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@#Abstract: Objective To understand the difference of DNA sequence and RNA sequence of paired pol region in HIV patients in constructing HIV genetic transmission network, and to provide scientific data for constructing molecular transmission networks using DNA sequences. Methods The whole blood and plasma samples of HIV patients living in 2014 and newly reported in 2015-2018 in Liuzhou, Guangxi, were collected, DNA and RNA sequences were extracted, amplified, sequenced, spliced and aligned, and then genetic transmission networks were constructed, and the connectivity consistency of genetic transmission networks constructed by DNA and RNA sequences was compared. Results In this study, a total 2 983 participants were investigated, which were 2014 baseline and 2015-2018 newly reported HIV patients, of which 2 590 participants were only DNA sequences in 2014 baseline, 196 HIV patients were both DNA and RNA sequences of paired pol region in 2014 baseline, and 197 newly reported HIV patients were both DNA and RNA sequences of paired pol region in 2015-2018. In 393 DNA and RNA sequences of paired pol region, the genotype of DNA sequence and RNA sequence were consistent, and there was no statistically significant difference in genetic distance between paired DNA sequences and RNA sequences (Z=-2.72, P=1.00). The connection consistency rate of genetic transmission networks constructed by DNA and RNA sequences of paired pol region of 2015-2018 newly reported with the baseline DNA sequences was 91.4% (108/197). And the connection consistency rate of genetic transmission networks constructed by DNA and RNA sequences of paired pol region of 2015-2018 newly reported with the baseline RNA sequences was 97.0% (191/197). There was no statistical difference in antiretroviral therapy to reduce the risk of HIV secondary transmission between genetic transmission networks constructed by DNA and RNA sequences of paired of pol gene newly reported from 2015 to 2018 with baseline DNA sequence. Conclusion DNA sequence and RNA sequence of paired pol region of HIV patients have good consistency in genotype, genetic distance, and genetic transmission network construction, and both DNA and RNA sequences can be used for genetic transmission network analysis.
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@#Abstract: Objective To investigate the growth and development of HIV-infected children initiating antiretroviral therapy (ART) and its influencing factors. Methods This retrospective cohort study was conducted in Guangxi. HIV-infected children initiating free antiretroviral therapy (ART) from 2004 to 2019 were included. Z-score was calculated according to the Chinese Child Growth and Development Standard, the Cox-Stuart test was used for trend analysis, and the generalized estimating equation was used to analyze HAZ (Height-for-age Z-score)≥-2 and WAZ (Weight-for-age Z-score)≥-2 influencing factors. Results A total of 943 children with HIV infection were enrolled in the cohort. The median HAZ at baseline and 1, 2, 5, and 10 years after treatment was -2.47, -2.14, -1.94, -1.55, -1.23, respectively, and the median WAZ was -1.85, -1.40, -1.30, -1.21, -1.09, respectively. By Cox-Stuart trend test, HAZ and WAZ showed an upward trend with the treatment time (P<0.05). The proportions of HAZ≥-2 at baseline and at 1, 2, 5, and 10 years after treatment were 38.1%, 46.5%, 51.6%, 66.8%, and 74.6%, respectively, and the proportions of WAZ≥-2 were 57.1%, 76.9%, 81.1%, 85.8% and 89.2%, respectively. According to Cox-Stuart trend test, the proportions of HAZ≥-2 and WAZ≥-2 increased with the treatment time (P<0.05). The results of multivariate generalized estimating equation analysis showed that the associated factors with HAZ≥-2 were that age at ART initiation was 3-7 years old (aOR=0.71, 95%CI: 0.53-0.94), age at ART initiation was >7 years old (aOR=0.66, 95%CI: 0.47-0.93), CD4 cell counts before ART was <200/μL (aOR=0.64, 95%CI: 0.47-0.87), WHO clinical stage before ART was Stage Ⅲ/Ⅳ (aOR=0.74, 95%CI: 0.56-0.97) and time on ART (aOR=1.01, 95%CI: 1.01-1.01); the associated factors with WAZ≥-2 were male (aOR=0.72, 95%CI: 0.53-0.97), WHO clinical stage before ART was Stage Ⅲ/Ⅳ (aOR=0.63, 95%CI: 0.45-0.86) and time on ART (aOR=1.01, 95%CI: 1.01-1.01). Conclusion Antiretroviral therapy can effectively improve the growth and development status of children with HIV infection, but a large proportion of children still have stunted growth and development in the 10th year after treatment. It is necessary to strengthen the training of antiretroviral treatment staff and the publicity and education of parents of children infected with HIV. Improve the effect of antiviral treatment and guide children's nutrition reasonably.
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@#Abstract: AIDS combined with Pneumocystis jirovecii pneumonia (PJP) and disseminated infections of Talaromyces marneffei and Cryptococcus neoformans are rare. This paper summarizes and analyzes the diagnosis and treatment of an AIDS patient with multiple fungal infections for reference. A 79-year-old male patient was admitted to the hospital with "stool habit change for more than 20 days". The white blood cell count was 4.57×109/L, the percentage of neutrophils was 81.8%, the absolute count of CD4+ lymphocytes was 6/μL, and the CD4/CD8 ratio was 0.17. HIV antibody positive was confirmed by CDC. The cerebrospinal fluid and alveolar lavage fluid were positive for Cryptococcus neoformans capsular antigen, and Pneumocystis jirovecii was found by the bronchoalveolar lavage fluid stained with hexamine silver. The cerebrospinal fluid culture was positive for Cryptococcus neoformans, and the blood culture was positive for Cryptococcus neoformans and Talaromyces marneffei. CT showed that bronchovascular bundles in both lungs were more thick, patchy and cable-like high-density shadows were seen in both lungs, and the edges were blurred. Nodular and cable-like high-density shadows were seen in the posterior apical segment of the left upper lobe, with clear margins. Infection of both lungs was considered, and secondary pulmonary tuberculosis occurred in the left upper lobe. After admission, the patient was treated with various anti-bacterial and fungal drugs due to recurrent fever, but the effect was not effective. The fever symptoms of the patient could not be significantly improved, and his condition continued to worsen, and he eventually died. The patient with AIDS complicated with bacterial and fungal infection, especially PJP infection in serious condifiton and has a poor prognosis for rapid development, so clinical attention should be paid to.
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In the recent years, the damage of the spleen has been increased due to trauma or neoplastic diseases. Traditional view holds the point that the damaged spleen should be completely removed, but with the development of spleen surgery, the important physiological function of the spleen has been widely recognized, and partial splenectomy has been well recognized by the surgeons. This paper summarized the clinical experience in partial splenectomy and raised some technical points.
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The number of death from insulin overdose, including accidental poisoning, suicide and homicide, is increasing these years. The forensic diagnosis of death from insulin overdose is a tough task. Glucose is the main energy source of the brain. Therefore, hypoglycemic brain damage is considered to be the main reason of death from insulin overdose. Recently, research of hypoglycemic brain damage caused by insulin overdose is gradually being paid attention in the field of forensic medicine. This paper summarizes the neuropathologic changes, pathophysiologic process and potential neural molecular markers of hypoglycemic brain damage caused by insulin overdose in terms of forensic neuropathology, providing reference for the research and practice in forensic medicine related fields.
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Humans , Brain , Drug Overdose , Hypoglycemic Agents , Insulin , NeuropathologyABSTRACT
Objective To summarize the characteristics of cases of electrocution due to direct current （DC） electronic hunter, and to provide references for forensic identification. Methods Four cases of electrocution due to DC electronic hunter were collected. Statistical analysis was carried out from the perspective of the scene and electric marks distribution, damage characteristics and histopathological changes. Results All the 4 cases of electrocution were accidental events. There were multiple electric marks, most of which were located in the lower limbs with serious damage. Some strip type electric marks were visible. Conclusion The distribution, morphological characteristics and severity of the electric marks caused by DC electronic hunter are different from those of the ordinary low-voltage alternating current damage. It is alerting that there would be actions of destroying the scene and abandoning the corpse in such cases.
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Humans , Cadaver , Electric Injuries/pathology , Electricity/adverse effects , Fatal Outcome , Forensic Pathology/methods , Lower ExtremityABSTRACT
Objective:To investigate the affordability of chronic diseases and drug use in families three prov-inces in western China. Methods: Questionnaire survey was conducted in 6 cities in 3 west provinces of China—Guangxi,Shanxi and Sichuan. In each province,one provincial capital city and one medium-sized city were select-ed. 2 community health service centers,2 secondary hospitals and 2 tertiary hospitals were selected from each city as the survey sites. Questionnaire was designed and pre-tested in advance,and delivered to sample patients'families in survey sites by face-to-face interview. Results:Totally 900 questionnaires were sent out,and 838 were effectively re-ceived with effective recovery of 93.11%. 97.85% of patients participated in various medical insurance. The aver-age health expenditure of households was 1 364.84 yuan per month and accounted for 37.43% of the total expendi-ture;chronic diseases expenditure was 700.34 yuan per month and accounted for 51.31% of the total health expend-iture. The average monthly drug expenditure was 628.74 yuan and represented 16.73% of the total household ex-penditure. Surveyed family members mainly suffered from chronic diseases,hypertension and diabetes,and the heav-iest disease burden in families came from ischemic heart disease and chronic kidney disease. Different provinces, provincial capitals and non-provincial cities,and different levels of medical institutions have a greater difference in drug burden. Patients have experienced the effect of medical reform,but not familiar with the specific health care reform poli-cies. Conclusions and Suggestions:The surveyed patients'families were basically involved in the Medicare,but the burden of family medication for patients with chronic diseases was still heavy. Therefore,government should take further measures to improve the proportion of chronic diseases outpatient and reduce the burden of medication costs.
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Objective To investigate the effects of IL-21,IL-23 and IL-4 in the pathogenesis of Guillain-Barré syndrome(GBS) of children,and to analyze the influence of intravenous immunoglobulin(IVIG) on the serum levels of IL-21,IL-23 and IL-4 in GBS patients.Methods Forty-one pediatric patients with GBS hospitalized in our department from Jan.2005 to Sep.2012 were studied.According to the time of IVIG administration,patients were divided into group A and group B,given IVIG respectively within the 7th day and the 8th-12th day.According to Hughes score,patients were divided into mild group and severe group.The serum levels of IL-21,IL-23 and IL-4 were detected by means of ELISA before and after treatment.Results Before treatment,the serum levels of IL-21,IL-23 and IL-4 had no signifiant difference between group A and group B.After treatment,the serum levels of IL-21,IL-23 in group A and group B were significantly decreased than those before treatment (all P ＜ 0.05),with no significant difference in IL-4 levels.There was no signifiant difference in group A and group B in the serum levels of IL-21,IL-23 and IL-4 after treatment (all P ＞0.05).In the severe group,the serum levels of IL-21,IL-23 were significantly higher than those in the mild group before and after treatment (all P ＜ 0.05),with no significant difference in IL-4 levels.After treatment,the serum levels of IL-21,IL-23 were significantly decreased than those before treatment in the mild group and the severe group (all P ＜ 0.05),with no significant difference in IL-4 levels.Conclusions The serum levels of IL-21,IL-23 are significantly increased in GBS children,indicating they play an important role in the pathogenesis of GBS.Levels of IL-21 and IL-23 are significantly decreased after administration of IVIG,which showed that IVIG could inhibit the secretion of IL21 and IL-23,reduce cellular inflammatory response,and eventually prevent the development of GBS.IL-4 secretion is not obviously affected with IVIG,it might have a role in the recovery of GBS.