Immunological effect and influencing factors of HAART on HIV/AIDS with baseline CD4 below 350 cells/mm3 / 公共卫生与预防医学

Objective To analyze the immunological effect and its influencing factors of HAART on HIV/AIDS with a baseline CD4 of less than 350 cells/mm3 in Hubei Province during 2011-2020. Methods The treatment information of people living with HIV/AIDS (PLWH) was collected through China Disease Control and Prevention Information System, and the change of CD4 mean value was analyzed by Wilcoxon sign rank sum test. Chi square test and multivariate logistic regression were used to analyze the factors influencing the immunological effect. Results The mean value of CD4 cell count at baseline was (172.78±107.65) cells/mm3 before treatment and (398.85±206.71) cells/mm3 in the fifth year after treatment. Patients with baseline CD4<50 /mm3 had the largest increase in CD4 mean value after treatment (P<0.05). Multivariate logistic regression analysis showed that Age ≥35 years, heterosexual transmission, time interval from diagnosis to treatment≥1 month, baseline CD4<50 /mm3, treatment time 7-<18 months, and drug failure were the risk factors for the success of antiviral therapy(P<0.05). Conclusion The immunological effect of HIV/AIDS antiviral therapy in Hubei Province is affected by many factors. It is necessary to strengthen the implementation of early detection and early treatment strategy and promote treatment compliance education for patients aged ≥35 years.

The mediating effect of self-control in the relationship between alexithymia and internet addiction among college students / 中华行为医学与脑科学杂志

Objective:To explore the mediating role of self-control in the relationship between alexithymia and internet addiction.Methods:From August to September 2019, a total of 433 college students were selected from three universities in Jiangxi province by cluster random sampling method. The Chinese internet addiction scale-revised, the twenty-item Toronto alexithymia scale and brief self-control scale were used for questionnaire testing. SPSS 23.0 software was used for descriptive statistics, Pearson correlation analysis and PROCESS V3.5 macro program was used to test the mediating effect.Results:The total scores of alexithymia, internet addiction and self-control were (53.61±9.44), (45.31±9.84) and (41.91±6.09), respectively. Pearson correlation analysis showed that alexithymia was significantly positively correlated with internet addiction ( r=0.47, P<0.01), and significantly negatively correlated with self-control ( r=-0.37, P<0.01). The negative correlation between self-control and internet addiction was significant ( r=-0.46, P<0.01). Multivariate hierarchical regression analysis showed that alexithymia directly predicted internet addiction after controlling the influence of gender. Self-control played a partially mediating role in the relationship between alexithymia and internet addiction (effect size=0.13, 95% CI: 0.082-0.185), the mediating effect accounted for 25% of the total effect. Conclusion:Alexithymia not only directly affects college students′ internet addiction, but also indirectly affects college students′ internet addiction through self-control.

Nitrogen removal and responses of bacterial communities in activated sludge under different operational manipulations.

Operational conditions are often manipulated to improve the nitrogen removal performance of wastewater treatment, yet the impacts of operational conditions on microbial communities were still not well understood. There is a pressing need to understand the microbial mechanisms that link operation manipulation and nitrogen removal performance. In this study, high-throughput analysis of 16S rDNA and quantitative polymerase chain reaction of functional genes were used to identify the microbial response to operational manipulations. The results showed that alteration of operational parameters could change the bacterial communities at the genera level and denitrification guild gradually dominated in the activated sludge bacterial communities. Heterotrophic Hyphomicrobium and Chromatiaceae drove the kinetic of dominant genera and denitrification guild. Carbon source supplement was the most efficient strategy for improving nitrogen removal, and greatly increased the abundance of denitrifiers and denitrification genes. However, carbon source supplement inhibited expression activities of denitrification genes, as well as the proliferation of autotrophic denitrifiers, and it was supposed to be unfavorable in terms of cost over the long term. The result should bring new inspiration for improving the effect of WWTP performance through the manipulation of operational parameters.

Difference of silicon dioxide-stimulated macrophage-derived exosomal miRNA expression profile / 中南大学学报(医学版)

To analyze the differential expression of RAW264.7 macrophage-derived exosomes miRNA stimulated by free silicon dioxide (SiO2).
 Methods: RAW264.7 was stimulated with SiO2 (200 mg/L) for 48 h (exo_48 h group), and the supernatant was collected. The exosomes in the supernatant were extracted by ultracentrifugation. Transmission microscopy, nanoparticle tracking analysis (NTA) and Western blotting were used to identify exosomes. High-throughput sequencing was performed to compare the differential expression of exosome miRNAs between the exo_control group (RAW264.7 cultured for 48 h without SiO2) and the exo_48 h group; miRanda, TargetScan and starBase were used to predict target genes of differential miRNAs. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were performed on target genes to further analyze the biological functions of genes.
 Results: The transmission microscopy showed that the exosomes were lipid membrane coated vesicles, which were heterogeneously distributed, with a diameter ranging from 30 to 100 nm, and the shape was round or elliptical. The volume kurtosis was concentrated between 40 and 100 nm and the exosome marker protein TSG101 was positive. High-throughput sequencing screened 148 differentially expressed exosomal miRNAs. MiR-219c-3p, let-7d-3p, let-7a-1-3p, miR-328-3p, miR-365-3p, and miR-7219-3p were significantly up-regulated, and miR-378d and miR-5106 were significantly down-regulated compared with the control group. Target genes were mainly enriched in mTOR signaling pathway, Wnt signaling pathway, TGF-β signaling pathway, and so on.
 Conclusion: The exosomes secreted by SiO2-induced macrophages contain abundant miRNAs, and their expressions are significantly different. These differential miRNAs may be involved in the activation of lung fibroblasts and epithelial-mesenchymal transition.

Gastrointestinal leiomyoma with interstitial cells of Cajal: mimicker of gastrointestinal stromal tumor / 中华病理学杂志

Objective@#To study clinical and pathologic characteristics of leiomyomas of the gastrointestinal tract, and to investigate the distribution characteristics of interstitial cells of Cajal ( ICCs ) in gastrointestinal leiomyomas.@*Methods@#One hundred and forty-seven cases of leiomyomas of gastrointestinal tract were collected at the Second Affiliated Hospital of Zhengzhou University from June 2012 to June 2017. Clinical and pathologic findings were analyzed, combined with immunohistochemistry, Alcian blue-osafranin staining and molecular study.@*Results@#The age of patients ranged from 13-82 years with mean age of 52 years. Male to female ratio was about 1∶2. Histologically, all tumors were composed of ovoid to spindle cells arranged in short intersecting fascicles. All tumors were diffusely and strongly positive for smooth muscle antibodies, desmin and h-caldesmon by immunohistochemical staining. A prominent interspersed subpopulation of elongated/dendritic-like cells with CD117 and DOG1 positivity (accounting for 1% to 30% of all tumor cells) and negative for Alcian blue-osafranin staining was identified in all esophageal leiomyomas, 16 of 20 (80%) gastric leiomyomas and 3 of 12 small bowel leiomyomas, but none in colonic/rectal leiomyomas. Mutational analysis in 16 cases showed absence of mutation in exons 9, 11, 13 or 17 of C-KIT and exons 12 or 18 of PDGFRA.@*Conclusions@#ICCs are identified in esophageal and gastric leiomyomas, as well as in small percentage of intestinal leiomyomas. Such findings may bring significant diagnostic pitfalls for misdiagnosis as gastrointestinal stromal tumor. Careful attention to the distribution of CD117 and DOG1 positive cells and molecular mutation analysis of C-KIT and PDGFRA may be necessary to establish the correct diagnosis.

Clinicopathologic features of gastric plexiform fibromyxoma / 中华病理学杂志

Objective@#To analyse the clinicopathologic features of gastric plexiform fibromyxoma (PF) including diagnosis, differential diagnosis, immunohistochemistry and molecular pathology.@*Methods@#Eight cases of PF were collected from June 2006 to June 2017 at the Second Affiliated Hospital of Zhengzhou University and the First Affiliated Hospital of Zhengzhou University. The clinicopathologic findings of eight cases of PF were retrospectively analyzed, and immunohistochemistry (EnVision method) and molecular detection of glioma-associated oncogene homologue 1 (GLI1) gene translocation were performed. All cases were histologically reviewed with immunohistochemical staining for smooth muscle actin (SMA), CD10, CD117, DOG1, CD34, ER, PR, ALK and S-100. Fluorescence in situ hybridization (FISH) was used to detect the GLI1 gene translocation, and mutation of CKIT exons 9, 11, 13 and 17; and PDGFRA exons 12, 14 and 18 were identified by Sanger sequencing in four cases. Relevant literature was reviewed.@*Results@#The study included four men and four women, age ranged from 26 to 72 years (mean 51 years). Histologically, the tumors were rich in small thin-walled blood vessels and myxoid matrix, and exhibited multiple nodular growth pattern in the gastric wall. The tumor cells were bland, spindled or oval. Immunohistochemically, all cases strongly expressed vimentin and SMA, and some expressed CD10 (4/8), desmin (3/8), H-caldesmon (5/8) and PR (5/8), but were negative for CD34, S-100, ER, ALK, CD117 and DOG1. The GLI1 gene translocation detection was performed in eight cases by FISH with three positive cases and five negative cases. Mutation analyses for exons 9, 11, 13, and 17 of CKIT genes and exons 12, 14, and 18 of the PDGFRA genes were performed and the tumors all of four tested cases were wild-type. Seven patients were followed up (ranged from 24 to 95 months, mean 50 months) after diagnosis and none of the patients had recurrence or metastasis.@*Conclusions@#PF is a rare novel mesenchymal tumor of the stomach. Its distinct clinicopathologic features and immunohistochemical positivity for SMA, CD10 and PR can help differentiating this entity from other gastrointestinal mesenchymal tumors. FISH detection of GLI1 gene translocation offers an additional molecular diagnostic marker for the diagnosis.

Survey on the Cognition and Attitude towards Dignity Therapy in College Students / 中国医学伦理学

Objective:To investigate the cognition of terminal stage patients'dignity therapy,attitude towards its concept and scheme,willingness of its promotion in college students and to gain some recommendations for improvement.Methods:Combined quantitative and qualitative methods,an anonymous questionnaire survey was conducted in a convenience sample of 220 college students,of which 20 students were selected for in-depth interviews.Results:Only 17.73％ of students had a correct understanding of dignity therapy,94.98％ of them accepted its concept,92.96％ of them held a positive attitude,74.38％ of them were willing to promote dignity therapy,in which female students were dominated (P =0.041).Interview results showed that the contents of dignity therapy were to some extent stiff and not fit for Chinese patients,which might impede its promotion.Conclusion:College students lack the cognition of dignity therapy.But they hold a positive attitude and are willing to promote dignity therapy when they get to know its concept and contents.As seen,dignity therapy has a good future but there are still some obstructions in the promotion,and need to be localized.

"Effect of ""Foot exercises"" on peripheral neuropathy and plantar pressure in patients with diabetic foot" / 现代临床护理

Objective To observe the effectiveness of routine nursing plus foot exercise on the peripheral neuropathy and plantar pressure in patients with diabetic foot.Methods Toally 100 patients with diabetic foot were randomly divided into 2 groups.On the basis of routine nursing care,50 patients in the observation group were given foot exercises for 12 weeks,50 patients in the control group were given routine nursing only.Before and after intervention,the Toronto clinical scoring system (TCSS),left and right foot peak pressure variation were observed.Results Before intervention,there was no statistical difference between the two groups' TCSS sore and the peak pressure of left and right foot (P ＞0.05).After intervention,the observation group's average total score of TCSS was lower,there was significantly different between two groups (P＜ 0.001).The peak pressure of left and right foot is lower in the observation group,the difference was statistically significant (P ＜ 0.05).Conclusion Foot exercises is worthy of clinical promotion,because it can improve the peripheral neuropathy of patients with diabetic foot,so as to reduce the plantar pressure,reduce the pain of patients and improve their life quality.

[Comprehensive therapy for infant vascular tumor associated with Kasabach-Merritt phenomenon].

OBJECTIVE: To summarize the management of infant vascular tumors with Kasabach-Merritt phenomenon (KMP) and to evaluate the effect of drug combined with sclerotherapy. METHODS: From Feb. 2007 to Nov. 2014, 25 cases with KMP, who underwent drug therapy combined with sclerotherapy, were retrospectively studied. Oral corticosteroids (2 mg/kg per day) was used as the first-line therapy on all of the patients and intravenous vincristine (1.5 mg/m2 every week) was added when the platelet counts didn't recover obviously after 2-3 weeks. After the recovery of the platelet counts, the patients were admitted for sclerotherapy (average, 4.56 sessions per case) with 100% alcohol (1-3 ml per session), Lauromacrogol (1.25-5 ml per session) and betamethasone (0.25-1 ml per session). All the patients were followed up for 42 months ( range, 9 months to 6.5 years). Therapeutic outcomes were assessed by evaluating platelet counts, size of lesion, function of trunk and limb. RESULTS: All the 25 cases got obvious recovery in the platelet counts [average, (94.3 ± 18.5) x 10(9)/L] after drug therapy, of which 16 were treated by single oral corticosteroids for 4-7 weeks and 9 were treated by corticosteroids plus intravenous vincristine for 2-5 weeks. Meantime, 11 cases received platelet transfusions, of which 3 were coupled with gamma globulin intramuscularly. During the first admission, each of the 25 cases received 1-4 sessions of sclerotherapy (average, 2.6 sessions each case). One week after the sclerotherapy, the platelet counts returned to (167-312) x 10(9)/L (average, (258.5 ± 34.4) x 10(9)/L). The hemoglobin and blood coagulation function returned to normal within 1-5 weeks. Meanwhile the mental condition, appetite, body weight, sleeping were greatly improved. The size of the lesions decreased gradually after the combined therapy including 13 cases within 3-12 months and 13 cases within 13-36 months. Long term follow-up indicated that only 1 case need treatment for recurrent decrease of platelet counts, and all of the 25 cases kept the normal weight, height, immunity as well as the growing development. CONCLUSIONS: Oral corticosteroids plus intravenous vincristine combined with sclerotherapy is a reliable management with high cure rate, short course and minor side-effect.

[Application of embolic sclerotherapy for the treatment of painful venous malformation in limbs].

OBJECTIVE: To investigate the safe and effective treatment for painful venous malformation (VM) in limbs. METHOD: (1) 97 cases with painful VM underwent MRI to detect the location of VM, as well as its size and structure, its relationship with the surrounding tissue. Statistical analysis was also performed. (2) The embolic agent (ethanol) was first injected to embolize the draining vessels of VM, then the Polidocanol plus Methotrexate (MTX) was followed to keep the embolization effect on VM. The therapeutic effect was observed and analyzed. RESULTS: From January 2010 to January 2012, 97 patients with painful VM were treated. A Spearman correlation analysis showed no significant correlation between symptoms of pain and lesion growth, volume, or MRI grades (P > 0.05). The lesions in the muscle space are more likely to have the symptoms of pain (P < 0.01), followed by the lesions in the muscle, then the lesions in the joint and subcutaneous tissue. The pain relieve percentage was 95.9% (93/97) after one time embolic sclerotherapy. No severe complication, such as distant embolization, nerve damage, or muscle atrophy happened. No pain reoccurrence happened after 0.5-1.5 years of follow-up period. CONCLUSIONS: The treatment of embolic scleratherapy is minimal invasive, safe and effective for painful VM with stable results.

Meta-analysis on the Efficacy and Safety of Amisulpride and Risperidone in the Treatment of Schizophrenia / 中国药师

Objective:To evaluate the efficacy and safety of amisulpride and risperidone in the treatment of schizophrenia. Meth-ods:The RCTs literatures on amisulpride and risperidone in the treatment of schizophrenia were retrieved and screened, and the quali-fied ones were analyzed by meta-analysis. Results:A total of 10 literatures were included involving 802 patients. Meta-analysis results showed that the difference between the two groups after the treatment was not statistically significant by comparing the clinical efficien-cy, PANSS score and TESS score. About the incidence of adverse reactions, amisulpride was better than risperidone in the endocrine function, extrapyramidal symptoms, weight gain and cardiovascular system. The incidence of nausea and vomiting of amisulpride was more than that of risperidone. There was no statistical significance in insomnia, headache, dizziness and the others. Conclusion:Ex-isting literature analysis shows that amisulpride is safe and effective in the treatment of schizophrenia.

Recent HIV infection among men who have sex with men in Hubei, 2010-2013 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the HIV infection status among MSM in Hubei province and provide scientific evidence for the development of intervention strategy.</p><p><b>METHODS</b>A total of 11 438 samples were collected from MSM in sentinel surveillance during 2010-2013 to detect HIV-1 antibody. BED-CEIA was used to identify the recent HIV infection, and the recent HIV infection rate among the MSM was estimated. The age, group and area specific recent infection rate and condom use rate were analyzed.</p><p><b>RESULTS</b>The annual HIV positive rates among MSM were 3.34% , 3.74% , 2.96% and 3.15% respectively and the annual recent infection rates were 2.31% , 1.91% , 1.53% and 1.71% respectively during 2010-2013. The HIV positive rate in age group ≤ 30 years was lower than that in age group >30 years, but the recent HIV incidence rate was higher in age group ≤ 30 years than in age group >30 years. The detection rate of recent HIV infection varied with sample source, the highest detection rate was among the samples form work group/CDC and public bathroom (3.54% and 3.49%, respectively). The recent HIV i nfection rate in Wuhan was highest (5.73%). The proportion of MSM using condoms in each homosexual behavior during past six months was 38.91% . Multiple logistic regression analysis indicated that the factors related to recent HIV infection included sample source (OR = 0.344-0.713), area (OR = 3.581-9.577) and condom usage (OR = 6.686).</p><p><b>CONCLUSION</b>The HIV-1 infection rate in MSM was at a high level in Hubei, especially in some areas. The condom use rate was low, it is necessary to strengthen the prevention and control of HIV infection in MSM.</p>

Some Barriers to the Legalization of Death with Dignity in China / 中国医学伦理学

Death with dignity is now not legislation in our country .This paper mainly discussed about some barriers to the legalization of death with dignity in China , from the viewpoint of Chinese traditional ideas , the lack of death education , risk of abusing , the subject change of the informed consent right , doctor-patient communica-tion and trust lsot and so on .It is proposed that our country should perfect the medical security system , strengthen the education of death at the same time and help the citizen set up the view of science .Outside, still need to fur-ther deepen the reform of medical system in our country , the maintaining patient ’ s autonomy and right of choosing , protect the informed consent right of patients .Create the doctor-patient relationship of mutual trust .

[Effects of propranolol on proliferation of hemangioma-derived mesenchymal stem cells ].

OBJECTIVE: To explore the new mechanism of propranolol for treatment of hemangioma and the effects of propranolol on proliferation of hemangioma-derived mesenchymal stem cells ( Hem- MSCs). METHODS: We isolated Hem-MSCs from hemangioma in the proliferating phase by their selective adhesion to plastic culture dishes. Immunofluorescence staining was used to examine the expression of marker antigens in Hem-MSCs. Human umbilical vein endothelial cells(HUVECs) were used as control. Indiuction of multi-lineage differentiation including osteogenesis and adipogeneis was performed with appropriate medium to identify the multi-lineage differentiation potential. MTT cell counting was used to observe the effects of different concentrations of propranolol on proliferation of Hem-MSCs. RESULTS: Hem- MSCs were fibroblast-like morphology. All of them expressed vimentin, most expressed α-SMA,CD133, some expressed Glutl, and none of them expressed VEGF. Osteogenic, adipogenic differentiations of Hem- MSCs were induced successfully. Effects of low concentration of propranolol on proliferation of Hem-MSCs were not obvious, while high concentration of propranolol can inhibit the proliferation of Hem-MSCs. CONCLUSIONS: The cells we isolated from hemangioma are Hem-MSCs. High concentration of propranolol can inhibit the proliferation of Hem-MSCs.

One case report and analysis of patient with renal immunoglobulin light and heavy chain deposited disease / 中国综合临床

Objective To report 1 case with renal immunoglobulin light and heavy chain deposited disease (IgG-κ light chain and γ1 heavy chain).Methods The clinical manifestations,serum immunofixation electrophoresis,light and heavy chain abnormalities of blood and urine,bone marrow biopsy and renal biopsy data laboratory data were recorded and analyzed.Results A 63-year-old woman presented with massive proteinuria,microscopic hematuria,hypertension,anemia and serum IgG-κ light chain.Bone marrow aspirate revealed 4％ plasma cells.Renal biopsy revealed nodular glomerulopathy with congo red staining-negative.Immunofluorescence showed that κ light chain and IgG1 (γ1 heavy chain) were deposited along the glomerular basement membranes (GBM) and tubular basement membranes (TBM).Electron-microscopy revealed electrondense deposits that delineate the outer aspect of TBM and endothelial aspect of GBM.Conclusion The diagnosis of renal immunoglobulin light and heavy chain deposited disease (IgG-κ light chain and γ1 heavy chain) should be addressed combine with clinical and is pathology,especially with immune pathological examination.

Implication of renal biopsy in donor and recipients with delayed graft function / 中华器官移植杂志

Objective To investigate the renal pathologic changes in both donors and transplant recipients with delayed graft function (DGF).Methods The clinical and laboratory data were retrospectively analyzed in 144 renal recipients with DGF.All the patients received renal biopsy,and donors' biopsy was performed on 131 recipients.The pathological changes were examined under the light microscopy (LM),immunofluorescence (IF) and electron microscopy (EM).Results (1) The incidence of DGF was 10.16%-7.48% during 1994 to 2005,and decreased to 5.35 % during 2006 to 2009.(2) Anuria occurred in 24 cases (16.67 %),oliguria in 24 (16.67%) and hypertension in 68 cases (47.22 %).The enlargement of transplanting kidney and the increased vascular resistance was detected in 79.67 % (98/123 cases) and 45.53 % (56/123 cases) respectively by ultrasound examination.(3) The level of serum creatinine was ranged from 451 to 707 μmol/L.The high level of urinary NAG enzyme was found in 102 cases (70.83 %),proteinuria in 79 recipients (54.86 %) and hematuria in 77 cases (53.47 %).(4) The acute rejection was observed in 66 cases (45.83 %),toxicity of CNI in 22 (15.28 %),IgA nephropathy in 18 (12.50 %),acute tubular necrosis in 8 (5.56 %),and recurrent FSGS in 2 cases (1.39 %).(5) In most recipients (66/109 cases,60.55 %)immunosuppressive regimen altered and renal replacement therapy was given.Conclusion The causes of DGF are complicated.The quality of donors' kidney and early histological changes of recipients are contributed to the development of DGF.It is necessary to perform renal biopsy not only in donors but also in recipients with DGF.And kidney biopsy in transplanted patients was also beneficial to the treatment.

Basic fibroblast growth factor-induced differences in gene expression of human umbilical cord blood CD34~+ and CD133~+ stem cells: Gene chip analysis / 中国组织工程研究

BACKGROUND: Further studies are needed to understand the cytobiological character, functional regulation, gene changes and expression difference of CD34~+ and CD133~+ stem cells induced by basic fibroblast growth factor (bFGF) using gene chip. OBJECTIVE: To compare the differences of gene expression and the response to bFGF of human umbilical cord CD34~+ and CD133~+ cells, and to explore gene expression changes of bFGF-induced umbilical cord CD34~+ and CD133~+ hematopotic stem cells/hemapoietic progenitor cells in vitro. METHODS: Human umbilical cord blood CD34~+ and CD133~+ cells were isolated and purified by MiniMACS immunomagnetic beads selection. The CD34~+ and CD133~+cells were cultured for 10 to 15 days in DMEM/F12 medium, supplemented with bFGF and B27. Total RNA from these cells was extracted and the genetic level of these cells was performed using Oligo GEArray(r) chip and GEArray software. Selected rate of CD34~+ and CD133~+ hematopoietic stem cells was detected using flow cytometry. CD34~+ and CD133~+ cell morphological changes were measured before and after bFGF induction. The concentration and purity of RNA were determined by agarose gel electrophoresis degeneration. Gene-chip test results were analyzed.

Clinical-pathological features and prognosis of thrombotic thrombocytopenic purpura in patients with lupus nephritis.

BACKGROUND: We investigated the clinical-pathological features and the prognosis of thrombotic thrombocytopenic purpura (TTP) in patients with lupus nephritis (LN). METHODS: A retrospective analysis was performed on the clinical-pathological data and prognosis in 8 patients with LN complicating with TTP. RESULTS: Thrombocytopenia and hemolytic anemia, neurologic symptoms, and renal dysfunction were the clinical manifestations in 8 patients. Six patients had fever. Eight patients presented with rapid progressive glomerulonephritis, and 1 patient with continuous gross hematuria. The histologic features of the 8 patients were thrombotic microangiopathy lesions. Immune-suppressive therapies were administrated in all patients, and blood purification therapy was applied in 7 patients. Three cases involved plasma exchange and/or immunoabsorption. Seven patients received a median follow-up of 12 months. One patient died, 3 cases received peritoneal dialysis, and 1 case failed to follow-up. During follow-up, 1 case was able to stop peritoneal dialysis, and 1 case changed to hemodialysis. The other 3 patients continued with stable renal function. CONCLUSION: The patients with LN with TTP have severe clinical-pathological changes. Active treatment including renal replacement therapy, plasma exchange, and immunoabsorption are promising.

Successful treatment of patients with lipoprotein glomerulopathy by protein A immunoadsorption: a pilot study.

BACKGROUND: No established therapy is available for patients with lipoprotein glomerulopathy (LPG). Protein A immunoadsorption has been proved to be effective in reducing proteinuria in patients with nephrotic syndrome. In this uncontrolled pilot study, we investigated the efficiency of immunoadsorption onto staphylococcal protein A as treatment for LPG. METHODS: Thirteen patients with renal biopsy-proven LPG were treated with staphylococcal protein A immunoadsorption. Immunoadsorption was administered for 10 cycles per session and 10 sessions as a course. A total of 30 l of plasma was regenerated in each course. RESULTS: Single immunoadsorption course led to a rapid decline in proteinuria from 4.01 +/- 3.09 g/24 h to 1.21 +/- 0.97 g/24 h (mean +/- SD) (n = 13, P = 0.001), along with a dramatic decline in apolipoprotein E (apo E) from 9.79 +/- 5.04 mg/dl to 6.20 +/- 2.22 mg/dl (P = 0.004). A repeated renal biopsy (n = 12) showed that intraglomerular lipoprotein thrombi almost disappeared. Six patients were enrolled in the investigation of long-term outcome, and proteinuria returned to baseline levels within 12 months. Four recurrent patients received repeat immunoadsorption treatment; proteinuria decreased from 5.02 +/- 1.85 g/24 h to 1.64 +/- 0.55 g/24 h at the end of the treatment, serum apo E decreased from 14.65 +/- 11.17 mg/dl to 7.90 +/- 1.72 mg/dl. No patients suffered from severe complications. CONCLUSION: Our observations suggest that immunoadsorption onto protein A might be an effective treatment for resolving intraglomerular thrombi and improving nephrotic syndrome in patients with LPG. Further studies are required to define the influence of immunoadsorption on long-term effects in LPG patients.

Sequence variation in the env V3-V4 region of human immunodeficiency virus-1 predominant subtype B strains in Hubei Province / 中华传染病杂志

Objective To study the sequence variation in the env V3-V4 human immunodeficiency virus (HIV)-1 predominant subtype B strains in Hubei Province and to understand the epidemic characteristics and mutations of HIV-1. Methods Epidemiologic survey was done in the HIV-1 carriers in Hubei area. HIV-1 env V3-V4 regions were amplified by nested-polymerase chain reaction (nPCR). The sequences were determined and then phylogenetic analysis was performed. The difference of gene distance were checked by chi square test and the variation of gene distance were descriptively analyzed. Results Four HIV-1 strains or circulating recombinant forms (CRF) were identified in Hubei Province subtype B', B'/C, CRF01_AE and C were 82.69%, 7.69%, 7.69% and 1.92% ,respectively. B' strains were closely related with B. CN. RL 42 from Yunnan Province and B. CN. 02. 02HN from Province Henan, the gene distances were 7.08 ± 2.19 and 7.88 ± 2.28, respectively. Genetic divergence of env of B' strains showed that subtype B' has existed in Hubei area for about 10 years. Amino acid sequence analysis of section env showed V4 was more variable than C3, V3. The top four peptides of V3 loop were GPGR (46.5%), GPGK (30.2%), GPGQ (13.6%) and GQGR (9.3%). Predictions for the potential use of co-receptors on the basis of the critical amino acids within V3 loop disclosed that 16.28% were CCR5-using (R5/NSI), 13.95% were CXCR4-using (X4/SI) while the co-receptor usage of the vast majority (69.77%) could not be predicted. The analysis of glycosylation sites showed that there were 9 sites in env V3-V4 regions of HIV-1 strains in Hubei area and there were deletions in 8 of them, Conclusions Subtype B' is still the main epidemic subtype in Hubei Province and high homologous to the strains from Yunan and Henan Province.