Clinicopathological features of intestinal mucosal lesions in AIDS patients and their relation with CD4+ T lymphocytes / 中华病理学杂志

Objective@#To observe the histopathological features of different opportunistic infections and tumors of the intestinal mucosa in AIDS patients, and to explore the correlation between different lesions and CD4+ T lymphocyte levels.@*Methods@#Colonic mucosal biopsy specimens of 263 patients with clinically diagnosed AIDS and abdominal pain, diarrhea, blood in the stool and other gastrointestinal symptoms were collected from Beijing Ditan Hospital from 2010 to 2018. There were 232 males and 31 females, with age range 10-81 (mean 40±13) years. HE staining, histochemical special staining, immunohistochemical staining, and in-situ hybridization were used to detect the expression of different opportunistic infection pathogens, tumors and CD4+ T lymphocytes. Peripheral blood was also taken for CD4+ T lymphocytes, CD8+ T lymphocytes, HIV viral load and routine indicators.@*Results@#The cohort included 263 intestinal mucosal biopsy specimens. There were 175 cases (66.5%) of non-specific inflammation, and pathogens were detected in 41 cases (15.6%), including 20 cases(7.6%) of cytomegalovirus (CMV) infection, 12 cases (4.6%) of mycobacterial infection, eight cases (3.0%) of amoeba infestation, and one case (0.3%) of talaromycesmarneffei infection; there were also 41 (15.6%) neoplastic lesions including 25 cases (9.5%) of intraepithelial neoplasia, 10 cases (3.8%) of adenocarcinoma and squamous cell carcinoma, six cases (2.3%) of lymphoma; and six cases (2.3%) of ulcerative colitis. The peripheral blood CD4+T lymphocyte levels of patients with CMV, mycobacteria and talaromycesmarneffei were less than 200/μL; the peripheral blood CD4+ T lymphocyte level (P<0.01) and intestinal mucosa CD4+T lymphocytes (P<0.01) were all significantly lower than those in patients with non-specific inflammation. The peripheral red blood cells and hemoglobin levels of patients with CMV and mycobacterial infection (P<0.01), adenocarcinoma and squamous cell carcinoma (P<0.05) were significantly lower than those of non-specific inflammation patients.@*Conclusions@#Pathologic examination of intestinal mucosa can identify specific infections and neoplastic lesions in AIDS patients; the most common lesions are non-specific inflammation, and CMV infection is the most common opportunistic infections; CMV, mycobacteria and talaromycesmarneffei infections are associated with decreased levels of CD4+ T lymphocytes in peripheral blood and intestinal mucosa; entamoeba histolytica infestation and non-HIV-related neoplastic lesions such as intraepithelial neoplasia, adenocarcinoma and squamous cell carcinoma are not associated with changes in AIDS immune function.

Pneumothorax in HIV/AIDS patients / 中华全科医师杂志

A total of 3 177 HIV/AIDS patients were admitted in Beijing Ditan Hospital,Capital Medical University from January 2009 to December 2015,among whom pneumothorax developed in 50 cases with a morbidity rate of 1.6％.Twenty six HIV/AIDS patients with pneumothorax died with a case fatality rate of 52.0％ (26/50).Pneunocystis jirovecii pneumonia (PCP) was the dominant lung disease related to pneumothorax (37/50).Risk factors of pneumothorax were assessed among 40 HIV/AIDS patients with PCP undergoing mechanical ventilation in ICU,including 20 cases with pneumothorax and 20 cases without pneumothorac.Multivariate logistic regression analysis revealed that positive end-expiratory pressure (PEEP) was independent risk factor of pneumothorax in HIV/AIDS patients with PCP under mechanical ventilation (OR =2.490,95 ％ CI:1.302-4.763,P =0.01).

The effect of HIV infection and HAART on mitochondrion in peripheral monocytes / 中华检验医学杂志

Objective To evaluate the effect of HIV infection and highly active antiretroviral therapy (HAART) on mitochondrial function and mass in peripheral monocytes.Methods There were 14 ART-naive HIV-infected patients,14 NRTI treated HIV-infected patients and 12 healthy controls from Beijing Ditan Hospital.The mitochondrial membrane potential and mitochondrial mass in monocytes were analyzed by flow cytometry.Mitochondrial disturbances related to HIV infection and HAART in monocytes were analyzed.Results In ART-naive patients and NRTI-exposed patients,the levels of mitochondrial membrane potential in monocytes (77.74 ± 14.77,73.94 ± 12.87) were significantly lower than these in healthy controls (89.43 ±4.06) (P =0.032 8,P =0.002 6).The amount of mitochondrial mass in NRTI-exposed patients (3 329.0 ± 836.7) was significantly higher than that in healthy controls (2 075.0 ± 932.2) and that in ART-naive patients (2 592.0 ± 781.5) (P ＜ 0.05).Conclusions The abnormal of mitochondrial membrane potential and mitochondrial mass in monocytes from HIV-infected patients were related to HIV infection and the introduction of HAART.

Prevalence and associated risk factors for obesity and nonalcoholic fatty liver disease in adolescents in Xi′an, Shaanxi province, China / 临床肝胆病杂志

ObjectiveTo provide a scientific basis for the prevention and early intervention of obesity and nonalcoholic fatty liver disease (NAFLD) in adolescents. MethodsAnthropometric measurements, liver function test, and abdominal ultrasonography were performed in adolescents who received physical examination in our hospital from March to April, 2012. Between-group comparison of continuous data was made by t test, and between-group comparison of categorical data was made by χ2 test. The further multivariate analysis was performed by logistic regression analysis. ResultsA total of 4141 adolescents, including 2061 girls and 2080 boys, were enrolled in the study with an average age of 18.62±0.66 years. Boys had significantly higher overweight and obesity rates than girls (χ2=49.5, P＜0.01; χ2=20.4, P＜0.01). The overall incidence of NAFLD in subjects was 8.1% (335/4141), while the incidence of NAFLD in boys was significantly higher than that in girls (13.4% vs 2.8%, χ2=156.4, P＜0.01). The detection rate of NAFLD was the highest in obese subjects, followed by subjects with high body mass index (BMI) and subjects with normal BMI. Moreover, obese boys had a significantly higher detection rate of NAFLD than obese girls (71.6% vs 29.0%, χ2=56.5, P＜0.01). Among both boys and girls, BMI, body mass, alanine aminotransferase level, and aspartate aminotransferase level were significantly higher in the NAFLD group than in the non-NAFLD group (all P＜0.05). Logistic regression analysis revealed that body mass and BMI were likely to be independent risk factors for NAFLD. ConclusionThe prevalence of obesity and NAFLD in adolescents in Xi′an is not optimistic. For obese adolescents, healthy lifestyle, body mass control, and BMI reduction are important approaches for prevention of NAFLD.

Pharyngeal ulcer in patients with acquired immune deficiency syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To understand the high incidence of pharyngeal ulcer in patients with acquired immune deficiency syndrome (AIDS). By analyzing the clinical features in AIDS patients with pharyngeal ulcer, this study provided reference for clinicians.</p><p><b>METHODS</b>Twenty AIDS patients with pharyngeal ulcer were retrospectively analysed to explore its clinical features and mechanism, and to explore the feasible therapeutic methods.</p><p><b>RESULTS</b>The patients generally had severe sore throat and dysphagia for 7 days to 8 months, resulting in significant weight loss. Common therapeutical method does not work. The ulcers developed mainly at vestibule of pharynx (10 cases), tonsil (3 cases), epiglottis (3 cases) and pyriform sinus (2 cases). Ulcer types included major aphthous ulcer (MaAU, 14 cases), fungal ulcer (2 cases), herpes zoster (1 case), ulcer secondary to drug eruption(1 case ), and lymphoma(2 cases). The disease course was long with CD4(+) T lymphocytes decreased significantly. Treatment was given with highly active antiretroviral therapy (HARRT), regulation of immune function, analgesic, anti-inflammatory and anti fungal. Treatment lasted from 2 weeks to 3 months, ulcer healed in 13 cases; 1 patient lost to follow-up, 6 patients dead.</p><p><b>CONCLUSIONS</b>The manifestation of pharyngeal ulcer in AIDS patients has its particularity. It is often associated with a variety of opportunistic infection and tumors. Local treatment is preferred. HAART therapy and systemic comprehensive treatment play more important and effective role. Pharyngeal ulcer persists for a long time, complicated with fever, diarrhea and other symptoms. The history of blood transfusion, injection drug use or unsafe sexual behavior may predict HIV infection.</p>

Relationship between CD4(+) T lymphocyte cell count and the prognosis (including the healing of the incision wound) of HIV/AIDS patients who had undergone surgical operation / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the relationship between CD4(+) T lymphocyte cell count and prognosis as well as healing of the surgical incision in HIV/AIDS patients who had received operation.</p><p><b>METHODS</b>Data were collected and analysed retrospectively from 234 HIV/AIDS patients hospitalized at the Beijing Ditan hospital who underwent operation between January 2008 and December 2012. Following factors were taken into consideration that including:age, gender, time and where that anti-HIV(+) was diagnosed, CD4(+)T lymphocyte cell count at the time of operation, part of the body that being operated, typology of incision, different levels of healing on the surgical incision, infection at the incision site, post-operative complications and the prognosis, etc. Wilcoxon rank sum test, χ(2) test, Kruskal-Wallis H test and Spearman rank correlation were used for statistical analysis to compare the different levels on healing of the incision in relation to the different CD4(+)T lymphocyte cell counts. Rates of level A healing under different CD4(+)T cell counts were also compared.</p><p><b>RESULTS</b>1) Among the 234 patients including 125 males and 109 females, the average age was 36.17±11.56 years old. Time after discovery of anti-HIV(+)was between 0 and 204 months. The medium CD4(+)T cell count was 388.5 cell/µl; 23.93% of the patients having CD4(+)T lymphocyte cell counts as <200 cell/µl. 2) 7.26% of the operations were emergent. There were 23 different organs affected at the time of operation, due to 48 different kinds of illness. 21.37% of the operations belonged to class I incision, 49.57% was class II incision and 29.06% was class III incision. 86.32% of the incisions resulted in level A healing, 12.51% resulted in level B and 1.71% in level C. 4.27% of the patients developed post-operative complications. Differences between level A healing and level B or C healing in terms of CD4(+)T lymphocyte cell count were not significant (P > 0.05). There was no statistically significant difference on the CD4(+) T lymphocyte count in patients with or without postoperative complications. Difference of the HIV infection time was also not statistically significant between the two groups of patients. Rate of level A healing for the different CD4(+)T lymphocyte cell count was not significant (P > 0.05). Healing of the incision did not show significant correlation with CD4(+) T lymphocyte cell count, duration of antiretroviral therapy or the time that HIV infection was discovered (P > 0.05).</p><p><b>CONCLUSION</b>As long as both the in/exclusion criteria were strictly followed, prognosis for operation on HIV/AIDS seemed to be generally good. Low CD4(+)T lymphocyte cell count should not be taken as a exclusion criteria for operation on HIV/AIDS patients.</p>

Clinical effect analysis of four kinds of neuroendoscopic operation mode in treatment of hydrocephalus / 重庆医学

Objective To evaluate the application effect and value of four kinds of neuroendoscopic operation mode in the treat-ment of hydrocephalus .Methods The four kinds of neuroendoscopic operation mode ,including endoscopic third ventriculostomy , septostomy of the septum pellucidum ,cyst ventriculostomy and ventrideperitoneal cavity ,were selected in 58 cases of hydrocephalus according to the indications .The treatment effects were analyzed and the application value was evaluated .Results Among 58 cases of hydrocephalus ,50 cases were significantly improved after operation ,the total effective rate was 86 .21% ,2 cases appeared some complications .The four kinds of operation mode could better treat hydrocephalus .Conclusion Neuroendoscopy is an ideal method in treating hydrocephalus and has the advantages of the slight trauma and fewer complications ,which is a method deserving to be promoted in clinic .

The effect of silencing ATP1A1 gene expression by RNA interference on proliferation of human U 251 glioma stem cells / 重庆医学

Objective To investigate the effects of ATP1A1 knockdown by RNA interference(RNAi) on proliferation of human U251 glioma stem cells .Methods The human U251 glioma stem cells were infected with lentivirus expressing ATP1A1-shRNA . The mRNA and protein expressions of ATP1A1 in U251 glioma stem cells were detected by RT-qPCR and Western blotting ,re-spectively .The cell cycle and apoptosis were evaluated by flow cytometry .The proliferation of U251 glioma stem cells was deter-mined by MTT assay .Results The expressions of ATP1A1 in U251 glioma stem cells transfected with ATP1A1-shRNA were in-hibited significantly at both mRNA and protein levels ,with an inhibitory rate of 84 .15% for ATP1A1 mRNA and of 55 .33% for ATP1A1 protein respectively .The proliferation of cells was inhibited ,the cell apoptotic rate was significantly increased and the cell cycle was arrested in G1 phase and S phase decreased significantly in ATP1A1-shRNA cells(P<0 .05) .Conclusion RNAi targe-ting ATP1A1 gene could down-regulates the ATP1A1 expression ,induces cell apoptosis ,regulates cell phase redistribution and in-hibits cell proliferation in U 251 glioma stem cells .

Clinical analysis of 31 cases with AIDS associated oral candidiasis / 实用口腔医学杂志

Objective:To study the clinical features and treatment outcome of AIDS associated oral candidiasis.Methods:The clinical data of 31 cases with AIDSassociated oral candidiasis from 201209 to 201303 were studied retrospectively,including general data,clinical features,oral manifestation,CD4 cell count,opportunistic infections,and antifungal therapy outcome,etc.Results:CD4cell count ＜200 cell/μl was found in 30 cases,AIDSrelated multiple opportunistic infection was observed in 29 cases.30 cases hadpseudomembranous candidiasis,1 cases had erythematous candidiasis and 2 cases had pseudomembranous candidiasis with angular candidiasis.After antifungal treatment,the lesion of 8 cases reduced,that of 23 cases disappeared completely,lesion relapse after drugwithdrawal happened in 3 cases.Conclusion:AIDSassociated oral candidiasis was more common in AIDS patients with CD4 ＜200cells/μl,the main clinical form is pseudomembranous type,and with multiple opportunistic infections.The antifungal treatment is effective for the patients.

Clinical features of patients with acquired immunodeficiency syndrome complicated by cytomegalovirus viremia / 中华传染病杂志

Objective To understand the clinical features of patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) complicated by cytomegalovirus (CMV)viremia.Methods The clinical data of 249 cases of HIV/AIDS patients hospitalized in Beijing Ditan Hospital from Oct 2008 to Nov 2009 were analyzed retrospectively,in which 43 HIV/AIDS patients were diagnosed with CMV viremia.The symptoms and signs,cerebrospinal fluid (CSF)tests,and pathological detections by bronchoscope,gastroscope and fibercoloscope were collected.The database was set up using Excel software.The association between cellular immunity and CMV DNA level was determined by SPSS12.0 software.Results Forty-three patients (17.3%)were diagnosed with CMV viremia by positive results of CMV pp65 antigen and CMV DNA tests; 14 patients manifested retinal bleeding or infiltration and 4 patients displayed retinal fibrosis; 1 patient was diagnosed with CMV pneumonitis by pathological results of bronchoalveolar lavage fluid.Low level of CD4+ T lymphocytes and CMV DNA levels were positively correlated.Conclusions CMV pp65 antigen and CMV DNA should be detected in HIV/AIDS patients with CD4+ T lymphocytes less than 100 × 106/L and anti-CMV treatment should be given according to the results.Ophthalmologic examination and bronchoalveolar lavage fluid pathological detection are effective methods in diagnose of CMV retinitis and pneumonitis.

Expressions of folkhead helix transcription factor 3 on CD4+ CD25+ regulatory T lymphocyte in intestinal mucosa in human immunodeficiency virus infected patients / 中华传染病杂志

Objective To investigate the changes of CD4+ CD25+ regulatory T lymphocyte (Treg) and expressions of folkhead helix transcription factor 3 (FoxP3) in intestinal mucosa in human immunodeficiency virus (HIV) infected patients. Methods Twenty-one HIV infected patients and 17 control subjects without HIV infection were included in this study. The expression of FoxP3, which was considered as a specific marker of CD4+ CD25 + Treg, was detected in intestinal mucosa specimens from HIV infected patients by immunohistochemistry. Meanwhile, the in situ expression of CD4+ T lymphocyte was also determined by immunohistochemistry. The data were analyzed by t test. Results The positive labeling index of CD4+ T lymphocyte in intestinal mucosa was significantly lower in HIV infected patients compared to the controls (11. 56%±4. 44% vs 43. 49% ±8. 90% ,t=-11. 86,P<0. 01). The positive labeling index of FoxP3 in intestinal mucosa was also significantly lower in HIV infected patients compared to the controls (0.46% ± 0.20% vs 1. 18% ± 0. 44% ,t= - 5. 98,P<0.01). Conclusion The depletion of CD4+ CD25+ Treg is accompanied with the depletion of CD4 + T lymphocyte and the reduction of FoxP3 expression in intestinal mucosa of HIV infected patients.

A comparison study on the detection of anti-human immunodeficiency virus type 1 (HTV-1) antibodies in different populations with a new rapid test using oral mucosal transudate samples versus enzyme linked immunosorbent assay (ELISA) using serum samples / 中华皮肤科杂志

Objective To evaluate the consistence in the detection of antibodies against HIV-1 between a new rapid test using oral mucosal transudate (OMT) samples and ELISA using serum samples. Methods Two-hundred patients who were positive for anti-HIV-1 antibodies by serum ELISA and confirmed by Western blot to be infected with HIV, and 600 healthy human controls negative for anti-HIV-1 antibodies by serum ELISA, were eligible for this study. OMT samples were collected from these subjects and subjected to a rapid test for anti-HIV-1 antibodies. The factors influencing the performance of the rapid test were analyzed. Results Of the 200 OMT specimens from HIV-infected patients, 198 showed positive reaction, 2 showed negative reaction. Among the 198 positive reactions, 192 (96%) were "clear" and easy to make decisions, 4 (2%) were "faint", 2(1%) were "very faint" and required professionals to make decisions. The rapid test was negative in all the 600 OMT specimens from the control group. Conclusions The consistence in the detection of anti-HIV-1 antibodies between the OMT rapid test and serum ELISA was 99% in HIV-positive specimens, 100% in HIV-negative specimens, and 99.75% in all the specimens.

The correlation between CD4+ T cell count and the routine blood tests in HIV/AIDS patients / 中华检验医学杂志

Objective To determine the feasibility of human routine blood tests as a surrogate for CD4+ T cell count through studying the correlation of CD4+ T cell count with total lymphocyte count(TLC),hemoglobin(Hb),blood platelet(PLT),and white cell count(WBC)in HIV/AIDS patients.Methods 1 038 person-time blood tests among 778 HIV/AIDS patients were performed and Spearman correlation analysis was used.Predictive power and the cut-off for potential predictors of CD4+ T cell count were assessed through receiver operating characteristic(ROC)curves.Combination test was used to assess the capability of multipie indexes to serve as surrogate markers for CD4+ T cell counL Results Significant correlations with CD4+ T cell count were observed for TLC,Hb,PLT and WBC.The Spearman correlation coefficients were r=0.64,P=0.000;r=0.36,P=0.000;r=0.24,P=0,000;r=0.09,P=0.000,respectively.No correlation between TLC and CD4+ T cell count was found when,TLC was more than 2 000 × 106/L(r=0.12,P=0.15).The areas under ROC curve of TLC and Hb for predicting CD4+ T cell count were between 0.82 to 0.84,and 0.66 to 0.70,respectively.When CD4+ T cell count were less than 50,200,350 cells/μl respectively,the optional cut-off value was TLC＜1 100 × 106/L,1 200 × 106/L and 1 400 × 106/L.When the study combined TLC＜1 200 × 106/L and Hb＜120 g/L for prediction of CD4+ T cell count＜200/μl,the sensitivity was 45.3% and specificity was 82.8%.Conclusion There is no significant application value for combination of TLC＜1 200×106/L and Hb＜120 g/L as a surrogate for prediction of CD4+ T cell count＜200/μl.

Effect of transcatheter bladder arterial chemoembolization on microvessel density change in bladder cancer of the elderly / 中华老年医学杂志

Objective To investigate the effect of transcatheter bladder arterial chemoembolization on microvessel density(MVD)change in bladder cancer. Methods The MVD count of bladder cancer tissue of 30 patients before and after chemoembolization were examined by SP immunohistochemical staining.Cancer tissues were examined pathology after chemoembolization.All the cases were followed up for 12 to 36 months(mean 24.6 months),the 3 years survival rate was evaluated clinically. Results MVD counts were 69.8±3.4 and 56.4±3.3 before and after therapy respectively(P<0.05).Cancer tissues were severely damaged ultramicroscopically after interventional chemotherapy.The recurrent rate was 16.67%in 30 cases. Conclusions The chemoembolization could decrease MVD,improve survival rate and reduce the recurrence rate.

Clinical characteristics of 275 pediatric cases of acquired immune deficiency syndrome / 中华传染病杂志

Objective To study the clinical characteristic of acquired immune deficiency syndrome (AIDS) patients younger than 15 years old and to explore the influence of human immunodeficiency virus (HIV) infection on them. Methods The clinical information, including demographic profile, clinical stages of the disease, laboratory test results and developmental status were gathered from 275 antiretroviral therapy naive patients. Results Seventy eight point nine percent patients were infected by vertical transmission. Sixteen percent were infected by receiving blood products. The average age was (7.6±3. 7) years, with 5 cases younger than 1 year old, 104 cases ranging from 1 - 5 years and 166 cases elder than 6 years. Seventy point one percent patients were classified as stage 3 or 4 according to World Health Organization definitions. The average CD4 count was ( 137 ± 159 )/μL, ( 304 ± 317 ) /μL and ( 1 246 ± 776 )/μL respectively in children elder than 6 years, ranging from 1 to 5 years and younger than 1 year. One hundred and eighty one cases suffered from anemia on different severity grading. The most common HIV related symdromes included persistent fever, skin damage, persistent diarrhea, oral candidiasis and recurrent upper respiratory tract infection. Among these infected children, 49. 6% showed height lower than x - 2s and 19. 9% showed weight lower than x - 2s. Conclusions Most survival pediatric AIDS patients are elder than 6 years. HIV infection can significantly affect the children's immune system function,growth and development.

Expression and significance of ABCG2 in U251cells and U251 stem cells / 重庆医科大学学报

Objective:To investigate the expression and significance of ABCG2(the G2 member of ATP-binding cassette family)in U251and its stem cell.Methods:The U251 were cultured in serum-free medium with EGF,bFGF,LIF and B27.The tumor spheres formed and cultured continuously in the serum-free medium through the monoclonal formation experiment.The immunofluorescence staining was employed to identify the U251 stem cell.The expression of ABCG2 was detected by confocal microscopy and Western blot.Results:The stem cells from malignant glioma cell line U251 have been successfully isolated.The cells expressed CD 133.The ABCG2 protein positive stain was located in the cell membrane in both U251 cells and its stem cell with confocal microscopy method.Western blotting showABCG2 was expressed in U251 cells and in its stem cells.The expression level in the stem cells was significantly higher than U251 cells.Conclusion:ABCG2 is expressed in U251 cells and in U251 stem cells.The expression level in the latter was higher.