Dual therapy with lopinavir/ritonavir plus lamivudine could be a viable alternative for antiretroviral-therapy-naive adults with HIV-1 infection regardless of HIV viral load or subgenotype in resource-limited settings: A randomised, open-label and non-inferiority study from China.

BACKGROUNDS: This randomised controlled, open-label, non-inferiority trial was conducted in antiretroviral-naïve HIV-1-infected patients to assess the efficacy and safety of 48-week dual therapy of LPV/r plus 3TC (DT group) compared with Chinese first-line triple-therapy regimen (TT group). METHODS: 198 were randomised to DT (n = 100) or TT (n = 98). RESULTS: Ninety-two DT patients (92%) and 88 TT patients (89.8%) achieved HIV-1 RNA <50 copies/ml at week 48 (P = 0.629). Moreover, the safety profile was similar between two groups, and no secondary HIV resistance was observed. CONCLUSION: The results suggest that dual therapy of LPV/r plus 3TC is non-inferior to the first-line triple-therapy regimen in China.

Effect of hyperthermic intrathoracic chemotherapy (HITHOC) on the malignant pleural effusion: A systematic review and meta-analysis.

BACKGROUND: Although hyperthermic intraperitoneal chemotherapy (HIPEC) has been widely used to treat malignant ascites or as a preventive strategy for microscopic carcinomatosis following surgical resection of abdominal tumors, application of hyperthermic intrathoracic chemotherapy (HITHOC) in the treatment of malignant pleural effusion is limited. The objective of the current study was to conduct a systematic review and meta-analysis on the application of HITHOC in the palliative treatment of malignant pleural effusion. METHODS: After thorough searching of online databases, total 27 articles were included into qualitative systematic review and 5 of them were used to conduct qualitative meta-analysis. RESULTS: It was found that most of HITHOC was used in combination of cytoreductive surgery (CRS) including pleurectomy/decortication or after surgical resection of primary tumors, which mainly were lung cancer, thymoma or thymic carcinoma, breast cancer, and ovarian cancer. Patients who received HITHOC had significantly longer median survival length compared to the patients without HITHOC (Hedges g = 0.763, P < 0.001). In addition, HITHOC therapy was favored (Hedges g = 0.848, P < 0.001) in terms of median survival length, tumor-free survival rate, with tumor survival rate or Karnofsky performance status (KPS) scale. CONCLUSION: HITHOC is a safe and effective therapy in controlling pleural effusion and increasing patient's survival rate.

Natural Polymorphisms Conferring Resistance to HCV Protease and Polymerase Inhibitors in Treatment-Naïve HIV/HCV Co-Infected Patients in China.

BACKGROUND: The advent of direct-acting agents (DAAs) has improved treatment of HCV in HIV co-infection, but may be limited by primary drug resistance. This study reports the prevalence of natural polymorphisms conferring resistance to NS3/4A protease inhibitors and NS5B polymerase inhibitors in treatment-naïve HIV/HCV co-infected individuals in China. METHODS: Population based NS3/4A sequencing was completed for 778 treatment-naïve HIV/HCV co-infected patients from twelve provinces. NS3 sequences were amplified by nested PCR using in-house primers for genotypes 1-6. NS5B sequencing was completed for genotyping in 350 sequences. Resistance-associated variants (RAVs) were identified in positions associated with HCV resistance. RESULTS: Overall, 72.8% (566/778) of all HCV sequences had at least one RAV associated with HCV NS3/4A protease inhibitor resistance. Variants were found in 3.6% (7/193) of genotype 1, 100% (23/23) of genotype 2, 100% (237/237) of genotype 3 and 92% (299/325) of genotype 6 sequences. The Q80K variant was present in 98.4% of genotype 6a sequences. High-level RAVs were rare, occurring in only 0.8% of patients. 93% (64/69) patients with genotype 1b also carried the C316N variant associated with NS5B low-level resistance. CONCLUSIONS: The low frequency of high-level RAVs associated with primary HCV DAA resistance among all genotypes in HIV/HCV co-infected patients is encouraging. Further phenotypic studies and clinical research are needed.

Physician perceptions of HIV cure in China: A mixed methods review and implications for HIV cure research.

There are over 100 clinical trials worldwide focused on developing an HIV cure. Research participants will assume substantial individual risks while receiving little or no individual benefit. Physicians will have important dual roles of leading HIV cure research studies and guiding patient expectations. Many low and middle-income nations have started HIV cure trials, including China. The goal of this study was to better understand physician attitudes, behaviors, and perceptions of HIV cure research within the context of China. We conducted a quantitative and qualitative evidence review of published literature on physician perceptions of HIV cure in China. Quantitative survey data revealed that physicians rarely believed HIV was curable, but this perception may be more common compared to other countries. Qualitative data showed that inconsistent terminology used among physicians may contribute to the perception of HIV as curable. The belief that HIV is curable among some physicians in China may be related to the influence of traditional Chinese medicine beliefs. Rather than seeking elimination of pathogens, traditional Chinese medicine aims to achieve harmony between organs and a vital life force. In this context, HIV infection can be seen as a temporary state of imbalance rather than an irreversible change. There is a wide range of physician perceptions about HIV cure in China. Conflicting information about HIV cure from physicians and other sources could thwart the progress of HIV cure research. Enhancing patient-physician communication about ongoing HIV cure research trials will be important for developing an HIV cure.

The effect of hyperbaric oxygen on clinical outcome of patients after resection of meningiomas with conspicuous peritumoral brain edema.

OBJECTIVE: The goal of this study was to determine the effect of hyperbaric oxygen therapy on the clinical outcome of patients after resection of meningiomas with conspicuous peritumoral brain edema (PTBE). PATIENTS AND METHODS: 232 patients with intracranial meningiomas and conspicuous PTBE were allocated to the HBO2 Group or the Control Group (116 in each group). The Karnofsky Performance Score (KPS), the focal brain edema and the encephalomalacia in the operative region, as well as the number of patients with neurological deficits were compared statistically between the two groups at different times after the operation. RESULTS: On the third day after operation, the KPS and focal brain edema in the operative region between the HBO2 Group and the Control Group were not significantly different (p > 0.05), but 15 days after surgery, compared with the Control Group, the KPS of the HBO2 Group appeared obviously higher (p < 0.05), and the focal brain edema in the operative region was definitely smaller (p < 0.05). Six months after surgery, the volume of encephalomalacia in operative region and the number of patients with neurological deficits in the HBO2 Group were significantly less than those in the Control Group (p < 0.05). CONCLUSION: HBO2 therapy is effective in reducing edema formation and neurological deficits after resection of meningiomas with conspicuous PTBE.

Effects of early hyperbaric oxygen therapy on clinical outcome in postoperative patients with intracranial aneurysm.

OBJECTIVE: To investigate the effects of hyperbaric oxygen (HBO2) in postoperative patients with intracranial aneurysm. METHODS: A total of 120 patients who underwent clipping of intracranial aneurysm of the anterior circulation were randomized into the HBO2 group (n = 60) or the Control group (n = 60). Compared with the Control group, patients in the HBO2 group received additional HBO2 therapy, which was initiated within one to three days as soon as they were deemed clinically stable, for at least 20 sessions (one session per day). Mean flow velocities of the middle cerebral artery (MCA) on the operative approach side were measured on Days 1, 3, 7, 14 and 21 after operation. CT scans were performed on Days 1, 7, 14 and 21 after surgery to determine the abnormal density volume in the operative area. Cases associated with symptomatic cerebral vasospasm (CVS) were assessed on Days 3, 7 as well as 14, and the functional state determined by Karnofsky Performance Scale (KPS) score was evaluated on Days 3 and 21 after operation. Finally, Glasgow Outcome Scale (GOS) scores were obtained at six months after surgery. RESULTS: There were no differences between groups in terms of the mean flow velocities of MCA on the operative approach side, the cases with symptomatic CVS, and the KPS scores within three days after surgery (P > 0.05). Compared with those of the Control group, the mean flow velocities of MCA on the operative approach side were significantly lower in the HBO2 group on Days 7 and 14 (P < 0.05 or P < 0.01). On Days 7, 14 and 21, patients in the HBO2 group had smaller HBO2 density volume in the operative region than those in the Control group (P < 0.05). The HBO2 group developed less cases of symptomatic CVS than the Control group did on Days 7 (chi2 = 4.04, P < 0.05) and 14 (chi2 = 4.18, P < 0.05). The KPS scores were higher on Day 21 after surgery in the HBO2 group (P < 0.05). More patients in the HBO2 group achieved GOS scores of 4 and 5 at six months after surgery (chi2 = 6.032, P < 0.05). CONCLUSIONS: Early HBO2 appears to be beneficial asan adjunctive treatment of postoperative intracranial aneurysm. Attenuating postoperative CVS, brain edema, and cerebral ischemia contributes to the effectiveness of HBO2.

[Appraisal of occupational stressor in petrochemical industry workers].

OBJECTIVE: To discuss the origin of occupational stress among petrochemical industry workers and to access the main occupational stressors that impact job satisfaction and mental health of petrochemical industry workers. METHODS: A survey on occupational stressor was carried out by Occupational Stress Indicator (OSI) in 532 petrochemical industry workers (345 chemical and 187 logistic workers). RESULTS: The environment in workplace of chemical group was worse than that of contrast. The chemical workers had less control over job and they experienced more hazards, monotonous as well as role stressors than the logistic group. The scores of job satisfaction and mental health of chemical group (36.867 +/- 0.656, 43.734 +/- 0.542, respectively) were higher than that of contrast (40.321 +/- 0.901, 46.714 +/- 0.745, respectively) (P < 0.05). CONCLUSION: The occupational stressors exist in chemical workers which affect chemical workers' job satisfaction and mental health with different levels.

Effects of land use on phosphorus loss in the hilly area of the Loess Plateau, China.

The hilly area of Loess Plateau has some of the highest soil erosion rates in the world, and serious soil erosion causes great losses of plant nutrients. As the most common land use in Loess Plateau, slope farmland contributed most of the erosion soils. This study was designed to examine the effects of land use and slope angle of farmland on phosphorus (P) loss in the hilly area of loess plateau. Farmland (FR), barrenland (BR), and four forest treantment (seabuckthorn+ poplar (SP), immature seabuckthorn (IS), mature seabuckthorn (MS), immature Chinese pine (ICP)) were the types of land use; 10, 15, 20, 25, 30 degrees were the slope angles of FR that were compared. The results showed a larger proportion of P loss occurred in erosion soil fraction of FR, ICP, ICP, and the five slope treatments of FR; in SP, IS, and MS, P loss was primarily through runoff. FR produced more P loss than SP, IS, ICP, BR, and MS. 20 approximately 30 degrees may be the slope ranges for P loss of FR; FR in this ranges would loss more P with soil erosion. SP, IS, and MS were reasonable land uses for their less runoff, soil loss, and P loss. Farmlands over 15 degrees should be abandoned or reforested for it would produce more runoff, soil loss, and P loss.