Efficacy and effect on lipid profiles of Ainuovirine-based regimen versus Efavirenz-based regimen in treatment-naïve people with HIV-1 at week 24: A real-world, retrospective, multi-center cohort study.

This study aimed to compare the efficacy and effect on lipid profiles of Ainuovirine (ANV)- and efavirenz (EFV) -based regimens in treatment-naïve people living with HIV-1 (PLWH) at week 24. The proportion of PLWH achieving HIV-1 RNA < the limit of quantification in the ANV group was significantly higher than that in the EFV group (89.18% vs. 76.04%, P = 0.002). The mean change of log10 HIV-1 RNA from baseline was greater (-4.34 vs. -4.18, P < 0.001), the median change from baseline in CD4+ T cell count increased more (106.00 cells/µL vs. 92.00 cells/µL, P = 0.007) in the ANV group, while the CD4+/CD8+ ratio was similar (0.15 vs. 0.20, P = 0.167) between the two groups. The mean changes from baseline in total cholesterol (-0.02 for ANV vs. 0.25 mmol/L for EFV, P < 0.001), triglyceride (-0.14 for ANV vs. 0.11 mmol/L for EFV, P = 0.024), and low-density lipoprotein cholesterol (-0.07 for ANV vs. 0.15 mmol/L for EFV, P < 0.001) was significantly different between the two groups. The percentage of patients with improved lipid profiles was significantly higher in the ANV group (37.44 %) than in the EFV group (29.55%, P = 0.0495). The incidence of any adverse events in the ANV group was significantly lower than that in the EFV group at week 12 (6.2% vs. 30.7%, P < 0.001) and was comparable at week 24 (3.6% vs. 5.5%, P = 0.28). The ANV-based regimen was well tolerated and lipid-friendly in treatment-naïve PLWH.

Gestational chronic intermittent hypoxia induces hypertension, proteinuria, and fetal growth restriction in mice.

PURPOSE: Pregnant women are predisposed to obstructive sleep apnea (OSA). Based on the fact that OSA is an independent risk factor for hypertension among the general population, we hypothesized that chronic intermittent hypoxia (CIH), as a feature of OSA, may lead to preeclampsia. METHODS: Pregnant and non-pregnant C57BL/6 J mice were exposed to two conditions of chronic intermittent hypoxia: CIH1 (21-5% O2 alternations), CIH2 (21-10% O2 alternations), and room air until day 19. RESULTS: In non-pregnant mice, compared with their respective baseline values, systolic blood pressure (SBP) started to rise from day 14 in the CIH1 group, and SBP rose until day 19 in the CIH2 group. Compared with the pregnant mice exposed to room air, pregnant mice exposed to CIH1 maintained elevated SBP from day 14, accompanied by proteinuria, fetal and placental growth restriction, and a reduction in the number of fetuses. An imbalance between proangiogenic and antiangiogenic factors and impairment of vascular remodeling existed in the placenta of pregnant mice exposed to CIH1. Maternal serum levels of the soluble form of vascular endothelial growth factor receptor-1 were also significantly increased. Pregnant mice exposed to CIH2 seemed to have milder changes than pregnant mice exposed to CIH1. CONCLUSION: Our results demonstrated that gestational CIH may induce gestational hypertension, proteinuria, fetal and placental growth restriction as well as impairments in placental angiogenesis and vascular remodeling.

Evaluation of symptoms and risks in stable chronic obstructive pulmonary disease patients with radiographic bronchiectasis.

OBJECTIVE: To investigate the presence of previously undiagnosed radiographic bronchiectasis in stable chronic obstructive pulmonary disease (COPD) patients using high resolution computed tomography (HRCT) and to evaluate the effect of radiographic bronchiectasis on the symptoms and risks in stable COPD patients. METHODS: From May 2012 to April 2014, there were 347 patients enrolled in COPD database. Data describing the general conditions, the frequency of acute exacerbations the year before, COPD assessment test, modified medical research council (mMRC) score, spirometric classification, and HRCT were collected. COPD patients were classified into two groups: COPD with bronchiectasis and COPD without bronchiectasis. The clinical characteristics of both groups were compared. RESULTS: Bronchiectasis was presented in 18.4% (n = 64). The proportion of smokers, smoking index, and forced expiratory volume in 1 second predicted value were 62.5%, 27.3 ± 13.2, 48.2 ± 26.4, respectively, in the bronchiectasis group, which were lower than those of the group without bronchiectasis (82.0%, 32.6 ± 17.6, and 57.9 ± 18.8) (P < 0.05). Complications, COPD assessment test (CAT) and the rate of CAT ≥ 10 in the bronchiectasis group were 2.8 ± 1.7,13.6 ± 7.4 and 26.6%, respectively, which were higher than those of the group without bronchiectasis (2.3 ± 1.5,11.3 ± 6.0, and 11.7%) (P < 0.05). The proportion of type D (high-risk more-symptoms) in the bronchiectasis group was 50.0%; it was significantly higher than that of 35.7% in the group without bronchiectasis (P < 0.05). CONCLUSIONS: COPD with bronchiectasis is associated with more complications, symptoms, and risks. More attention should be paid to the treatment of COPD with bronchiectasis to reduce the frequency of exacerbation and improve the health status.

[Investigation of Lung Cancer Patients Complicated with Chronic Obstructive Pulmonary Disease in Thoracic Surgical Department].

BACKGROUND: Lung cancer is an important complication of chronic obstructive pulmonary disease (COPD), and even significantly affects the prognosis of patients with COPD. COPD also affects the postoperative complications and recurrence in patients with lung cancer. This study aims to investigate lung cancer patients complicated with COPD in thoracic surgical department. METHODS: All medical records of lung cancer patients discharged from the Department of Thoracic Surgery of People's Hospital, Peking University during January 2015 and December 2015 were reviewed, including gender, age, tobacco smoke history, harmful occupational exposure, clinic symptom, chest computed tomography (CT) scanning, postoperative pathology result report, discharged diagnosis and spirometry [All patients underwent pulmonary function test are received bronchial dilation test if the based predicted value of forced expiratory volume in one second (FEV1) <70%]. RESULTS: A full set of lung function test was measured in 703 lung cancer patients. Bronchial dilation test was finished in 67 patients. 62 (92.5%) patients were diagnosed as COPD. 677 cases with lung cancer were received surgery. Bronchial dilation test was measured in 42 cases. Of them 38 (92.7%) patients were diagnosed as COPD. It was found that the patients with lung cancer and COPD was more frequent in males, elders (≥65 yr), smokers, non-adenocarcinoma patients than those of patients without COPD (P<0.05). The males and the elders (≥65 yr) were more likely to suffer from COPD (OR: 2.374-2.807, 95%CI: 1.101-7.157)(P<0.05). Only 3 patients (4.3‰) were diagnosed as COPD and received standard treatment before admission. And only 5 patients (7.1‰) were diagnosed as COPD as discharged. CONCLUSIONS: The routine pulmonary function as well as bronchial dilation test are helpful for screening the patients with COPD. At present, the diagnosis and treatment of lung cancer combined with COPD is a serious problem, which needs to be paid attention to by thoracic surgeons and to join hands with physicians in order to improve the diagnosis level of COPD.

The link between mold sensitivity and asthma severity in a cohort of northern Chinese patients.

BACKGROUND: Mold sensitivity in asthmatic patients has recently attracted clinical interest; however the links between mold sensitivity and asthma severity in the Chinese population have been poorly characterized. In this study, we assess the relationship between asthma severity and airborne mold sensitivity in a cohort of northern Chinese patients. METHODS: Ninety-three non-smoking adult outpatients with asthma completed a questionnaire and underwent skin prick testing with five aeroallergens. For all patients, eosinophil cell counts, total serum IgE (sIgE) levels, and pulmonary function were measured. An asthma severity score was calculated based on the patient's forced expiratory volume in one second (FEV1), number of asthma attacks, number of hospital admissions, and use of inhaled or oral corticosteroids in the past year. RESULTS: Ninety-three patients were divided into three groups based on the results of their allergy tests: negative results for all tested allergens (group A, n=32); positive reactions to aeroallergens including mold antigens (group B, n=41); and positive reactions to aeroallergens other than molds (group C, n=20). Patients in group B had a lower FEV1 (74.46%±23.09% predicted) compared with group A (85.52%±19.53%, P=0.023). Patients in both group B and C had elevated absolute eosinophil count (AEC) (group A: 3.12%±2.71%, group B: 5.41%±2.85%, group C: 6.1%±4.49%; group A vs. group B, P=0.008; group A vs. group C, P=0.002), and total sIgE values (group A: 117.36±144.90 IU/mL, group B: 195.86±155.87 IU/mL, group C: 253.31±152.41 IU/mL; group A vs. group B, P=0.031; group A vs. group C, P=0.002) compared with patients in group A. Asthma severity scores were higher in patients in group B compared to patients in group C (7 vs. 5.5, P<0.05). Patients allergic to molds were more likely to have severe asthma [odds ratio 3.636, 95% confidence interval (CI): 1.394 to 9.484; for severe versus mild asthma, P<0.05]. There was no association between asthma severity and sensitisation to house mites or weeds. CONCLUSIONS: Mold sensitivity is positively correlated with asthma severity in our cohort of northern Chinese patients.

High prevalence of obstructive sleep apnea in Marfan's syndrome.

OBJECTIVE: To review the current evidence about the prevalence of obstructive sleep apnea in patients with Marfan's syndrome, and discuss some proposed potential mechanisms for this relationship. DATA SOURCES: The data in this review were mainly from Medline and PubMed articles published in English from 1990 to 2013. The search term was "Marfan's syndrome and sleep apnea". STUDY SELECTION: Clinical evidence about the epidemiology of obstructive sleep apnea in patients with Marfan's syndrome; the mechanism that causes obstructive sleep apnea; interventional therapy for patients with Marfan's syndrome, and coexisting obstructive sleep apnea. RESULTS: A high prevalence of obstructive sleep apnea exists in patients with Marfan's syndrome. The potential reasons are craniofacial abnormalities and lax upper airway muscles, which lead to high nasal airway resistance and upper airway collapse. Obstructive sleep apnea mechanically deteriorates aortic dilatation and accelerates progression of aortic aneurysms. The condition is reversible and rapid maxillary expansion and adequate continuous positive airway pressure therapy are possible effective therapies to delay the expansion of aortic diameter in patients with Marfan's syndrome. CONCLUSIONS: Obstructive sleep apnea is strongly associated with Marfan's syndrome. Craniofacial abnormalities and lax upper airway are the main mechanisms. Untreated obstructive sleep apnea accelerates progression of aortic dissection and rupture. Effective therapies for obstructive sleep apnea could postpone the aortic dilatation in patients with Marfan's syndrome.

Comparison of symptom and risk assessment methods among patients with chronic obstructive pulmonary disease.

BACKGROUND: The global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease (COPD) guidelines classify patients into four groups according to the number of symptoms and the level of future risk of acute exacerbation COPD (AECOPD). This study aimed to compare the results of different methods used in diagnosis of COPD and evaluate the accuracy of the assessment methods in guiding clinical practice. METHODS: A survey was conducted of 194 COPD outpatients between March and September 2012. Demographic characteristics, the number of exacerbations the patient has had within the previous 12 months, COPD assessment test (CAT), Modified British Medical Research Council (mMRC) scale, and results of the lung function tests were recorded. RESULTS: Of the 194 patients assessed, 21 had a CAT score ≥10 and an mMRC grade ≤1, 13 had a CAT score <10 and an mMRC grade ≥2. A predicted forced expiratory volume in one second (FEV1%) of <50% with less than two acute exacerbations was observed in 39 patients, while a predicted FEV1% of ≥50% was noted in 20 patients with two or more acute exacerbations. The sensitivity of a predicted FEV1% <50% in predicting the risk of AECOPD in the future was 80.9%, while that in the real number of AECOPD events recorded was 62.8%, the difference being statistically significant (P = 0.004). The sensitivity of CAT in predicting the severity of symptoms was 90%, while that of mMRC was 83.8%, and the difference was not statistically significant. CONCLUSIONS: The COPD assessment method recommended by the global initiative for chronic obstructive pulmonary disease (GOLD) 2011 is complicated and should be simplified. CAT is more comprehensive and accurate than mMRC. The lung function classification is a better tool for predicting the risk of AECOPD in the future, and the number of AECOPD can be referred to when required.

Predictors of long-term adherence to continuous positive airway pressure therapy in patients with obstructive sleep apnea and cardiovascular disease in the SAVE study.

STUDY OBJECTIVES: To determine the clinical variables that best predict long- term continuous positive airway pressure (CPAP) adherence among patients with cardiovascular disease who have obstructive sleep apnea (OSA). DESIGN: 12-mo prospective within-trial observational study. SETTING: Centers in China, Australia, and New Zealand participating in the Sleep Apnea cardioVascular Endpoints (SAVE) study. PATIENTS: There were 275 patients age 45-70 y with cardiovascular disease (i.e., previously documented transient ischemic attack, stroke, or coronary artery disease) and OSA (4% oxygen desaturation index (ODI) > 12) who were randomized into the CPAP arm of the SAVE trial prior to July 1, 2010. METHODS: Age, sex, country of residence, type of cardiovascular disease, baseline ODI, severity of sleepiness, and Hospital Anxiety and Depression Scale (HADS) scores plus CPAP side effects and adherence at 1 mo were entered in univariate analyses in an attempt to identify factors predictive of CPAP adherence at 12 mo. Variables with P < 0.2 were then included in a multivariate analysis using a linear mixed model with sites as a random effect and 12-mo CPAP use as the dependent outcome variable. MEASUREMENTS AND RESULTS: CPAP adherence at 1, 6, and 12 mo was (mean ± standard deviation) 4.4 ± 2.0, 3.8 ± 2.3, and 3.3 ± 2.4 h/night, respectively. CPAP use at 1 mo (effect estimate ± standard error, 0.65 ± 0.07 per h increase, P < 0.001) and side effects at 1 mo (-0.24 ± 0.092 per additional side effect, P = 0.009) were the only independent predictors of 12- mo CPAP adherence. CONCLUSION: Continuous positive airway pressure use in patients with coexisting cardiovascular disease and moderate to severe obstructive sleep apnea decreases significantly over 12 months. This decline can be predicted by early patient experiences with continuous positive airway pressure (i.e., adherence and side effects at 1 month), raising the possibility that intensive early interventions could improve long-term continuous positive airway pressure compliance in this patient population. CLINICAL TRIALS REGISTER: Clinical Trials, http://www.clinicaltrials.gov, NCT00738179.

[Survey on the prevalence rate of bronchial asthma in Beijing area among the residents aged over 14 years from 2010 to 2011].

OBJECTIVE: To survey the prevalence rate of bronchial asthma in Beijing area among residents aged over 14 years. METHODS: In accordance with stratified cluster random sampling, epidemiological questionnaires were performed in Beijing residents aged over 14 years during household visits from February 2010 to August 2011. Asthma was diagnosed on the basis of case history, clinical signs and lung function test. The statistical software SAS 9.2 was employed to analyze the epidemiological status of asthma. RESULTS: In a sampling population of 61 107, 57 647 questionnaires were effective. Among 687 asthmatics, there were 296 males and 391 females. The overall prevalence rate of asthma was 1.19% (687/57 647). The asthma prevalence rates were 1.09% (418/38 468) and 1.40% (269/19 179) in urban and suburb Beijing respectively and the prevalence rate of asthma in suburb area was significantly higher than that of urban area (χ(2) = 10.850, P = 0.001). The prevalence rates of males and females were 1.06% (296/27 947) and 1.32% (391/29 700) respectively and the prevalence rate of asthma in females was much higher than that of males (χ(2) = 8.098,P = 0.004). Significant differences existed among different age groups (χ(2) = 404.874, P = 0.000) and residents aged at or over 71 years had the highest prevalence rate. The prevalence rates in urban and suburb Beijing area increased by 1.12 and 2.26 folds respectively than that of 2002. And 198 asthmatics were first diagnosed in this survey and accounted for 28.8% (198/687) in all asthma diagnosed asthmatics. CONCLUSIONS: The prevalence rate of asthma in Beijing area among residents aged over 14 years increased greatly from 2010 to 2011. And the epidemiological data may reflect the current distribution status of asthma in Beijing area.

[Chinese literature review of etiology distribution of adult patients with fever of unknown origin from 1979 to 2012].

OBJECTIVE: To review the etiology of 10 201 adult patients with fever of unknown origin (FUO) in China from 1979 to 2012, and to compare the reasons between the South and the North of China, and to illustrate the change in different periods. METHODS: Literatures containing key word "fever of unknown origin" were selected in China National Knowledge Infrastructure (CNKI) database from 1979 to 2012. Articles were excluded if patient population were less than 100. Diagnostic criteria of FUO were confirmed by the standard of Petersdorf and Beeson in 1961. Totally 43 literatures including 10 201 patients were enrolled in this study. The period of the literatures were divided into the early, middle and later period, and the regions were partitioned into the South and the North. RESULTS: A total of 42 articles (including 9787 patients) provided the gender information with 5063 men and 4724 women. The etiologies of 10 201 FUO patients included infectious diseases (53.5%), rheumatic diseases (20.1%) and tumor (12.0%). The positive diagnostic rate was 91.8%. Tuberculosis (23.8%) was the most common reason in infectious diseases. Adult Still's disease (7.0%) was the most common cause of FUO among rheumatic diseases. Lymphoma (3.4%) was the most common tumor in FUO patients. Besides, drug-induced fever (1.7%) should also be considered. In the recent 30 years, the proportion of FUO caused by infectious diseases had decreased, rheumatic diseases and other reason had increased (P < 0.05). The proportion of tumor in middle period was significantly higher than that in the early and later period (P < 0.05). The negative diagnostic rate had increased (all P < 0.05). The proportion of infectious diseases in North China was significantly lower than that in the South (P < 0.05). The proportion of other reason was significantly higher in the North (P < 0.05). CONCLUSION: In the recent 30 years, the most common cause of FUO was still infectious diseases, especially tuberculosis.

Chronic intermittent hypoxia aggravates cardiomyocyte apoptosis in rat ovariectomized model.

BACKGROUND: The prevalence of obstructive sleep apnea (OSA) increases after menopause in women, but remains under diagnosed because of social or lifestyle factors. It is important to evaluate the hazards of OSA on cardiovascular disease in menopausal women. We tested the hypothesis that chronic intermittent hypoxia (CIH) may aggravate cardiomyocyte apoptosis in ovariectomized (OVX) Sprague Dawley (SD) rats; the changes of anti-oxidation ability in cardiac muscles may be one of the reasons for cardiomyocyte apoptosis. METHODS: Forty-eight 60-day old female SD rats were randomly divided into a CIH group, OVX group, OVX+CIH (OC) group, and handled control (HC) group, and the rats were exposed either to CIH (nadir O2 6%) or handled normoxic controls. The changes of body weight and whole heart weight were measured. Super oxide dismutase (SOD) and malonaldehyde (MDA) were used to evaluate the level of oxidative stress. TdT-mediated dUTP nick end labeling (TUNEL) was used to measure apoptosis in each rat. Western blotting was used to measure apoptosis associated proteins in cardiac muscle samples from each rat. RESULTS: When compared with the HC and CIH groups, the levels of oxidative stress in the OC and OVX groups were significantly higher. The levels of SOD in the HC, CIH, OC, and OVX groups were (47.99 ± 4.89), (53.60 ± 4.47), (20.99 ± 2.72), and (30.64 ± 3.79) mmol/mg protein; significantly increased in the CIH group (P < 0.05) and significantly decreased in the OC (P < 0.01) and OVX (P < 0.05) groups. The levels of MDA in the HC, CIH, OVX, and OC groups were (1.63 ± 0.20), (1.93 ± 0.77), (3.30 ± 0.39), and (1.95 ± 0.20) mmol/mg protein; it significantly increased in the CIH (P < 0.05), OC (P < 0.01), and OVX (P < 0.05) groups compared with the HC group. Bax protein expression was significantly increased and bcl-2 protein expression was significantly reduced after CIH compared with HC rats (P < 0.05). The protein expression of bax and bcl-2 in the OC group was not significantly different from the CIH group, but the ratio of bax/bcl-2 was significantly increased in the OC group (P < 0.05); this was associated with severe cardiomycyte apoptosis in the OC group. TUNEL confirmed this observation. CONCLUSIONS: This study found that CIH may induce oxidative stress in OVX rats but not in CIH rats, and cause more severe cardiomyocyte apoptosis in OVX rats compared with CIH rats. This means that OVX rats exposed to CIH suffered more severe cardiac injury compared with CIH rats due to reduced antioxidation. These findings may partly explain the reason why OSA has a worse cardiovascular impact on menopausal women, and emphasize the importance of detection and early treatment of OSA in menopausal patients.

Elevated nocturnal and morning blood pressure in patients with obstructive sleep apnea syndrome.

BACKGROUND: The nocturnal nondipping and elevated morning blood pressure (BP) in patients with obstructive sleep apnea syndrome (OSAS) have not yet been well investigated in Chinese patients. This study aimed to describe the BP profile, and to elucidate the relationships between daytime BP and nighttime BP, and between evening BP and morning BP in patients with OSAS. METHODS: Twenty teaching hospital sleep centers in China were organized by the Chinese Medical Association to participate in this study and 2297 patients were recruited between January 2004 and April 2006. BP assessments were made at four time points (daytime, evening, nighttime and morning) and polysomnography (PSG) was performed and subjects were classified into four groups by their apnea-hypopnea index (AHI): control, n = 213 with AHI < 5; mild, n = 420 with AHI ≥ 5 and < 15; moderate, n = 460 with AHI ≥ 15 and < 30; and severe, n = 1204 with AHI ≥ 30. SPSS 11.5 software package was used for statistical analysis and figure drawing. RESULTS: All the average daytime, nighttime, evening and morning BPs were positively correlated with AHI and negatively correlated with nadir nocturnal oxygen saturation. The ratios of nighttime/daytime and morning/evening average BP were positively correlated with AHI. The ratio of nighttime/daytime systolic BP became a "reversed BP dipping" pattern until the classification reached severe, while the ratio of nighttime/daytime diastolic BP became reversed at moderate. Similarly, the ratio of morning/evening diastolic BP becomes reversed even at mild. CONCLUSIONS: OSAS may result in higher BP levels at all four time points. The ratios of nighttime/daytime and morning/evening BP increase with increased AHI. The increasing of diastolic BP, which is inclined to rise more quickly, is not parallel with increasing systolic BP.