Association of Inflammatory Cytokines With the Symptom Cluster of Pain, Fatigue, Depression, and Sleep Disturbance in Chinese Patients With Cancer.

CONTEXT: Pain, fatigue, depression, and sleep disturbance are common in patients with cancer and usually co-occur as a symptom cluster. However, the mechanism underlying this symptom cluster is unclear. OBJECTIVES: This study aimed to identify subgroups of cluster symptoms, compare demographic and clinical characteristics between subgroups, and examine the associations between inflammatory cytokines and cluster symptoms. METHODS: Participants were 170 Chinese inpatients with cancer from two tertiary hospitals. Inflammatory markers including interleukin-6 (IL-6), interleukin-1 receptor antagonist, and tumor necrosis factor alpha were measured. Intergroup differences and associations of inflammatory cytokines with the cluster symptoms were examined with one-way analyses of variance and logistic regression. RESULTS: Based on cluster analysis, participants were categorized into Subgroup 1 (all low symptoms), Subgroup 2 (low pain and moderate fatigue), or Subgroup 3 (moderate-to-high on all symptoms). The three subgroups differed significantly in Eastern Cooperative Oncology Group (ECOG) performance status, sex, residence, current treatment, education, economic status, and inflammatory cytokines levels (all P < 0.05). Compared with Subgroup 1, Subgroup 3 had a significantly poorer ECOG physical performance status and higher IL-6 levels, were more often treated with combined chemoradiotherapy, and were more likely to be rural residents. IL-6 and ECOG physical performance status were significantly associated with 1.246-fold (95% CI 1.114-1.396) and 31.831-fold (95% CI 6.017-168.385) increased risk of Subgroup 3. CONCLUSION: Our findings suggest that IL-6 levels are associated with cluster symptoms in cancer patients. Clinicians should identify patients at risk for more severe symptoms and formulate novel target interventions to improve symptom management.

Characteristics of Long-term Nonprogressors and Viremia Controllers Infected with HIV-1 via Contaminated Blood Donations or Transfusions Conducted 20 Years Earlier.

To characterize long-term nonprogressors (LTNPs) and viremia controllers (VCs), infected with HIV-1 through contaminated blood donation or transfusion between 1992 and 1996 in Henan, China. LTNPs and VCs were defined by CD4+T lymphocyte (CD4) count and viral load (VL). Of 29,294 patients infected with HIV-1 via contaminated blood donation or transfusion that had conducted for more than 20 years, 92 were LTNPs/VCs. There were 70 LTNPs (0.24%), 43 VCs (0.15%), and 48 LTNPs+VCs- (0.16%). VCs had a significantly lower CD4 nadir, compared to LTNPs and LTNPs+VCs-, and no significant differences for the highest VL and HIV-1 DNA. Cases P4 and P5 were LTNPs, while their VL reached approximately 4.3 log copies/mL. P6 was a VC, but with CD4 < 500 cells/µL constantly. Data from the LTNPs/VCs cohort provided valuable information, future research is needed.

Red and processed meat consumption and the risk of lung cancer: a dose-response meta-analysis of 33 published studies.

This meta-analysis was to summarize the published studies about the association between red/processed meat consumption and the risk of lung cancer. 5 databases were systematically reviewed, and random-effect model was used to pool the study results and to assess dose-response relationships. Results shown that six cohort studies and twenty eight case-control studies were included in this meat-analysis. The pooled Risk Radios (RR) for total red meat and processed meat were 1.44 (95% CI, 1.29-1.61) and 1.23 (95% CI, 1.10-1.37), respectively. Dose-response analysis revealed that for every increment of 120 grams red meat per day the risk of lung cancer increases 35% and for every increment of 50 grams red meat per day the risk of lung cancer increases 20%. The present dose-response meta-analysis suggested that both red and processed meat consumption showed a positive effect on lung cancer risk.

[Epidemiological survey on the hepatitis C virus and its genotyping analysis in Henan province in 2012].

OBJECTIVE: To investigate the prevalence and distribution of hepatitis C virus (HCV) genotypes in Henan province in 2012. METHODS: A total of 32 203 permanent residents (1 to 74 years old) in Henan were recruited using multi-stage random samping method from March to June 2012. All participants were asked to complete a questionnaire to collect demographic information, past medical history and the exposure history of risk factors. A blood sample of 5 ml was collected at the same time. The condition of anti-HCV and HCV RNA was determined through the ELISA test and nested RT-PCR. HCV RNA positive samples were further subject to the nonstructural protein 5 region (NS5B) gene amplification and sequencing. The sequence was amplified for the phylogenetic tree and genetic analysis. The differences of the positive rate of anti-HCV and HCV RNA and the HCV genetic subtype distribution in different respondents'characteristics were analyzed. RESULTS: Among 32 203 subjects, the overall positive rate of anti-HCV and HCV RNA were 0.48% (153/32 203) and 0.24% (78/32 203), in which men were 0.42% (65/15 634), and 0.23% (36/15 634), and women were 0.53% (88/16 569) and 0.25% (42/16 596). The differences between men and women were not statistically significant (χ(2) values were 2.26, 0.18, respectively, both P values > 0.05). The results of NS5B genotyping and molecular evolution analysis showed that there were six subtypes in the 71 HCV RNA positive samples.In those six subtypes, the proportion of genotypes 1b, 6a, 3a, 2a, 3b and 1a were 56.3% (40/71), 19.7% (14/71), 11.3% (8/71), 8.5% (6/71), 2.8% (2/71) and 1.4% (1/71), respectively. The HCV genetic subtypes of infestor were mainly present with two branches of 1b and 6a, and the two subtypes Bootstrap values were 0.95. CONCLUSION: The prevalence of HCV infection was high in Henan. The major HCV genotypes in patients with HCV infection were 1b and 6a.

Comparative study of the influence of diabetes distress and depression on treatment adherence in Chinese patients with type 2 diabetes: a cross-sectional survey in the People's Republic of China.

BACKGROUND: The purpose of this study was to explore diabetes-related distress and depression and their influence on treatment adherence in Chinese patients with type 2 diabetes. METHODS: We surveyed 200 type 2 diabetic patients from two public hospitals using the Diabetes Distress Scale (DDS), Zung Self-rating Depression Scale, and Revised Treatment Adherence in Diabetes Questionnaire (RADQ). A multiple regression model was used to explore the relationship between diabetes distress, depression, and treatment adherence. RESULTS: In the 200 eligible patients, the incidence of depression and diabetes distress was approximately 24% and 64%, respectively. The mean score on the RADQ was 23.0 ± 6.0. Multiple regression analysis showed that DDS scores (ß = 5.34, P = 0.000), age (ß = 0.15, P = 0.014), and family history (ß = 3.2, P = 0.016) had a positive correlation with depression. DDS scores (ß = -2.30, P = 0.000) and treatment methods (ß = -0.93, P = 0.012) were risk factors for poor treatment adherence, whereas age (ß = 0.089, P = 0.000) and cohabitation (ß = 0.93, P = 0.012) increased treatment adherence. The independent-samples t- test showed that depression also affected treatment adherence (t = 2.53, P < 0.05). CONCLUSION: These findings suggest that the DDS is a predictor of depression and that diabetes distress plays a more important part than depression in treatment adherence. Screening for diabetes distress may be useful for primary prevention of psychologic problems; however, some form of specialized psychologic intervention should be incorporated to promote patient adherence with treatment.

[A cross-sectional study on the prevalence of HIV drug resistance in patients receiving antiretroviral treatment in Shenqiu county, Henan province].

OBJECTIVE: To understand the prevalence of drug resistance in AIDS patients who had been receiving HAART in a long run, in Shenqiu county, Henan province. METHODS: This cross-sectional study included 120 HIV infected patients who began receiving ART (antiretroviral therapy) in 2003. Viral loads and CD(4)(+) T cells counts were measured, and In-house drug resistance test was performed in VL > 1000 copies/ml patients. RESULTS: 114 cases out of 120 patients had complete viral load data. Among them, 33 cases having viral loads less than 50 copies/ml, and the remaining viral loads showed an average of lg (4.09 ± 1.10) copies/ml. The average of CD(4)(+) T cell counts was (377 ± 218) cells/ml, with 64 (53.3%) cases showing their CD(4)(+) T cell counts higher than 350 cells/ml. In 67 patients, 58 of them showed genotypic resistance, and 40 cases showed reverse transcriptase inhibitors (RTIs) resistance. The ratios of nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) resistance were 53.4% (31/58) and 67.2% (39/58), respectively. There were no differences of drug resistance ratio in the three treatment programs. The highest drug resistance rates in NRTIs and NNRTIs were zidovudine, lamivudine, nevirapine. However, protease inhibitors (PIs) resistance variants were not found. CONCLUSION: The prevalence of drug-resistant strains seemed to be high in Shenqiu country, Henan province. Long-term follow-up monitoring strategy should be developed to optimize the timely treatment programs.

[Men who have sex with men and its relationship with HIV-1 strains prevailing in the paid blood donors from Zhengzhou city, Henan].

OBJECTIVE: To clarify the genetic characteristics of human immunodeficiency virus (HIV) circulated in the population of men who have sex with men (MSM) in Zhengzhou, Henan and to analyze its relationship with HIV-1 prevailing in the paid blood donors (PBDs). METHODS: Thirty-one MSM who were confirmed as HIV positive individuals in 2010 together with 41 HIV-positive former PBDs were enrolled in the study. Information on related epidemiological characteristics and their plasma were collected. RT-PCR was used to amplify HIV-1 full length gag (1584 bp), pol (3147 bp) genes and partial env gene (C2V3 segment, 558 bp) followed by sequencing on those subjects. Online software available at LosAlamos HIV Database was used to identify the HIV subtypes based on the findings of the sequences. Phylogenetic tree was used to identify the possible relationship of transmission. RESULTS: Fifty-three full length gag, 38 full length pol and 48 partial env (C2V3) genes were collected from 72 participants. Among the 31 HIV(+) MSM individuals, 14 CRF01_AE strains, 5 CRF07_BC strains and 12 subtype B (1 subtype B and 11 B') strains were identified respectively. All of the 41 strains identified from former PBDs were infected by B' strains. The CRF01_AE strains identified in MSM showed a close relationship to those identified from both Hebei and Liaoning provinces. The CRF07_BC strains showed a close relationship with those from Shijiazhuang and Beijing cities. Among the 12 subtype B strains, 8 sequences grouped into 1 cluster with 1 sequence from the former PBDs. Two sequences grouped with 02HNseq4 suggested that B' had been prevailed in the MSM population might come from the former PBDs and were closely related to the strains identified in the MSM population. CONCLUSION: Complicated genetic background and multiple introductions of HIV in the MS population in Zhengzhou, were found. This was also the first report which noticed that the subtype B epidemic among Zhengzhou MSM was mainly originated from the B' among the former PBDs.

[Follow-up study on 84 AIDS patients having received the replaced therapy program for six months in one county of Henan, China].

OBJECTIVE: To analyze the situation of AIDS patients who had received replaced therapy program in Henan province. METHODS: 84 AIDS patients had been enrolled into the national free first-line antiretroviral treatment for more than 5 years and would soon be replaced with another antiretroviral treatment program, were selected to a follow-up program to be carried out six months later. Data on CD4(+) t-lymphocyte count, viral load and genotypic resistance were included in the study. RESULTS: The DDI+AZT+NVP treatment program was used by all the 84 patients at baseline. A replacement by 3TC + AZT + NVP (post first-line) in 31 patients and 3TC + TDF + LPV/r (second-line) in another 53 patients were taken place within a week. All the patients were followed for six months. RESULTS: showed that: all of the 84 patients appeared an amelioration of CD4(+) t-lymphocyte count median from the baseline of 374.00 cell/µl to 406.50 cell/µl (P = 0.005). Those patients who had changed to second-line treatment program also showed an improvement of CD4(+) t-lymphocyte count median from the baseline of 267.00 cell/µl to 365.00 cell/µl (P = 0.015), while patients who were on the post first-line program with their CD4(+) t-lymphocyte count mean did not show significant change as compared to the baseline (P = 0.158) data. All the 84 patients showed a decrease of virus load median from the baseline of 3.61 log(10)copies/ml to 0.00 log(10) copies/ml (P = 0.000). Both of the two types of patients who had been changed to different programs, had a lower virus load median in the end of the follow-up period (for post first-line: P = 0.007; for second-line: P = 0.000). 13 patients kept their viral load more than 1000 copies/ml, including 5 cases bore more than three thymidine analogue mutations (TAMs) a the end of the follow-up program. Another 4 patients had no resistance mutations detected and no significant variation of viral load (less than 3 times) in the pre- or post-surveys. CONCLUSION: AIDS patients who had received long-term first-line antiretroviral treatment program, showed an amelioration six months after changing of the treatment program. Timely and effective testing on drug resistance as well as the strengthening of the follow-up program still seemed to be the link to those patients who were receiving first-line treatment that should not be ignored.

[The primary HIV drug resistance in partial region of Henan province].

OBJECTIVE: To study the prevalence of primary HIV drug resistance in antiretroviral therapy (ART) areas of Henan province. METHODS: A total of 121 drug-naive long-term infected individuals and 154 patients with newly diagnosed from January 2011 to March 2012 were recruited, the questionnaires were surveyed and whole blood were collected to analyze the CD4(+)T cell counts and viral load. In-house method for genotypic resistance test was determined in those with viral load > 1000 copies/ml samples, the differences of demographic characteristics, immunological parameters and primary drug resistance were compared between the two groups. RESULTS: A total of 121 cases of long-term individuals who had infected (12.50 ± 3.21) years were mainly previous paid blood donors, and the age was (46.61 ± 9.32) years old. The infection route of the newly diagnosed were diversity, including blood, sexual transmission and others, the cases were 73, 73, 8, respectively, the confirmatory year was (0.91 ± 0.28) years, and average age was (22.21 ± 3.11) years old. The difference were statistically significant in the route of transmission, age and infection time from demographic analysis of the two groups (P < 0.05). The absolute M(P(25)-P(75)) counts of CD4(+)T lymphocytes of long-term group was 322 (217 - 422) cell/µl, which was lower than the newly diagnosed was 434(308 - 578) cell/µl (P < 0.05), and viral load was 4.0 (2.96 - 4.64) copies/ml, 3.77 (2.94 - 4.53) copies/ml, the difference was not significant (P > 0.05). The prevalence of primary drug resistance in long-term group and newly diagnosed was 5.79% (7/121), 9.09% (14/154), respectively, and the difference was statistically different (P < 0.05), and one PI-resistant strain was found in the newly diagnosed group. CONCLUSION: The primary drug resistant strains in untreated patients were found in Henan province of ART areas, and there was difference in degree of resistance between long-term infected individuals and newly diagnosed.

The prevalence and distribution of Chlamydia trachomatis genotypes among sexually transmitted disease clinic patients in Guangzhou, China, 2005-2008.

This study was designed to determine the prevalence and distribution of Chlamydia trachomatis genotypes from clinical specimens in Guangzhou, China, obtained in the period 2005-2008. One hundred and ninety-four urogenital C. trachomatis samples were collected from sexually transmitted disease clinic patients, and the VS1-VS2 of OmpA gene was amplified by nested PCR and sequenced using an ABI-prism 3730 sequencer. Clinical C. trachomatis strains were genotyped and analyzed for a mutation with respect to the reference VS1-VS2 sequence. VS1-VS2 fragments with 453 bp were amplified from 194 clinical samples. Upon alignment with the sequences of the reference strains, 189 strains with discernible sequences were typed into 9 genotypes, while 5 with ambiguous sequences were considered to be mixed-serovar samples. The most prevalent genotypes were E (50, 26%), F (46, 24%), J (35, 19%), and D (24, 13%). There was no significant difference in the distribution of any of the genotypes detected during the study period, except for genotype K (P<0.01). A total of 16 (8%, 16/189) genetic variants of the OmpA VS1-VS2 of the reference strains were identified. Mutations occurred frequently for genotypes D (2/24, 8%), E (6/50, 12%), F (2/46, 4%), G (1/8, 13%), H (1/12, 8%), and K (4/11, 36%), with most of these being sense mutations that may result in amino acid substitution. Sequencing the OmpA VS1-VS2 enabled the genotype and sequence variations within each genotype to be analyzed. Genotypes E, F, J, and D continued to dominate among urogenital C. trachomatis, whereas genotype K increased significantly in Guangzhou between 2005 and 2008.