Evaluation of PIMA point-of-care CD4 analyzer in Yunnan, China.

BACKGROUND: CD4 count is used to determine antiretroviral therapy (ART) eligibility. In China, flow cytometers are mostly located in urban areas with limited access by patients residing in remote areas. In an attempt to address this issue, we conducted a study to validate the performance of Alere PIMA point-of-care CD4 analyzer. METHODS: Venous and finger-prick blood specimens were collected from HIV-positive participants from two voluntary counseling and testing sites in Yunnan Province. Both venous and finger-prick blood specimens were tested with the PIMA analyzer. Venous blood specimens tested with the Becton Dickinson FACSCalibur were used as a reference. RESULTS: Venous specimens from 396 and finger-prick specimens from 387 persons were available for analysis. CD4 counts by PIMA correlated well with those from FACSCalibur with an R2 of 0.91 for venous blood and 0.81 for finger-prick blood. Compared to FACSCalibur, the PIMA analyzer yielded lower counts with a mean bias of - 47.0 cells/µl (limit of agreement, [LOA]: -204-110 cells/µl) for venous blood and -71.0 cells/µl (LOA: -295-153 cells/µl) for finger-prick blood. For a CD4 threshold of 350 cells/µl, the positive predictive value (PPV) of PIMA was 84.2% and 75.7% and the negative predictive value (NPV) was 97.6% and 95.8% for venous and finger-prick blood, respectively. For an ART threshold of 500 cells/µl, the corresponding PPV was 90.3% and 84.0% and NPV was 94.3% and 93.4%, respectively. CONCLUSIONS: CD4 counting using venous blood with PIMA analyzers is a feasible alternative to a large flow cytometer to determine ART eligibility.

[Diagnosis and treatment of pyriform sinus perforation].

OBJECTIVE: To study the early diagnosis, treatment and Prognosis of pyriform sinus perforation. METHODS: To study the clinical feature about 15 cases of pyriform sinus perforation, Most of the 15 cases with pyriform sinus perforation were associated with pharyngeal pain or fever. contrast x-ray studies and CT scan were used to confirm the perforation. conservative treatment in 9 cases and surgical intervention in 6 cases. and review relevant literature. RESULTS: Of all 15 cases, 9 cases with wild symptoms for conservative treatment, 6 cases with severe symptoms and complications were treated surgically. All achieved better clinical efficacy, By relevant examination, the perforation were healed within 2 - 4 weeks and none had re-perforation for 1 - 30 months follow-up. CONCLUSIONS: Pyriform sinus perforation with wild symptoms and within 12 hours can be treated conservatively. Large perforation (> 2 cm) last more than 12 hours or any complications require exploration, operation repair if possible and adequate drainage. early diagnosis and effective treatment can reduce the incidence of complications and improve the survival rate of patients.

[Study on the role of western blot band profile for the detection of recent HIV infection].

OBJECTIVE: To obtain information on HIV disease progression through western blot (WB) band profile. METHODS: 1466 available serum samples of newly reported HIV/AIDS cases, confirmed by WB from Dehong prefecture of Yunnan province in 2011, were tested, using the BED HIV Incidence Capture Enzyme Immunoassay (BED-CEIA) and Limiting Antigen Avidity Enzyme Immunoassay (LAg-Avidity EIA), respectively. Differences of WB band profiled between recent infections and established infections were then compared. RESULTS: Infections defined as 'recent' showed lower mean antibody intensities to p17, p24, p31, gp41, p51, p55, p66, gp120 and gp160 in WB when compared to those established infections with statistical difference(P < 0.05). CONCLUSION: These WB band profiles which were considered as 'recent' infections would include factors as:lack of antibody reactivity to gp41 antigen, with intensity scores of all bands lower than 13, and those intensity scores of antibody to env protein lower than 5 or to pol protein lower than 4.

[Distribution of HIV-1 subtypes among different populations in Dehong prefecture, Yunnan province, in 2011].

OBJECTIVE: To investigate the distribution of HIV-1 subtypes in Dehong prefecture, Yunnan province, in 2011. METHODS: 300 HIV-1 positive plasma samples were collected from Jan. 2011 to May 2011 in Dehong prefecture. HIV-1 gag genes and env genes were amplified by nested-polymerase chain reaction (PCR) from viral RNA. After sequencing, the HIV-1 subtypes were determined by phylogenetic analysis. RESULTS: Based on the phylogenetic trees of gag gene and env gene fragments, a total of 222 samples were genotyped. Subtype C was the predominant strain in Dehong (43.2%, 96/222), followed by unique recombinant forms (URFs, 27.0%, 60/222), CRF01_AE (21.2%, 47/222), CRF08_BC (5.0%, 11/222), B' (2.3%, 5/222) and CRF07_BC (1.4%, 3/222). Subtype C strains were predominant in both heterosexually transmitted population and intravenous drug users (IDUs), but different subtype distribution patterns were found in these two populations. All 6 genotypes including subtype C (40.7%, 70/172), CRF01_AE (25.0%, 43/172), and URFs (25.0%, 43/172) found in this area among heterosexually transmitted population, which showed the diversity of genotypes in this population. Except subtype B' and CRF07_BC, the other 3 subtypes and URFs were detected among IDUs, mainly including subtype C (54.8%, 23/42) and URFs (38.1%, 16/42), which showed the concentration trend of genotypes distribution among IDUs. The proportion of URFs increased significantly in this area, including the new BC recombinants (41.7%, 25/60) and CRF01_AE relative URFs (58.3%, 35/60). However, the distributions of these two URFs among heterosexually transmitted population and IDUs showed no statistical significance. CONCLUSION: The distribution of HIV-1 strains prevailing in Dehong prefecture was diversity, including 5 subtypes and a variety of URFs, of which subtype C was the predominant strain. The distribution patterns of subtype were different among different populations.

[Adherence and related determinants on methadone maintenance treatment among heroin addicts in Dehong prefecture, Yunnan province].

OBJECTIVE: To determine the adherence to and its determinants of methadone maintenance treatment (MMT) among heroin addicts in Dehong prefecture in Yunnan province from 2005 to 2009. METHODS: A dynamic cohort analysis was conducted with the time of treatment initiation as the time of cohort entry, to calculate the proportion of adhering to the treatment at different time points after initiation of the treatment, and to study the determinants of adherence. RESULTS: A total of 3758 had been treated. Among them, 95.8% were males, 75.8% aged between 20 - 39 years, 90.4% were peasants or unemployed, 57.0% were ethnic minorities, 35.0% were single and 55.5% were married with spouses, 43.9% were illiterate or educated at most primary school. The age of first using drugs averaged at 23.93 years. About 96.3% of the study subjects had used heroin and 21.7% were HIV-infected. The minimum time under MMT was less than 1 month and the maximum 61 months. The median methadone dose at first delivery was 25 ml, with the minimum 1 ml and the maximum 330 ml. By the end of the study or observation period, a total of 1798 patients had withdrawn from treatment and 1960 were still under treatment. The proportions of adherence to or still being under the treatment after 1, 3, 6, 9, 12, 24, 36, 48 and 60 months treatment were 0.919, 0.847, 0.756, 0.690, 0.637, 0.519, 0.417, 0.360 and 0.321, respectively. Multiple regression analysis using Cox proportional hazard model indicated that withdraw from the methadone maintenance treatment was significantly associated with location of the treatment clinics, year of treatment initiation, marital status, HIV infection status, methadone dose of first delivery and the result of last urine test for heroin use. CONCLUSION: MMT attendants in Dehong prefecture had a relatively high withdraw rate and low adherence rate. More efforts are needed to provide tailored counseling and education to MMT attendants, to provide family and community support, appropriate methadone dose at first delivery, and to better coordinate with local police department.

[Studies on the determinants and changes related to the natural CD4(+) T cell counts among antiretroviral treatment-naive HIV/AIDS patients in Dehong prefecture, Yunnan province].

OBJECTIVE: To explore the determinants and changes of CD4(+) T cell counts among antiretroviral treatment-naive HIV/AIDS patients in Dehong prefecture, Yunnan province. METHODS: A retrospective cohort analysis was conducted on HIV-infected local residents, being reported during 1989 through May 2010, in Dehong prefecture. The patients had received at least two CD4(+) T cell counting tests before receiving the antiretroviral treatment (ART). Difference between the first and the last CD4(+) T cell counts was calculated and described. Logistic regression analysis was conducted to examine the determinants of significant depletion of CD4(+) T cell counts among them. RESULTS: A total of 4487 HIV/AIDS patients were included in the study. The change of CD4(+) T cell counts between the first and the last CD4(+) T cell count tests had a median of -2.0 cells/µl in month (IQR: -8.2 - 3.6) and was significantly associated with socio-demographic characteristics, HIV transmission mode, the first or baseline CD4(+) T cell counts and the time interval between the first and the last CD4(+) T cell counting tests etc. About 60.0% (2693/4487) of the HIV/AIDS patients had deletions of CD4(+) T cell counts, and 31.2% (1400/4487) had significant (≥ 30%) deletions of CD4(+) T cell counts. Results from the multiple logistic regression analysis indicated that age, ethnicity, marital status, HIV transmission mode, the first CD4(+) T cell counts and the interval between the first and the last CD4(+) T cell counting tests were significantly associated with the significant depletion of CD4(+) T cell counts. CONCLUSION: The changing rate of CD4(+) T cell count among ART-naive local HIV-infected patients in Dehong prefecture, Yunnan province was relatively slow. However, substantial proportion of them showed significant decreases of CD4(+) T cell counts, which was determined by many factors. More efforts were needed to systematically and consistently follow-up those HIV-infected patients and measure their CD4(+) T cell counts in China, in order to instantaneously monitor the disease progression, and the initiation of ART, if necessary.

[Survey on contact tracing of newly reported HIV infections in 2009 in Dehong prefecture, Yunnan province].

OBJECTIVE: To explore a new method for finding more HIV/AIDS. METHODS: In September 2009, newly reported HIV-infected individuals from May to August, 2009 in Dehong prefecture were asked to participate in a survey which requested demographic characteristics, history of high-risk behaviors and contact information of individuals with whom they had high risky contacts. People with risky contacts with HIV-infected cases (index cases) were also approached to participate in this survey and HIV testing was provided. RESULTS: A total of 342 HIV-infected individuals were newly reported and served as index cases from May to August, 2009. Among them, 47.1% (161/342) were transmitted by regular sexual partners. Through three-round surveys, 218 contacts were traced and among them, 84.9% (185/218) were traced by regular heterosexual partners. HIV positive rate of the tested was 34.7% (60/173) in the first-round tracing and 12.5% (1/8) in the second one. Among the 560 individuals (index cases and their high-risk contacts), the proportions of having regular heterosexual partners, non-regular and non-commercial sexual partners, commercial sexual heterosexual partners and men having sex men were 87.9% (492/560), 18.9% (106/560), 22.3% (125/560) and 0.3% (1/318), respectively, while the proportion of having never used condoms when having sex with the above four types sexual partners were 73.8% (363/492), 72.6% (77/106), 63.2% (79/125) and 0.0% (0/1), respectively. CONCLUSION: As an epidemiological method for HIV/AIDS finding, contact tracing identified a large number of HIV infectors who were traced by newly reported HIV-infected individuals.

[Proportions and correlates of recent HIV infections among newly reported HIV/AIDS cases from 2005 through 2009 in Dehong prefecture, Yunnan province].

OBJECTIVE: To determine the proportions and correlates of recent HIV infections among newly reported HIV/AIDS cases from 2005 through 2009 in Dehong prefecture, Yunnan province. METHODS: All available serum samples of newly reported HIV/AIDS cases during 2005 - 2009 period in Dehong prefecture, were tested using the BED HIV incidence capture enzyme immunoassay (BED-CEIA). RESULTS: A total of 9367 HIV/AIDS cases were newly reported in 2005 through 2009, of whom 7252 (77.4%) were tested with BED-CEIA. Among the tested, 954 (13.2%) were positive for BED-CEIA and were regarded as recent HIV infections. The proportion of recent HIV infection among newly reported HIV/AIDS cases was 11.21% in 2005, 11.87% in 2006, 17.55% in 2007, 13.22% in 2008, and 12.22% in 2009. Multiple logistic regression analysis indicated that the proportion of recent HIV infections among newly reported HIV/AIDS cases in 2009 was significantly higher among females, those aged 11 - 19 years, and internal residents outside of Dehong prefecture, but significantly lower among immigrants who were mostly from Myanmar, than local residents. CONCLUSION: From 2005 to 2009, the proportion of recent HIV infections among newly reported HIV/AIDS cases in Dehong prefecture in Yunnan province was fluctuating slightly. Future research is needed to examine its long-term and secular trend. Such proportion was significantly different by different sociodemographic characteristics.

[Survival analysis on 3103 HIV/AIDS patients receiving antiretroviral treatment in Dehong prefecture, Yunnan province].

OBJECTIVE: To determine the survival rate of HIV/AIDS patients after receiving free antiretroviral treatment in Dehong prefecture, Yunnan province. METHODS: A retrospective cohort analysis was conducted on all the HIV/AIDS patients aged over 16 years who had started antiretroviral treatment during January 2007 throughout December 2009 in Dehong prefecture. RESULTS: A total of 3103 HIV/AIDS patients had received antiretroviral treatment during the study period. Among them, the mean age was (36.0 ± 9.9) years and 62.4% were males. 66.2% of them were infected with HIV through heterosexual transmission, and the mean treatment follow-up time was 21.7 months. Most patients well complied with the treatment, i.e., the average times of not taking the medicine were less than 5 per month. The cumulative survival rate of antiretroviral treatment after 1, 2, 3, 4, and 5 years were 0.95, 0.94, 0.93, 0.92, and 0.92, respectively. Data from the Cox proportional hazard regression model analysis indicated that, after adjustment for age, gender, and marital status, the baseline CD4(+)T cell counts and transmission route could significantly predicate the rates of survival. Those who were with baseline CD4(+)T cell counts as 200 - 350/mm(3)were less likely to die of AIDS than those with CD4(+) T cell counts < 200/mm(3) (Hazard Ratio or HR = 0.16, 95%CI: 0.09 - 0.28), and HIV-infected through mother-to-child transmission or routes other than heterosexual transmission were less likely to die of AIDS than through injecting drug use (HR = 0.35, 95%CI: 0.13 - 1.00). CONCLUSION: Free antiretroviral treatment had significantly improved the survival of HIV/AIDS patients. Earlier initiation of antiretroviral treatment was likely to have achieved better survival effects.

[Incidence and risk factors of HIV infection among sero-negative spouses of HIV patients in Dehong prefecture of Yunnan province].

OBJECTIVE: To study the HIV incidence and risk factors among sero-negative spouses of HIV patients in Dehong prefecture of Yunnan province. METHODS: A cohort of sero-negative spouses of the HIV patients had been developed and followed up since November, 2005. HIV new infections and related behaviors had been investigated every six months. RESULTS: By the end of June, 2008, 790 sero-negative spouses of HIV patients had been recruited, of whom 702 were followed-up for at least one time. During the total 1202.35 person-years, 31 new HIV infections were identified, with an overall incidence of 2.58/100 person-years. The HIV incidence rates were 2.22/100 person-years in 2006, 2.95/100 person-years in 2007 and 2.74/100 person-years in 2008. Data from the Cox proportional hazard regression model indicated that those who resided in Yingjiang county [hazard ratio (HR) = 4.37, 95%CI: 1.48 - 12.90, P = 0.008], ever using drugs (HR = 3.49, 95%CI: 1.09 - 11.18, P = 0.035), or having an HIV-infected spouse who never exposed to antiretroviral treatment (HR = 3.60, 95%CI: 1.41 - 9.16, P = 0.007) were at higher risk for HIV infection. CONCLUSION: Sero-negative spouses of HIV patients in Dehong prefecture of Yunnan province had a relatively high incidence of HIV new infection during 2006-2008. More efforts should put on those people living in these areas, having a history of drug use or having an HIV-infected spouse who had never been exposed to antiretroviral treatment.

[Tracing the sources of newly reported HIV infections in Dehong prefecture of Yunnan province].

OBJECTIVE: To trace and provide HIV-testing among those having contacts with HIV-infected individuals at various levels in Dehong prefecture, Yunnan province and to evaluate the effectiveness and feasibility of such investigation as a supplemental strategy for HIV testing and control. METHODS: Newly reported HIV infections from August throughout October in Dehong prefecture, in 2008 were asked to provide contact information of persons whom they had high risk contacts with. Persons having had risk contacts with HIV-infected cases were here of interviewed and their blood tested on the sero-status of HIV. RESULTS: A total of 335 HIV cases were newly reported during this three-month period. A total of 309 cases of them and 148 HIV infections identified thereafter from their risk contacts were under informed consent, to participate in this study. A total number of 3395 risk contacts were reported, of whom only 20.7% (704/3395) had 'contact information' and 51.3% (361/704) were successfully located and interviewed, including 117 previously confirmed HIV infections and 244 people with unknown HIV status. The majority of them (203 or 83.2% of 244) were then tested for HIV and 56 (27.6% of 203) were tested positive for HIV. The proportion of having detailed contact information and the proportion of being traced or followed among reported risk contacts of HIV infections were 68.8% and 68.2% for spouses of HIV patients, respectively, which were much higher than those among commercial sex partners (1.2% and 16.7%), casual sex partners (37.3% and 22.3%) and peers who sharing needles (34.1% and 56.4%). CONCLUSION: Newly reported HIV infections reported a large number of risk contacts and new HIV infections were identified among them. It was extremely difficult to trace commercial sex partners or casual sex partners on their HIV infection status. Nevertheless, tracing the risk contacts of newly reported HIV infections seemed to be helpful in identifying new HIV infections and in understanding the nature of transmission towards controlling the HIV epidemics.

[Incidence and risk factors on HIV infection among injection drug users in Dehong prefecture area of Yunnan province].

OBJECTIVE: To determine the incidence and risk factors on HIV infection among injection drug users (IDU) in Dehong prefecture area of Yunnan province. METHODS: An epidemiological cohort of HIV-negative IDU had been developed and followed since October, 2004. HIV new infections and related behaviors had been investigated every six months. RESULTS: By the end of 2008, 760 HIV-negative IDU had been recruited and followed for a total of 1153.6 person-years. 47 new HIV infections were identified, with an overall incidence of 4.07/100 person-years during the follow-up period. The HIV incidence was 4.45/100 person-years during 2004 - 2006, 4.50/100 person-years in 2007 and 2.54/100 person-years in 2008. Both the behavior of drug injection and the HIV incidence among the cohort had substantially decreased during the follow-up period. Multiple regression analysis using Cox proportional hazard model indicated that people with Jing-po ethnicity (Hazard ratio, HR = 2.56, 95%CI: 1.06 - 6.19) and other minorities except for Dai (HR = 3.26, 95%CI: 0.89 - 11.96) were at higher risk for HIV infection than the people with Han ethnicity. People injecting drugs with (HR = 2.27, 95%CI: 0.98 - 5.25) or without (HR = 5.27, 95%CI: 2.25 - 12.34) needle sharing were at higher risk for HIV infection than those reporting having no drug injection behavior during the follow-up period. CONCLUSION: Both the behavior of drug injection and the HIV incidence among former IDU in Dehong prefecture area of Yunnan province had been decreasing during the four years. However, needle sharing remained the most important risk factor for HIV new infection among IDUs. IDUs with different ethnicities seemed to have different risks towards HIV infection.

[Electrophysiological findings for 106 cases with auditory neuropathy].

OBJECTIVE: To analyses the clinical characteristics and electrophysiological finding of 106 patients with auditory neuropathy (AN). Investigate the differential curve type of pure tone audiogram and the abnormal ABR. METHODS: Review the history of patients, pure tone audiometry, middle ear acoustic reflexes, auditory brainstem response, distortion product otoacoustic emission and radiologic imaging studies of the brain of 106 patients with AN during December 2001 to May 2007 in retrospect. RESULTS: The 106 patients with AN were of both genders. The age were between 11-37 years old, and the average age was 17.5 years old. The most patients were adolescence (70.8%). Twelve cases of the 106 patients had evidence of other peripheral neuropathy in addition to hearing loss. Another 94 patients were idiopathic origins. The pure tone audiogram showed a minimal to moderate sensorineural hearing loss at low frequencies 0.5 kHz and 0.25 kHz in 209 ears (98.6%). The average hearing threshold (WHO 1997) in 23.2% of disordered ears at less than 25 dB in the "normal" range. Auditory brainstem response could not be recorded in 124 ears (58.5%) at maximum stimulus. The other 88 ears showed 1 or 2 wave, but the wave were small. There were 23 patients which one side ear ABR was 1 or 2 small waves presented, but the contralateral side were all waves absent. In 3 cases of AN with other peripheral neuropathy which ABR were both ears 1 or 2 small wave ear recorded. However, 1 patient in our sample could not be detected distortion product otoacoustic emission at 3-6 kHz (left ear) and 5-6 kHz (right ear). CONCLUSIONS: AN was not rare in adolescence. The average hearing threshold for AN should be discussed.

[Study on the drug resistance situation among recently infected HIV-1 patients in Dehong].

OBJECTIVE: To study the HIV-1 drug resistance (DR) situation among newly infected persons in Dehong. METHODS: 1048 HIV-1 positive blood samples from July to December in 2006 from Dehong prefecture of Yunnan, were collected. HIV drug resistance were tested using TruGene in newly infected people that were distinguished with BED-CEIA, while the subtype were determined with phylogenetic analysis using a set of reference sequences available on the Los Alamos Database. RESULTS: Of sixty-four successfully analyzed samples, drug resistance mutations were detected in 4 samples with the resistance rate as 6.25%. Minor mutation in PR region such as M361/V, L63P and H69K appeared frequently and the rates were 81.25%, 70.31% and 65.63% respectively. The predominantly prevalent strains were seen as C/CRF07 _ BC/08 _ BC(65.63%, 42/64) in this study. CONCLUSION: The prevalence of genotypic drug resistances in HIV-1 recent infections in Dehong prefecture appeared to be at moderate level. Drug-resistance surveillance program among HIV-1 infections should be continued and strengthened.

[Combined flap of postauricular musculo-periosteal and ear canal skin flap with bone paté for mastoid obliteration and canal wall down mastoidectomy].

OBJECTIVE: To investigate the long-term outcome and clinical value of modified radical mastoidectomy with mastoid obliteration using pedicled combined flap of postauricular musculo-periosteal and ear canal skin flap in conjunction with bone paté. METHODS: During 2 years from April 2003 to March 2005, 71 otitis media patients (71 ears) with cholesteatoma were subjected to this kind of operation. RESULTS: The follow-up period was more than 2 years. The period of complete reepithelialization ranged from 3 weeks to 1.5 months, with the mean period of 29 days. All of the patients, treated by the described method of operation had a dry, disease-free mastoid of ear. CONCLUSIONS: Mastoid obliteration with pedicled combined flap of postauricular musculo-periosteal and ear canal skin flap in conjunction with bone paté, had the advantages as follows: (1) Healing of the mastoid cavity in a short time. (2) Better reepithelialization of the obliterated mastoid cavity. (3) No need of skin grafting in the mastoid cavity. (4) High rate of the dry ear in postoperation. (5) nearly no need of the mastoid cavity cleaning postoperatively.

[Apoptosis in the immune response of inner ear].

OBJECTIVE: To investigate whether apoptosis is one of the mechanism in the immune response of inner ear,and to detect the expression of Fas, FasL, Bcl-2 and Bax in the inner ears. METHODS: Sixteen healthy, female guinea pigs were employed in the experiment. Sensitized systematically with keyhole limpet hemocyanin (KLH), the KLH-immunized animals were inoculated with the same antigen, and the control animals were injected PBS through cochlea basal turn. The animals were sacrificed at 7 day after inner ear vaccination. Transmission electron microscopy was used to detect inner ear apoptotic cells, and paraffin sections of cochlea from animals were stained using a terminal-deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) assay to identify inner ear cells undergoing apoptosis. Immunohistochemistry method was used to detect the expression of Fas, FasL, Bcl-2 and Bax in the inner ears. RESULTS: The observation of electron microscopy had shown the features characteristic of apoptotic cells in the KLH-immunized inner ears but not in the control inner ears. TUNEL-positive cells were found in the KLH-immunized inner ears but not in the control inner ears. The positive cells were the hair cells in Corti's organ, and the marginal cells in the stria vascularis and the neurons in the spiral ganglion. Moreover under morphological analysis by light microscope, these cells had the features characteristic of apoptosis. High expression of Fas and FasL could be detected in Corti's organ, the stria vascularis, the spiral ligament and the neurons of the spiral ganglion in the KLH-immunized inner ears. A low expression of Fas could be detected in the stria vascularis and the neurons of the spiral ganglion in the control inner ears, but no cells staining positive for FasL were found in the control inner ears. No cells staining positive for Bcl-2 were found in the KLH-immunized animals but moderate expression of Bcl-2 could be detected in Corti's organ, the lateral wall and the neurons of the spiral ganglion in the control inner ears. High expression of Bax could be detected in Corti's organ, the lateral wall and the neurons of the spiral ganglion in the KLH-immunized inner ears. A low expression of Bax could be detected in the neurons of the spiral ganglion and no cells staining positive for Bax were found in Corti's organ, the lateral wall in the control inner ears. CONCLUSIONS: These findings suggest apoptosis is involved in the pathogenesis of the immune response of inner ear and Fas- FasL pathway is one of important signal transportation of the course and Bcl-2 and Bax have a critical role in the regulation of apoptotic cell death induced by the immune response of inner ear.

Cell proliferation in the endolymphatic sac in situ after the rat Waldeyer ring equivalent immunostimulation.

OBJECTIVES/HYPOTHESIS: It has been recognized that immunological mechanisms could be involved in the pathogenesis of different inner ear disorders, such as progressive sensorineural hearing loss, Meniere's disease, and even sudden deafness. The endolymphatic sac acts as an immune control organ for the inner ear and has been considered as an effector site of the mucosa-associated lymphoid tissue. The purpose of the study was to determine the potentially immunological relationship between endolymphatic sac and Waldeyer ring equivalent, one of the most important affector organs in mucosa-associated lymphoid tissue. STUDY DESIGN: Animal model. METHODS: Thirty-six rats were employed. Two animals were killed for histological observation of Waldeyer ring equivalent, and another 34 animals were randomly divided into experimental and control groups and received bilateral intranasal immunizations with keyhole limpet hemocyanin or Freund adjuvant, respectively. The ears of immunized animals and control animals were examined for keyhole limpet hemocyanin-positive memory cells and immunoglobulin G-positive plasma cells with the technique of immunohistochemical analysis. The histopathological changes and cell proliferation in those ears were also assessed. RESULTS: There were paired and organized lymphoid tissues in the lateral wall of the first choana in the rat. Keyhole limpet hemocyanin-positive lymphocytes appeared within the endolymphatic sac at 3 days after the first anti-genetic stimulus of the Waldeyer ring equivalent. Endolymphatic hydrops in the cochlea, elevated amounts of immunocompetent cells, and increased activity of cell proliferation within the endolymphatic sac were also considered after four intranasal injections of keyhole limpet hemocyanin. CONCLUSION: Presumably, endolymphatic sac is supplied with immunocompetent cells from Waldeyer ring equivalent and has an ability of co-reaction with Waldeyer ring equivalent.

[Protective effect of daizein on apoptosis cells of nasal mucosas in ovariectomized rats].

OBJECTIVE: To study the protective effect of daizein on apoptosis cells of atrophic nasal mucosas in ovariectomized rats. METHODS: Sixty rats were divided into four groups as contrary, ovariectomized, ovariectomized + nylestriol (O + N) and ovariectomized + daizein (O + D), each with 15 rats. Earlier apotosis cells of nasal mucosas taken from nasal septum were measured with flow cytometry. RESULTS: Compared with contrary group, the number of apoptosis cells of mucosas increased after being ovariectomized, the number of apoptosis cells of mucosas in O + N and O + D groups didn't change. CONCLUSION: Estrogen replacement and daizein might have effects on protecting cells of mucosas from lacking of estrogen by decreasing apoptosis cells in ovariectomized rats.