. In AIDS with intestinal TM infection group, 27 patients were cured or improved, five patients died or deteriorated, while all patients in the AIDS without intestinal TM infection group improved after treatment without death. Conclusions:There are no specific gastrointestinal symptoms in AIDS patients with intestinal TM infection, while the patients present with decreased immunological cells and multiple colony pathological features. Specific fungal spores can be seen.
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Aim To assess the effects of Banqiao Codonopisis Pilosula(BCP)decoction on learning and memory dysfunction in AD model rats induced by high activity GSK-3β and its possible mechanism.Methods The SD rats(4 months old,♂)were divided into five groups,namely,sham-operated group(blank group),AD model group,BCP high-dose(2.16 g·kg-1·d-1)group,BCP medium-dose(1.08 g·kg-1·d-1)group,and BCP lower-dose(0.54 g·kg-1·d-1)group.Treatment group received BCP decoction by gavage once a day for 14 days,while other groups were offered drinking water by gavage once a day for 14 days.The autonomous behavior activities of all rats were observed and recorded after gavage.In the last seven days by gavage,Morris water maze test was used to test the spatial learning and memory ability of the five groups.After five days training,treatment groups and AD model group were injected wortmannin(WT,PI3K specific inhibitor)and GF-109203X(GFX,PKC specific inhibitor)(100 μmol·L-1 of each,total volume of 10 μL)into the right lateral ventricle of the rats.The blank group was only injected 2％DMSO.The spatial memory retention was detected by water maze 24 hours after lateral ventricle injection.Then,changes in the spatial learning memory of rats were observed.The level of Tau phosphorylation in SD rat hippocampus and the expression and activity changes of related protein kinase GSK-3β were detected by Western blot and immunohistochemistry.The changes of Nissl bodies in SD rat hippocampus were observed by Nissl′s staining.Results After intragastric administration of BCP,the rat autonomous behavior activities in each group all showed a declining trend,and the differences in low-dose and middle-dose groups had statistical significance compared with blank group.The Morris water maze tests showed that the latency navigation of model group was significantly longer than that of blank group(P<0.01),while that of the BCP three doses groups was shorter than that of model group(P<0.05).Compared with the same group,the latency navigation of the three groups after gavage BCP low,middle and high dose was significant shorter than that without gavage(P<0.05).Western blot results showed that the activity of GSK-3β in AD model group was up-regulated compared with the blank group.However,BCP inhibited activity of GSK-3β.Western blot and immunohistochemistry results showed the level of Tau phosphorylation in AD model group was increased compared with the blank group in the area of CA3(P<0.05).Compared with AD model group,the level of Tau phosphorylation was decreased in treatment group.Nissl′s staining results showed that dendritic spines in AD model group was significantly attenuated compared with the blank group(P<0.05).Far more dendritic spines were observed in treatment group than in AD model group.The number of Nissl′s bodies in neuron cells of hippocampus in hippocampal CA3 was obviously larger in treatment groups than in AD model group.These effect of BCP was dose-dependent.Conclusions BCP can prevent the learning and memory dysfunction in AD model rats induced by high activity of GSK-3β.The mechanism may be related to inhibiting GSK-3β activity and then reducing the level of phosphorylation of Tau and improving neural development.
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Objective To investigate the characteristics of mycobacteria species distribution in human immunodeficiency virus (HIV)-positive patients co-infected with mycobacteria in Guangzhou. Methods A total of 133 mycobacteria strains isolated from HIV-positive patients and 150 strains isolated from HIV-negative patients were included in this study. After DNA extraction of mycobacteria, mycobacteria species identification was performed by sequencing of multiple genes.Differences in the identified species were compared between patients with and without HIV infection and the correlation between CD4 + T cells level and the mycobacterial species distribution was analyzed.Chi-square test was used for statistical analysis.Results Of the 133 mycobacteria strains isolated from HIV-positive patients, 82 were identified as Mycobacterium tuberculosis complex (MTC ). Fifty-one were identified as nontuberculous mycobacteria (NTM),of which the main species was Mycobacterium avium complex (MAC,31/51).Of the 150 mycobacteria strains isolated from HIV-negative patients,126 were identified as MTC and 24 as NTM,of which the main species was Mycobacterium abscessus (9/24).In patients with CD4 + T cell counts ≤100/μL,the positive rate of mycobacteria was 75 .94%(101/133),93.55 %(29/31) of MAC and 85 .00%(17/20)of other NTM.When the CD4 + T cell counts >100/μL,the positive rate for mycobacteria were all obviously decreased.Conclusions The proportion of NTM infection is higher in HIV-positive patients than HIV-negative patients in Guangzhou. Among HIV-positive patients > the most prevalent NTM species is MAC, while Mycobacterium abscessus is the most common species in HIVnegative patients. Mycobacterial infection in acquired immunodeficiency syndrome patients is closely associated with low CD4+ cells level.
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Objective To investigate the histopathological characteristics of colonoscopic biopsy specimens from AIDS patients .Methods A total of 310 clinically confirmed AIDS patients with abdominal pain, diarrhea or tenesmus were enrolled from Guangzhou NO .8 People’s Hospital during 2010 and 2014. All patients underwent colonoscopic examination , and the biopsy specimens were collected .Conventional HE staining, special stainings including Gomori’s methenamine silver ( GMS), Periodic Acid-Schiff stain (PAS), acid-fast staining, and immunohistochemical staining of cytomegalovirus (CMV) were performed. Results The biopsy specimens showed mucosa chronic inflammation (93.9%), epithelial degeneration and necrosis;the local erosion and ulcer formation were observed in severe cases .Among 310 patients, the infective pathogens were identified in 139 ( 44.8%) cases, including 47 ( 15.2%) cases with CMV infections, 36(11.6%) cases with mycobacterium infections , 21(6.8%) cases with penicillium marneffei infections, 10(3.2%) cases with Cryptococcus infections, 3(1.0%) cases with candida infections, 2(0.6%) cases with cryptozoite infections and the rest 20(6.5%) cases were with uncertain pathogens . Conclusion Chronic inflammatory lesions are common in patients with AIDS , and colonoscopic mucosal biopsy can help to identify the pathogens of intestinal opportunistic infection .
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BACKGROUND:Fracture must be properly reset, cannot present angle, rotation and overlapping shift. Kirschner wire fixation is fit for transverse fracture of first metacarpal bone of proximal phalanx and middle phalanx. Mini-plate fixation is fit for disfigurement or short bevel fracture of metacarpal bone and proximal finger backbone. Which is fit for cmplicated fracture of metacarpal bone? OBJECTIVE:To analyze the clinical effective and safety of complicated metacarpal fractures after fixed with mini-plates and Kirschner wires. METHODS:A total of 68 cases of complicated metacarpal fractures (72 sites) were chosen from Sanshui Hospital of Foshan Municipal Hospital of Traditional Chinese Medicine as the research subjects. They received open reduction and internal fixation, and were divided into two groups. Mini-plate group contained 36 cases (39 sites). Kirschner wire group contained 32 cases (33 sites). Healing time of metacarpal and phalangeal fractures, functional recovery and wound infection were observed. Clinical effects and complications were compared between the two groups. Bone healing was observed using X-ray. The recovery of hand function was evaluated using total action flexion score of American Society for Surgery of the Hand. RESULTS AND CONCLUSION:Patients in the mini-plate group were fol owed up for 3-12 months, and patients in the Kirschner wire group were fol owed up for 3-10 months. In the mini-plate group, the excel ent and good rate of total action flexion score was 92%. X-ray films revealed that healing time was 4-6 weeks, averagely 4.7 weeks. Complications:no bone nonunion occurred. Moreover, patients with closed fracture did not suffer from postoperative infection. Patients with open fracture suffered from infection to different degrees at three fracture sites. In the Kirschner wire group, the excel ent and good rate of total action flexion score was 76%. X-ray films demonstrated that healing time was 6-9 weeks, averagely 7.7 weeks. Complications:bone nonunion was observed at three fracture sites. After bone grafting, postoperative infection was found in 4 sites of 28 sites of open fracture. Statistical analysis showed that significant differences in total action flexion score were detectable between the two groups at 3 months of fol ow-up (P<0.05). These results suggest that the clinical effect of mini-plate fixation for complicated metacarpal fracture was apparently better than that of Kirschner wire, so mini-plate fixation can be used as an effective repair method for complicated metacarpal fracture.
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Objective To explore the possible role of neuropilin-1 (NRP-1) and extracellular regulated protein kinases (ERK) in the mechanisms underlying the promotive effect of vascular endothelial growth factor (VEGF) on the proliferation of HaCaT cells.Methods HaCaT cells were cultured in vitro and transfected with a NRP-1 expression plasmid EX-O0008-M02.Reverse transcription (RT)-PCR and Western blot were performed to detect the mRNA and protein expression of NRP-1 in HaCaT cells respectively before and after the transfection.Some HaCaT cells were divided into three groups to be transfected with liposome (liposome control group),control plasmid pReceiver-M02 (plasmid control group),and objective plasmid EX-O0008-M02 (objective plasmid group),respectively,and each of the three groups was classified into several subgroups to be treated with phosphate buffer solution (PBS),U0126 (MEK1/2 inhibitor) and VEGF alone or in combination.After additional culture,methyl thiazolyl tetrazolium (MTT) assay was performed to determine the proliferative activity of HaCaT cells,Western blot to quantify the expression of total and phosphorylated ERK1/2 as well as proliferating cell nuclear antigen (PCNA) protein in HaCaT cells.Intergroup differences were assessed by one-way analysis of variance (ANOVA),and multiple comparisons and correction were done by using the least significant difference (LSD) test.Results RT-PCR and Western blot analysis confirmed that the transfection with NRP-1 effectively promoted the mRNA and protein expression of NRP-1 in HaCaT cells.A significant increase was observed in cellular proliferative activity (absorbence value at 570 nm) in the objective plasmid group compared with the liposome control group and plasmid control group (0.88 ± 0.14 vs.0.63 ± 0.07 and 0.62 ± 0.13,F =8.755,P ＜ 0.05),also in the VEGF-stimulated objective plasmid group compared with the VEGF-stimulated plasmid control group (1.14 ± 0.18 vs.0.88 ± 0.10,F =4.591,P ＜ 0.05).The U0126 pretreatment markedly suppressed the VEGF-induced proliferation of A375 cells in the objective plasmid group (0.50 ± 0.13 vs.1.14 ± 0.18,F =42.106,P ＜ 0.01).As Western blot analysis suggested,the objective plasmid significantly enhanced the VEGF-induced increase in ERK1/2 phosphorylation degree and PCNA expression intensity in HaCaT cells compared with the control plasmid,but the enhancing effect of objective plasmid was effectively inhibited by U0126.Conclusion The activation of ERK1/2 signaling pathway may play a key role in the NRP-1 protein-mediated promotive effect of VEGF on the proliferation of HaCaT cells.
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ObjectiveTo explore the treatment options for fresh Grauer type Ⅱ odontoid fractures and discuss corresponding clinical outcome.Methods The study involved 40 patients with fresh odontoid fractures including seven with type Ⅱ A fractures, 18 with type Ⅱ B and 15 with type ⅡC according to Grauer classification.There were five patients with incomplete cervical cord injuries.Type Ⅱ A fractures were treated by traction of occipital-jaw band or skull for 1-2 weeks and then fixed with head-neck-chest plaster or brace.Type Ⅱ B fractures were treated with anterior odontoid screw system fixation.Fifteen patients with type Ⅱ C fractures and three patients with type Ⅱ B fractures combined with severe fracture displacement were managed with posterior atlantoaxial pedicle screw fixation.Results All the patients were followed up for 6-24 months.Seven patients with type Ⅱ A fractures showed union after fixation with head-neck-chest plaster or brace for 3-6 months.Fifteen patients treated with odontoid screw fixation had good positions of screws, with no injury to the spinal cord, of which 14 patients obtained bone union, with union rate of 93.3％.Eighteen patients (including 15 patients with type Ⅱ C fractures and three with type Ⅱ B fractures combined with severe displacement) managed with atlantoaxial pedicle screw system showed no injury to the vertebral artery and spinal cord.Solid bone fusion was achieved.in 31 patients after 3 to 6 months.The X-ray and SCT scans verified proper fixation of the screws, with no deformation, loosening or breakage of the screws.Five patients with incomplete cervical cord injuries obtained neural function recovery at various degrees after surgery.ConclusionsConservative treatment cau be alternative to type ⅡA fractures.Anterior odontoid hollow screw fixation is better for type ⅡB fractures (non-displaced or reducible) and has advantages of minor trauma, fast postoperative recovery and high union rate.However, posterior atlantoaxial pedicle screw system fixation and fusion is suitable to type Ⅱ C and ⅡB fractures with severe displacement and has the advantages of stable three-dimension fixation, direct screw placement, intraoperative reduction, short-segment fixation and high fusion rate.
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Objective To explore the technique and clinical outcome of the atlantoaxial pedicle screw system in the treatment of the unstable atlantoaxial dislocation post traction.Methods The study involved 32 patients with atlantoaxial dislocation(type T2 of TOI classification)admitted from March 2005 to September 2009.There were 17 patients with fresh odontoid fracture and two with old odontoid fracture,five with traumatic disruption of the transverse atlantal ligament and eight with congenital odontoid dysplasia.JOA scores of neurological function before operation was at a range of 5-13(average 8.38).The average of space available for the cord(SAC)was 9.15 mm.Before the atlantoaxial pedicle screw system was carried out,the skull traction was performed in all the patients preoperatively.Results A total of 128 pedicle screws were inserted safely,with mean operation time and perioperative blood loss for 1.5 hours and 300 ml,respectively.No injury to the vertebral artery or spinal cord was observed.All the patients were followed up for 12-24 months,which showed that JOA scores one year after operation was increased to 10-17(average 14.56),with the improvement rate of 71.70%,and that the SAC was average 14.86 mm.The X-ray and SCT scans verified the proper position of the screws,with no internal fixation failure or atlantoaxial redislocation.After 3-6 months,all the patients except for one patient achieved a solid bone fusion.One year after operation,the one patient with no bone graft fusion was removed of the internal fixation system and obtained satisfactory restoration of the rotational function.Conclusions Atlantoaxial pedicle screw system is an effective method for the treatment of the unstable atlantoaxial dislocation post traction,for it has the advantages of stable three-dimension fixation,direct screw placement,intraoperative reduction and high fusion rate.
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By complexation reaction with water-soluble carboxymethyl chitosan and Ca 2+ ?Fe 2+ ?Zn 2+ in solution,the metal complexes of Ca 2+ ?Fe 2+ ?Zn 2+ were preparated.The effects of various factors:reaction time,etmperature,substitution degree of carboxymethyl group,ionic strength and pH value on the reaction were investigated.The results showed that the optimum reaction condition was pH 5~7,time 10 min,the complex capacity of CMCS for metal ions increasing with the substitution degree of carboxymethyl group,decreasing with the ionic strength of solution.