Reasons, safety and efficacy analysis for conversion of HAART to TAF/FTC/BIC among HIV-infected patients / 中华医学杂志(英文版)

BACKGROUND@#This study aimed to determine the reasons for conversion and elucidate the safety and efficacy of transition to tenofovir alafenamide/emtricitabine/bictegravir sodium (TAF/FTC/BIC) in highly active antiretroviral therapy (HAART)-experienced HIV-infected patients in real-world settings.@*METHODS@#We conducted a retrospective cohort study. The treatment conversion rationales, safety, and effectiveness in 1684 HIV-infected patients with previous HAART experience who switched to TAF/FTC/BIC were evaluated at Beijing Ditan Hospital from September 2021 to Auguest 2022.@*RESULTS@#Regimen simplification (990/1684, 58.79%) was the most common reason for switching, followed by osteoporosis or osteopenia (375/1684, 22.27%), liver dysfunction (231/1684, 13.72%), decline in tenofovir alafenamide/emtricitabine/elvitegravir/cobicistat (TAF/FTC/EVG/c) with food restriction (215/1684, 12.77%), virological failure (116/1684, 6.89%), and renal dysfunction (90/1684, 5.34%). In patients receiving non-nucleotide reverse transcriptase inhibitors (NNRTI)-containing regimens, lipid panel changes 1 year after switching indicated a difference of 3.27 ± 1.10 mmol/L vs . 3.40 ± 1.59 mmol/L in triglyceride ( P  = 0.014), 4.82 ± 0.74 mmol/L vs . 4.88 ± 0.72 mmol/L in total cholesterol ( P  = 0.038), 3.09 ± 0.70 mmol/L vs . 3.18 ± 0.66 mmol/L in low-density lipoprotein ( P  <0.001), and 0.99 ± 0.11 mmol/L vs . 0.95 ± 0.10 mmol/L in high-density lipoprotein ( P  <0.001). Conversely, among patients receiving booster-containing regimens, including TAF/FTC/EVG/c and lopinavir/ritonavir (LPV/r), lipid panel changes presented decreased trends. We also observed an improved trend in viral load suppression, and alanine transaminase (ALT), aspartate transaminase (AST), estimated glomerular filtration rate (eGFR), and serum creatinine levels after the transition ( P  <0.001).@*CONCLUSION@#The transition to TAF/FTC/BIC demonstrated good treatment potency. Furthermore, this study elucidates the motivations behind the adoption of TAF/FTC/BIC in real-world scenarios, providing clinical evidence supporting the stable conversion to TAF/FTC/BIC for HAART-experienced patients.

Longitudinal analysis of immune reconstitution and metabolic changes in women living with HIV: A real-world observational study / 中华医学杂志(英文版)

BACKGROUND@#Women comprise more than half of people living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) worldwide and incomplete immune recovery and metabolic abnormalities affect them deeply. Studies of HIV antiretroviral therapy (ART) have a low female representation in China. We aimed to investigate immune reconstitution and metabolic changes of female HIV-positive cohort in China longitudinally.@*METHODS@#HIV-positive women who initiated ART from January 2005 to June 2021 and were followed up regularly at least once a year were included in this study. Immunological indicators (cluster of differentiation 4 [CD4] counts and CD8 counts), viral load (VL), and metabolic indicators were collected at follow-up. All data were collected from the China Disease Prevention and Control Information System (CDPCIS). VL was tested half a year, 1 year after receiving ART, and every other year subsequently according to local policy. CD4/CD8 ratio normalization was considered as the primary outcome and defined as a value ≥1. Incidence rate and probability of CD4/CD8 ratio normalization were estimated through per 100 person-years follow-up (PYFU) and Kaplan-Meier curve, respectively. Multivariate Cox regression was used to identify independent risk factors associated with CD4/CD8 ratio normalization. We further studied the rate of dyslipidemia, hyperuricemia, diabetes, liver injury, and renal injury after ART initiation with the chi-squared tests or Fisher's exact probability tests, and a generalized estimating equation model was used to analyze factors of dyslipidemia and hyperuricemia.@*RESULTS@#A total of 494 female patients with HIV/AIDS started ART within 16 years from January 2005 to June 2021, out of which 301 women were enrolled with a median duration of ART for 4.1 years (interquartile range, 2.3-7.0 years). The overall incidence rate of CD4/CD8 ratio normalization was 8.9 (95% confidence interval [CI], 7.4-10.6) per 100 PYFU, and probabilities of CD4/CD8 normalization after initiating ART at 1 year, 2 years, 5 years, and 10 years follow-up were 11.7%, 23.2%, 44.0%, and 59.0%, respectively. Independent risk factors associated with CD4/CD8 normalization were baseline CD4 cell counts <200 cells/μL, CD8 counts >1000 cells/μL, and more than 6 months from the start of combined ART (cART) to first virological suppression. Longitudinally, the rate of hypercholesterolemia (total cholesterol [TC]) and high triglyceride (TG) showed an increasing trend, while the rate of low high-density lipoprotein cholesterol (HDL) showed a decreasing trend. The rate of hyperuricemia presented a downtrend at follow-up. Although liver and renal injury and diabetes persisted during ART, the rate was not statistically significant. Older age and protease inhibitors were independent risk factors for increase of TC and TG, and ART duration was an independent factor for elevation of TC and recovery of HDL-C.@*CONCLUSIONS@#This study showed that women were more likely to normalize CD4/CD8 ratio in comparison with findings reported in the literature even though immune reconstruction was incomplete.

Optimization of production process of Aeromonas veronii CA07 strain inactivated vaccine / 中国生物制品学杂志

@#Abstract：Objective To optimize the production process of inactivated vaccine of Aeromonas veronii（AV）CA07 strain. Methods The fermentation culture process of AV CA07 strain liquid was determined through the optimization of the culture time（2～16 h），medium（optimized fermentation medium，LB medium and NB medium）and fermentation conditions（in⁃ oculation amount of 1%，5%，10% and 15%；ventilation rate of 2，4，6 and 8 L／min and fermentation time of 6，8，10 and 12 h）. The optimal inactivation process was determined through the comparison of the final concentration of formalde⁃ hyde solution（0. 10%，0. 20%，0. 30% and 0. 40%），inactivation temperature（28 and 37 ℃）and inactivation time（24， 48 and 72 h）. The large⁃scale production process of inactivated vaccine of AV CA07 strain in 500 L fermentor was estab⁃ lished and the prepared vaccines were tested for safety and immunogenicity. Results The optimal inoculation amount of AV CA07 strain was 5%，ventilation rate was 4 L／min and culture time was 10 ~ 12 h. The optimal inactivation condition was adding formaldehyde solution with final concentration of 0. 30% incubating at 37 ℃ for 24 h. The number of viable bacteria in the fermentation broth of AV CA07 strain prepared in 500 L fermentor was more than 8 × 109 CFU／mL. All crucian carps immunized with the inactivated vaccine by abdomen survived. After challenge，the relative immune protection rate was more than 90%. Conclusion AV CA07 strain inactivated vaccine prepared by optimized production process showed good safety and immunogenicity.

Effects of plasma lipopolysaccharide changes on platelet release of vascular endothelial growth factor and thromobospondin-1 in patients with cirrhotic portal hypertension after TIPS procedure / 中华肝脏病杂志

Objective: To investigate the effects of plasma lipopolysaccharide (LPS) concentration changes on platelet release of vascular endothelial growth factor (VEGF) and thrombospondin (TSP)-1 in patients with decompensated cirrhotic portal hypertension after transjugular intrahepatic portosystemic shunt (TIPS) procedure. Methods: 169 cases with cirrhotic portal hypertension were enrolled, of which 81 cases received TIPS treatment. LPS, VEGF, and TSP-1 concentrations with different Child-Pugh class in peripheral blood plasma of patients were measured. After pre-incubation of normal human platelets with different concentrations of LPS and stimulated by collagen in vitro, platelet PAC-1 expression rate, VEGF, and TSP-1 concentrations were detected. PAC-1 expression rate and the concentrations of LPS, VEGF and TSP-1 in peripheral blood plasma of patients before and after TIPS procedure were detected. The relationship between plasma LPS, VEGF and TSP-1 concentrations and Child-Pugh score changes in patients after TIPS procedure was analyzed. Statistical analysis was performed by t-test, one-way ANOVA or Pearson's rho according to different data. Results: Plasma LPS and TSP-1 concentrations were significantly higher in Child-Pugh class C patients than class A and B, but the concentration of plasma VEGF was significantly lower than class A and B (P < 0.01). In vitro experiments showed that concentration of LPS, TSP-1, and platelet PAC-1 expression rate was higher in the supernatant, but the difference in the concentration of VEGF in the supernatant was not statistically significant. Portal vein pressure and platelet activation were significantly decreased (P < 0.01) in patients after TIPS procedure. Portal venous pressure, platelet activation, plasma LPS, and TSP-1 levels were significantly decreased continuously, while VEGF levels were significantly increased continuously after TIPS procedure. Plasma LPS concentration was positively correlated with TSP-1 concentration (r = 0.506, P < 0.001), and negatively correlated with VEGF concentration (r = -0.167, P = 0.010). Child-Pugh score change range was negatively correlated with change range of plasma VEGF concentration (r = -0.297, P = 0.016), and positively correlated with change range of plasma TSP-1 concentration (r = 0.145, P = 0.031) after TIPS. Conclusion: Portal venous pressure gradient, plasma LPS concentration and corresponding platelet activation was decreased in cirrhotic portal hypertension after TIPS procedure, and with TSP-1 reduction and VEGF elevation it is possible to reduce the liver function injury caused by portal venous shunt.

Epidemiology and influencing factors of human immunodeficiency virus and hepatitis B virus co-infected patients in Beijing / 中华内科杂志

Objective:To analyze the epidemiological characteristics of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) co-infected patients in Beijing and investigate the associated factors.Methods:The clinical data of patients with HIV infection who were treated in HIV/AIDS designated hospitals (Peking Union Medical College Hospital, Beijing Ditan Hospital and Beijing Youan Hospital) were retrospectively analyzed.Results:A total of 11 572 patients were finally included in the study, among whom 532 patients (4.6%) were co-infected with HIV and HBV. Most of the co-infected patients were young male adults (28~48 years old), accounting for 85.9%. The main transmission route was homosexual behavior (74.8%). There were 87.4% co-infected patients treated with two anti-HBV drugs, including lamivudine (3TC) and tenofovir (TDF). From 2013 to 2018, the annual prevalence of HIV and HBV co-infection decreased gradually, with the rate of 6.37%, 4.55%, 3.92%, 4.68%, 4.24% and 2.74%, respectively. In our study, The main influencing factors of HIV and HBV co-infection were age older than 28 years old versus<28 years old ( OR=2.807, 95% CI 1.241-6.345) and marriage status (married versus unmarried, OR=1.259, 95% CI 1.004-1.579). Conclusions:The proportion of HBV infection in HIV-infected patients is 4.60% (532) in our cohort. From 2013 to 2018, the prevalence of HIV and HBV co-infection in Beijing shows a decreasing trend. The risk of co-infection is higher in married young adults (28~48 years old).

Prevalence and risk factors for bone mineral density changes in antiretroviral therapy-naive human immunodeficiency virus-infected adults: a Chinese cohort study / 中华医学杂志(英文版)

BACKGROUND@#Studies have reported that low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected patients; however, the factors that contribute to HIV-related BMD changes are yet to be fully understood. Due to the application of dual X-ray absorptiometry (DXA) among a select group of hospitals only, the prevalence and risk factors of low BMD in HIV-infected populations have not been intensively investigated in China. Thus, the aim of our study was to investigate the prevalence of and risk factors associated with BMD changes among antiretroviral therapy (ART)-naive HIV-positive patients in China.@*METHODS@#The assessment of the prevalence of and risk factors associated with BMD changes was conducted among 156 ART-naive HIV-infected patients. Demographic and clinical data, as well as results of fasting blood tests were obtained from patients. Further, all patients underwent DXA scans to determine BMD, which was then used to classify patients with osteopenia/osteoporosis. The risk factors of reduced BMD were then evaluated using binary logistic regression.@*RESULTS@#Among the 156 ART-naive HIV-infected participants, osteopenia and osteoporosis were diagnosed in 48.7% (76/156) and 4.5% (7/156) of patients, respectively. The lumbar spine was most likely to have reduced BMD (49.4% [77/156]), and the proportion of osteopenia in the left hip (32.7% [51/156]) was higher than in the right hip (24.4% [38/156]). In the lumbar spine, bone loss rate in the L1 section (60.9% [95/156]) was the most significant (L2, 53.2% [83/156]; L3, 45.5% [71/156]; L4, 52.6% [82/156]). Further analysis showed that, compared with the neck (26.9% [42/156] in the left, 18.6% [29/156] in the right) and the interior (15.4% [24/156] in the left, 13.5% [21/156] in the right), the trochanter had the greatest probability of reduced BMD (46.2% [72/156] in the left, 28.8% [45/156] in the right). In the risk factor analysis, low body mass index (BMI: <18.5 kg/m2) was positively associated with reduced BMD (Exp (B) = 39.743, 95% confidence interval: 3.234-488.399, P = 0.004), and was specifically positively correlated with BMD values at three sites (r = 0.335 at right hip, r = 0.327 at left hip, r = 0.311 at lumbar spine).@*CONCLUSION@#Reduced BMD was found in the majority of ART-naive HIV-infected patients and BMI was identified as an additional risk factor for reduced BMD. Our results show that BMD reduction was simultaneously present in the left hip, right hip, and lumbar spine among nearly one fifth of patients. Our work highlights the importance of closely monitoring BMD in ART-naive patients and provides a foundation for the clinical intervention of bone demineralization in them.

The Application of Multi-modal CT in Stent Embolectomy for Acute Ischemic Stroke / 中山大学学报(医学科学版)

@#【Objective】To explore the image evaluation value of multi-model CT in the treatment of acute ischemic stroke with Solitaire stent embolectomy. 【Methods】 A total of 62 patients diagnosed with acute ischemic stroke from January 2015 to June 2016 in Guangdong Second Provincial General Hospital were included in this study. Multi- model CT inspection，including CT scan（NCCT），CT angiography（CTA）and CT perfusion imaging（CTP），was performed in all patients within 3~8 h. The improved vascular TICI classification standard（mTICI）was used to assess vascular embolization，and we evaluated the responsible vessels and blood perfusion state by CTA and CTP blood vessels ，to determine the feasibility of embolectomy with Solitaire stent preliminarily. The patients underwent multi-mode CT examination 24 h after stent embolization to evaluate the responsible vessels. NIHSS was used to assess the neurological function at admission and 72 h after stent embolization.【Results】A total of 34 patients with indication of stent thrombus removal were selected by multi-mode CT examination from 62 patients. Re-examination of multi-mode CT after stent thrombus removal showed that 30 of the 34 cases（30/34，the successful rate was 88.2%）gained success in vascular recanalization. Before the stent thrombus removal of the 34 patients，CTP imaging showed ischemic penumbra（IP），and there was significant decrease in cerebral blood flow（CBF）and slight decrease in cerebral blood volume（CBV），significantly prolonged peak time （TTP） and mean transit time （MTT） compared with the contralateral image area. The difference is statistically significant（P < 0.01）. After the stent thrombus removal，the relative cerebral blood flow（rCBF）and relative cerebral blood volume（rCBV）were elevated，the relative peak time（rTTP）and relative mean transit time（rMTT）were shortened. The difference is statistically significant（P < 0.01）. Compared with admission，there is significant statistical difference in the NIHSS score of patients 72 h after operation（P < 0.01）.【Conclusion】Multi-model CT has guiding effect and important evaluation value in the treatment of acute ischemic stroke patients with Solitaire stent thrombolysis.

An analysis of periodontal status in desquamative gingivitis and the correlative factors / 口腔疾病防治

Objective @#To study the clinical periodontal status of patients with desquamative gingivitis (DG) and analyze the factors that influence clinical periodontal indicators.@*Methods @#A purposive sampling method was used to obtain 42 subjects for a DG case group and a control group. Periodontal clinical indicators were detected, and related factors were analyzed. @*Results @#The DG patients were primarily middle-aged women. Periodontal clinical indicators were more prevalent in individuals with oral lichen planus (OLP) and mucous membrane pemphigoid (MMP) than in the control group. Probing depth (PD) (χ2=53.058, P<0.001; χ2=32.989, P<0.001), clinical attachment (χ2=30.292, P<0.001; χ2=32.470, P<0.001) and the positive rate of bleeding on probing (BOP) (χ2=50.003, P<0.001; χ2=36.236, P<0.001) were higher in the OLP and MMP group than in the control group. The time interval between the onset and treatment of DG was correlated with PD (rs=0.523, P<0.001) and the rate of positive BOP sites (rs=0.377, P=0.014). @*Conclusion@# Patients with DG have obvious periodontal lesions. Early medical intervention is helpful for diagnosing and treating DG-related oral and systemic disease.

Aberrant histone modification in peripheral blood CD4+ T lymphocytes in oral lichen planus / 口腔疾病防治

Objective@#To investigate the histone acetylation level and histone deacetylase (HDAC) activity of peripheral blood CD4+ T lymphocytes in patients with oral lichen planus (OLP). @*Methods @#Twenty-three OLP patients were selected from August 2016 to January 2017 from the Stomatological Hospital, Southern Medical University. The diagnosis was confirmed by pathology, and the lesions were divided into a nonerosive OLP group (11 cases) and an erosive OLP group (12 cases). Ten healthy sex- and age-matched volunteers served as controls. Immunomagnetic beads were used to separate CD4+ T lymphocytes, and histones and nucleoproteins were extracted. The global histone H3/H4 acetylation levels and HDAC activity of CD4+ T lymphocytes from all subjects were detected by ELISA. The differences between the OLP and control groups were statistically analyzed. @*Results@#Global histone H3 hypoacetylation was observed in the OLP group compared with the control group (u = -2.410, P = 0.012). However, there was no significant difference in the serum CD4+ T lymphocyte histone H4 acetylation level between the OLP and control group (u = -1.412, P = 0.158). HDAC activity was significantly higher in the OLP group than in the healthy control group (F = 5.749, P = 0.023), and much higher HDAC activity was observed in the erosive group than in the nonerosive (P = 0.014) and healthy control groups (P = 0.001). The degree of histone H3 acetylation correlated negatively with increased HDAC activity in the OLP group (rs = -0.771, P < 0.001). There was no correlation between the level of histone H3 acetylation and HDAC activity in the healthy control group (rs = 0.382,P = 0.276). The histone H4 acetylation level in the OLP group showed no correlation with HDAC activity (rs = 0.149, P = 0.498), and the histone H4 acetylation level in the control group also showed no correlation with HDAC activity (rs = 0.527, P = 0.117).@*Conclusion @#Abnormal histone acetylation of CD4+ T lymphocytes in the peripheral blood of patients with OLP was identified and could be related to HDAC activity, suggesting that the epigenetic modification of histone acetylation may play a role in the pathogenesis of OLP.

Characteristics of collateral circulation in adult moyamoya disease based on modified Suzuki staging / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the characteristics of collateral circulation in adult moyamoya disease (MMD).</p><p><b>METHODS</b>The clinical data were collected from all adult patients with MMD undergoing digital subtractive angiography (DSA) in our department from 2006 to 2016. Based on the imaging findings, the patients were divided into ischemia group and bleeding group. A double-blind analysis was conducted of the CT or magnetic resonance imaging findings and the severity of the disease was graded using the modified Suzuki score (mSS). We classified the anastomotic networks in MMD into the superficial meningeal type and deep parenchymal type. The superficial meningeal type was further classified into the leptomeningeal and the durocortical networks, and the deep parenchymal networks into subependymal networks and the inner striatal and inner thalamic networks.</p><p><b>RESULTS</b>No significant difference was found in the distribution of mSS scores between the hemorrhage group and the ischemic group (Χ=5.812, v=5, P=0.325), but the posterior communicating artery and internal carotid artery diameter ratio (Pcom/ICA ratio) was significantly greater in the hemorrhage group (t=2.119, v=108, P=0.036). The Pcom/ICA ratio differed significantly among the groups with different mSS scores (f=8.924, P=0.00), higher in groups with mSS scores of 3, 4 and 5. The incidence of anterior choroidal artery dilation differed significantly between hemorrhage and ischemic groups (Χ=11.79, P=0.001). The incidences of durocortical networks (Χ=0.327, P=0.567) and subependymal networks (Χ=0.011, P=0.917) were comparable between hemorrhage group and ischemic groups, but the incidence of leptomeningeal networks (P=0.018) and inner striatal and inner thalamic networks (Χ=7.551, P=0.006) differed significantly between the two groups.</p><p><b>CONCLUSION</b>The collateral circulation vascular system is an important component of cerebral blood flow in MMD patients and varies from patient to patient. Patients with MMD exhibit increased Pcom/ICA ratio with abnormal expansion of the anterior choroidal artery, and the leptomeningeal networks and the inner striatal and inner thalamic networks are independent risk factors for cerebral hemorrhage.</p>

Why universities terminated organized vaccination? An analysis using the Smith model of poli-cy implementation process / 中国卫生政策研究

Objective:Using the Smith Model of policy implementation, the paper analyses how an adverse e-vent,the"Si-xian County Vaccine Incident",caused the termination of organized vaccination in universities L city. Methods:Case study, in-depth interviews among 15 key insiders, and 5 focus-group interviews among college students. All interviews transcribed,coded and analyzed. Results:There are no clear policy targets nor specific im-plementation standards for college students' vaccination. The target group (college students) holds a low level of awareness of vaccination. Implementation departments are sensitive to any risks due to the prevalent stability-oriented social environment,and have limited space for action when facing emergencies. Conclusion:In the stability-oriented social environment,the Si-xian County Vaccine Incident amplified the risks and limited the space of vaccination poli-cy implementation. In the absence of policy goals for college student vaccination,it was safer to terminate organized vaccination programs,which had a negative impact on university vaccination. The government should lay out specific policy goals for vaccination,and broaden the possible implementation space,as well as establish mechanisms for at-tenuating the risks of vaccination.

Mechanism of quercetin improving rat coronary artery myogenic re-sponse under high glucose / 中国病理生理杂志

AIM:To investigate the mechanism of quercetin improving rat coronary artery myogenic response under high glucose ( HG) by measuring muscle tension of coronary arterial ring and recording voltage -gated K +channel ( Kv) current of coronary artery smooth muscle cells by whole cell patch clamp .METHODS:The coronary rings from the normal SD rats were acutely isolated , and then divided into 6 groups:(1) control group;(2) HG group;(3) HG+low dose (3 μmol/L) of quercetin group;(4) HG+moderate dose (10 μmol/L) of quercetin group; (5) HG+high dose (30 μmol/L) of quercetin group;(6) HG+C6303 (PKC inhibitor) +high dose of quercetin group.Determinations of coronary artery response to vasoconstrictor (60 mmol/L KCl or 0.1 mmol/L U46619) or vasodilator (Ach at 10 -9 ~10 -5 mol/L) were performed, and the percentage of coronary ring tension was calculated using the contraction as 100%caused by 60 mmol/L KCl.The rat coronary artery smooth muscle cells were acutely isolated for recording the Kv current using whole cell patch clamp .RESULTS:Compared with control group , the contraction amplitudes to 60 mmol/L KCl or 0.1 mmol/L U46619 were significantly increased under HG incubation .Quercetin intervention concentration-dependently re-duced the coronary artery contraction amplitude .Incubation of PKC specific inhibitor C 6303 attenuated the effect of querce-tin.Compared with control group , the diastolic amplitude to Ach decreased significantly in HG group , and quercetin inter-vention concentration-dependently increased the coronary artery diastolic amplitude .Incubation of PKC specific inhibitor C6303 attenuated the effect of quercetin .Compared with control group , HG incubation inhibited Kv current of coronary ar-tery vascular smooth muscle cells significantly , and quercetin intervention attenuated the inhibitory effect of HG on Kv cur-rent intensity .Incubation of PKC specific inhibitor C 6303 attenuated the effect of quercetin .CONCLUSION: Quercetin has a protective effect on myogenic response of coronary artery under HG and the effects is related to the increase in Kv cur -rent and the activation of PKC in vascular smooth muscle cells .

Effects of bronchoalveolar lavaging of fiberoptic bronchoscopy for the serum PCT and CRP of patients with severe VAP / 中国医学装备

Objective:To observe the effect of bronchoalveolar lavaging of fiberoptic bronchoscopy for the serum procalcitonin (PCT) and C-reactive protein (CRP) of patients with severe ventilator-associated pneumonia (VAP). Methods: 70 patients with severe VAP were enrolled in the retrospective study and were divided into observation group (35 cases) and control group (35 cases). Patients of observation group received the treatment of bronchoalveolar lavaging of fiberoptic bronchoscopy, and patients of control group received the treatment of routine bronchoalveolar lavaging combined with suctioning. The control time of pulmonary infection, therapy time of mechanical ventilation, time of bringing down fever, white blood cell count and clinical pulmonary infection score (CPIS) of the two groups were compared and analyzed. Besides, the changes of respiratory functional indicator, blood and respiration indicator, the expression of serum CRP and PCT of the two groups at pre-and post treatment were compared.Results:The control time of pulmonary infection, therapy time of mechanical ventilation and time of bringing down fever of observation group were significantly shorter than that of control group (t=12.954,t=13.124,t=11.062,P<0.05). And both of the white blood cell count and CPIS of observation group were significantly lower than that of control group (t=11.804,t=11.342,P<0.05). Besides, all of these indicators including DLC, Raw, PIP, WOB, PaO2, PaO2/FiO2 and PaCO2 of two groups were obviously improved while these results of observation group were significantly better than that of control group (t=9.324, 8.653, t=10.122,t=8.154,t=9.530,t=9.691,t=10.012,P<0.05). And both of the expression of CRP and PCT of the two groups were obviously reduced, and the results of observation group were significantly better than that of control group (t=15.358, t=13.157,P<0.05).Conclusion: Bronchoalveolar lavaging of fiberoptic bronchoscopy can significantly improve the respiratory function index, blood and respiration indicator and can reduce the expression level of serum CRP and PCT for patients with VAP, and its curative effect is remarkable.

Mechanism of quercetin improving rat coronary artery myogenic re-sponse under high glucose / 中国病理生理杂志

AIM:To investigate the mechanism of quercetin improving rat coronary artery myogenic response under high glucose ( HG) by measuring muscle tension of coronary arterial ring and recording voltage -gated K +channel ( Kv) current of coronary artery smooth muscle cells by whole cell patch clamp .METHODS:The coronary rings from the normal SD rats were acutely isolated , and then divided into 6 groups:(1) control group;(2) HG group;(3) HG+low dose (3 μmol/L) of quercetin group;(4) HG+moderate dose (10 μmol/L) of quercetin group; (5) HG+high dose (30 μmol/L) of quercetin group;(6) HG+C6303 (PKC inhibitor) +high dose of quercetin group.Determinations of coronary artery response to vasoconstrictor (60 mmol/L KCl or 0.1 mmol/L U46619) or vasodilator (Ach at 10 -9 ~10 -5 mol/L) were performed, and the percentage of coronary ring tension was calculated using the contraction as 100%caused by 60 mmol/L KCl.The rat coronary artery smooth muscle cells were acutely isolated for recording the Kv current using whole cell patch clamp .RESULTS:Compared with control group , the contraction amplitudes to 60 mmol/L KCl or 0.1 mmol/L U46619 were significantly increased under HG incubation .Quercetin intervention concentration-dependently re-duced the coronary artery contraction amplitude .Incubation of PKC specific inhibitor C 6303 attenuated the effect of querce-tin.Compared with control group , the diastolic amplitude to Ach decreased significantly in HG group , and quercetin inter-vention concentration-dependently increased the coronary artery diastolic amplitude .Incubation of PKC specific inhibitor C6303 attenuated the effect of quercetin .Compared with control group , HG incubation inhibited Kv current of coronary ar-tery vascular smooth muscle cells significantly , and quercetin intervention attenuated the inhibitory effect of HG on Kv cur-rent intensity .Incubation of PKC specific inhibitor C 6303 attenuated the effect of quercetin .CONCLUSION: Quercetin has a protective effect on myogenic response of coronary artery under HG and the effects is related to the increase in Kv cur -rent and the activation of PKC in vascular smooth muscle cells .

Effects of bronchoalveolar lavaging of fiberoptic bronchoscopy for the serum PCT and CRP of patients with severe VAP / 中国医学装备

Objective:To observe the effect of bronchoalveolar lavaging of fiberoptic bronchoscopy for the serum procalcitonin (PCT) and C-reactive protein (CRP) of patients with severe ventilator-associated pneumonia (VAP). Methods: 70 patients with severe VAP were enrolled in the retrospective study and were divided into observation group (35 cases) and control group (35 cases). Patients of observation group received the treatment of bronchoalveolar lavaging of fiberoptic bronchoscopy, and patients of control group received the treatment of routine bronchoalveolar lavaging combined with suctioning. The control time of pulmonary infection, therapy time of mechanical ventilation, time of bringing down fever, white blood cell count and clinical pulmonary infection score (CPIS) of the two groups were compared and analyzed. Besides, the changes of respiratory functional indicator, blood and respiration indicator, the expression of serum CRP and PCT of the two groups at pre-and post treatment were compared.Results:The control time of pulmonary infection, therapy time of mechanical ventilation and time of bringing down fever of observation group were significantly shorter than that of control group (t=12.954,t=13.124,t=11.062,P<0.05). And both of the white blood cell count and CPIS of observation group were significantly lower than that of control group (t=11.804,t=11.342,P<0.05). Besides, all of these indicators including DLC, Raw, PIP, WOB, PaO2, PaO2/FiO2 and PaCO2 of two groups were obviously improved while these results of observation group were significantly better than that of control group (t=9.324, 8.653, t=10.122,t=8.154,t=9.530,t=9.691,t=10.012,P<0.05). And both of the expression of CRP and PCT of the two groups were obviously reduced, and the results of observation group were significantly better than that of control group (t=15.358, t=13.157,P<0.05).Conclusion: Bronchoalveolar lavaging of fiberoptic bronchoscopy can significantly improve the respiratory function index, blood and respiration indicator and can reduce the expression level of serum CRP and PCT for patients with VAP, and its curative effect is remarkable.

Antimalarial activity of Isodon yuennanensis / 中国药学杂志

OBJECTIVE: To evaluate the antimalarial activity of Isodon yuennanensis for the development of neo-style antimalarial drugs or lead compounds from plants. METHODS: The crude extract and compounds from I. yuennanensis were screened for antimalarial activities by β-hematin formation inhibition assay, and the results were expressed as IC50 values. RESULTS: The crude extract, as well as some compounds, showed β-hematin formation inhibition activities in different degrees. CONCLUSION: The ethyl acetate fraction derived from the 70% acetone extract of I. yuennanensis and the compounds 2, 12, and 13 obtained from the ethyl acetate fraction are worthy of deeper research due to their significant antimalarial activities.

Chemical constituents from roots of Astragalus englerianus and their anti-oxidative activities / 中草药

Objective: To study the chemical constituents from the roots of Astragalus englerianus, and to determine their anti-oxidative activities. Methods: The compounds were isolated and purified by silica gel, RP18, and Sephadex LH-20 column chromatography, then their structures were elucidated on the basis of spectral data and physicochemical properties, and anti-oxidative activities were tested by DPPH method. Results: Twenty-nine compounds were obtained from the ethyl acetate fraction of the methanol extract from the roots of A. englerianus and identified as isoliquiritigenin (1), 4'-hydroxy-2, 4-dimethoxychalcone (2), xenognosin (3), formononetin (4), calycosin (5), prunetin (6), (3R)-vestitol (7), liquiritigenin (8), (6aR, 11aR)-medicarpin-3-O-β-D-glucopyranoside (9), olean-12-en-3β, 22β, 24-triol (10), friedelin (11), β-sitosterol (12), stigmasterol (13), 7β-hydroxysitosterol (14), 7-oxositosterol (15), 3β-sitosteryl (9'Z)-9'-heptadecenoate (16), stigmast-4-en-3-one (17), 5α, 8α-epidioxy-ergosta-6, 9, 22E-trien-3β-ol (18), 5α, 8α-epidioxy-ergosta-6, 22E-dien-3β-ol (19), D-2-O-methylinositol (20), octacosanol (21), methyl stearate (22), eicosanoic acid (23), heneicosanoic acid (24), oleic acid (25), linoleic acid (26), α-linolenic acid (27), tripalmitin (28), and trilinolein (29). The ethyl acetate soluble portion, compounds 1 and 3 showed DPPH free radical scavenging activity with IC50 values of (66.0 ± 1.8), (64.3 ± 0.4), and (57.1 ± 1.2) μg/mL, respectively. Conclusion: This is the first report on the compounds 2, 3, 6, 10, 11, 14-22, and 28 from the plants of Astragalus Linn., and all the compounds are obtained from A. englerianus for the first time. A. englerianus is found to possess the potent anti-oxidative activity.

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>

Side effects and tolerability of post-exposure prophylaxis with zidovudine, lamivudine, and lopinavir/ritonavir: a comparative study with HIV/AIDS patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In the era of highly active antiretroviral therapy (HAART), the use of antiretrovirals as post-exposure prophylaxis (PEP) was the most important strategy for preventing occupational exposure to blood or fluids containing human immunodeficiency virus (HIV). The objective of this study was to retrospectively evaluate the tolerability, safety, and side effects of a HAART regimen containing three antiretroviral drugs, consisting of zidovudine, lamivudine, and lopinavir/ritonavir, in healthcare personnel (HCP) who experienced occupational exposure to HIV.</p><p><b>METHODS</b>The tolerability, safety, and side effects in 26 HCPs who experienced PEP and in 27 HIV/AIDS patients with HAART regimen, AZT+3TC+Lpv/r, were evaluated between January 2010 and December 2012.</p><p><b>RESULTS</b>The most frequent clinical side effect was fatigue (in 23 cases, 88.5%), and gastroenterological symptoms were the second most common side effects in HCP with PEP. Liver dysfunction was found in 10 cases (38.5%), while drug rash was found in 18 cases (69.2%) after PEP. The prevalence of side effects in HCPs who experienced PEP was higher than that in HIV/AIDS patients P < 0.05. One nurse (3.8%) experienced severe gastrointestinal symptoms, which led to withdrawal of PEP. No HIV infection was found during 6-month follow-up period.</p><p><b>CONCLUSION</b>HCPs who received occupational PEP with triple-drug regimen, AZT+3TC+Lpv/r, experienced different side effects, and the tolerability and safety of PEP regimen were good in this cohort.</p>

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>