[Clinicpathological features and survival of patients with AIDS related non-Hodgkin's lymphoma].

Objective: To analyze the clinical characteristics, pathological features and survival of patients with AIDS related non-Hodgkin's lymphoma (ARL) . Methods: The clinical data of 53 ARL cases diagnosed and received care at Zhongnan hospital of Wuhan University were retrospectively studied, and 106 controls were enrolled as control group according to 1∶2 for paired cases and control. SPSS 13.0 package was used for statistical analysis. Kaplan-Meier was applied to assess the survival probability. Results: The mean age of patients with ARL was 43 (11-67) years. Male versus female was approximately 4∶1. The median CD4(+) T cell count was (146±20) /ml. The Ann Arbor clinical classification showed that 52.8% of the cases were of stage Ⅲ and Ⅳ. Approximately 54.7% of the patients had elevated serum lactate dehydrogenase (LDH) . According to international prognosis index score, 64.2% of the patients were in high risk group. Diffuse large B-cell lymphoma (DLBCL) was the predominant histological subtype. Among 53 cases, 33 cases (62.3%) received combination of anti-HIV therapy and anti-NHL (CHOP) chemotherapy regimen, 8 cases (15.1%) only received anti-HIV therapy, and 12 cases (22.6%) asked for alleviative treatment. Median survival time was (6.0±1.3) months for ARL cases versus (48.0±10.0) months for controls (P<0.05) . After eliminating cases who did not receive anti-lymphoma treatment, ARL cases showed a lower 1-year OS rates than control group (60.6% versus 83.0%) , but no difference about 2-, 3- and 5-year OS rates (53.5% versus 60.5%, 48.1% versus 45.9%, and 39.1% versus 27.5%, respectively) . Conclusions: ARL is more common in young adults; one-year mortality rate is high. Anti-HIV therapy combined with anti-NHL therapy could significantly improve the prognosis of ARL patients. CHOP regimen may be more suitable for ARL patients.

[Evaluation of prevalent status of kala-azar in endemic area of Hubei Province].

OBJECTIVE: To identify the diagnosis of 14 cases with "kala-azar" previously reported in Hubei Province since 1989 and to evaluate the present status of the disease. METHODS: Bone marrow smear, immunological test (LDTand IFAT), mouse inoculation, fungi culture, vector (Phlebotomus) and reservoir host (dog) survey. RESULTS: Among the 14 cases, 12 cases were progressive disseminated histoplasmois, one was an imported case and another one was a remnant skin type "kala-azar" case. An immunological survey was conducted during 1997-1999 in 25 townships located in 23 counties of 9 prefectures and cities. A total of 13,890 persons had been examined by LDT, the positive rate was 0.07%, no positive case was found among the persons under 40 years of age. During the survey, 1,756 persons had been examined by IFAT, the results were negative. No Phlebotomus chinensis had been found in the surveyed area. A total of 302 dogs were examined, no sick dog had been found. CONCLUSION: Kala-azar has been eradicated in Hubei Province.

[The detection and significance of HBV-DNA in serum and liver of advanced schistosomiasis patients].

Hepatitis B virus deoxyribonucleic acid (HBV-DNA) and surface antigen (HBsAg) in the serum and liver specimens from 31 patients with advanced schistosomiasis were investigated. The patients have been followed up for six years. The presence of HBsAg and HBcAb in serum among patients with advanced schistosomiasis were significantly more frequent than that in the control group (P < 0.05), but the prevalence of HBV-DNA and HBeAg in the patients were not significantly different from that in the controls (P > 0.05). The positive rate of HBV-DNA and HBsAg in liver was 19.4% and 48.4% respectively, which were greater than that in serum. The presence of HBV-DNA in patients with advanced schistosomiasis was associated with high mortality and the cause of death was either hepatic failure or hepatocellular carcinoma. The results suggest that it is important to detect HBV-DNA both in surum and liver. Antiviral therapy for patients with advanced schistosomiasis who had detectable HBV-DNA may improve the prognosis.

Natural killer cell activity in renal transplant recipients receiving cyclosporine.

Normal subjects (n = 11) had a mean circulating natural killer (NK) cell activity of 188 lytic units per 10(7) peripheral mononuclear blood leukocytes. This activity was significantly enhanced by in vitro incubation with 500 U of alpha-interferon (+207 lytic units). The mean NK activity of renal transplant recipients on azathioprine (n = 17) or on cyclosporine (n = 17) studied at various times after transplantation was significantly decreased, as was the ability of interferon to enhance NK activity. In the cyclosporine group, interferon could not enhance NK titers 1 to 6 weeks after transplantation when the patients were on the highest doses of cyclosporine (mean, 1,002 mg/day) or when they were viremic for cytomegalovirus. After 18 weeks, when the patients received 546 mg/day or when viremia was no longer detected, the ability of interferon to enhance NK activity was more normal. Cyclosporine and cytomegalovirus infection may have a greater effect on the action of interferon on NK activity than on the NK titer per se. This defect may diminish the reserve of NK cells and contribute to post-transplant immunosuppression.

Lymphocyte subsets and natural killer cell responses during cytomegalovirus mononucleosis.

Cell-mediated immunity in seven patients with cytomegalovirus mononucleosis was assessed by monoclonal antibody to lymphocyte subsets, lymphocyte blastogenesis, and natural killer cell activity. The patients had decreased ratios of helper (Leu 3a) to suppressor-cytotoxic (Leu 2a) T cells as compared with normal donors. Leu 2a+ T cells from the patients were uniquely sensitive to overnight culturing, which resulted in a 2.6-fold increase in the helper/suppressor cell ratio and the appearance of an unusual third Leu 1+ 2a- 3a- T cell subset. This correlated directly with enhanced blastogenesis to concanavalin A after preculture. Base-line and interferon-boosted natural killer cell responses versus K562 cell targets during cytomegalovirus mononucleosis did not differ from those of normal donors. This suggests that certain cellular immune functions are depressed during cytomegalovirus mononucleosis in correlation with the emergence of a culture-sensitive subset of suppressor T cells. In contrast, cytotoxic lymphocytes appear to function normally and may aid in the resolution of the illness.