Effects of different concentrations of intraluminal sodium chloride solution on intracavitary ECG used for arm infusion port implantation.

At present, there are few clinical studies on the application of high-concentration sodium chloride solutions in intracavitary ECG-guided catheter tip localization during the arm infusion port implantation. This study observed the effects of sodium chloride solutions with different concentrations on intracavitary ECG-guided arm infusion port implantation in the patients with cancer. The 657 patients receiving arm infusion port implantation in our hospital between January 2020 and August 2021 were randomly divided into 0.9% sodium chloride solution conduction group (group A), 5.45% sodium chloride solution conduction group (group B) and 10% sodium chloride solution conduction group (group C). The derived rate of stable intracavitary ECG, the occurrence rate of characteristic P wave, the time used for catheter tip localization and the optimal position rate of catheter tip were compared between the three groups. The derived rate of stable intracavitary ECG was significantly higher in the group B (97.78%) and group C (98.63%) than in the group A (93.90%) (all P < 0.05). The occurrence rate of characteristic P wave was also significantly higher in the group B (96.89%) and group C (97.72%) than in the group A (88.73%) (all P < 0.001). The time used for catheter tip localization was significantly shorter in the group B [(49.73 ± 8.15) s] and group C [(48.27 ± 8.61) s] than in the group A [(69.37 ± 19.99) s] (all P < 0.001). There was no significant difference in the optimal position rate of catheter tip among the three groups (P > 0.05). The 5.45% and 10% sodium chloride solutions are significantly superior comparing with 0.9% sodium chloride solution in the derived rate of stable intracavitary ECG, occurrence rate of characteristic P wave and time used for catheter tip localization, but there were no significant differences between 5.45 and 10% sodium chloride solutions. Moreover, the 5.45% sodium chloride solution is closer to physiological state comparing with 10% sodium chloride solution, so the 5.45% sodium chloride solution may be recommended for the intracavitary ECG-guided arm infusion port implantation.

Volatile compounds, bacteria compositions and physicochemical properties of 10 fresh fermented rice noodles from southern China.

To clarify the discrepancy in characteristic flavor and bacteria composition of 10 fresh fermented rice noodles from southern China, the volatile and bacteria composition were determined by headspace-gas chromatography ion mobility spectrometry and 16SrRNA sequencing methods. The potential relationship between volatile compounds and bacterial composition has also been further revealed using spearman's correlation analysis. The contents of proximate composition, cooking properties and texture properties of 10 fresh fermented rice noodles exhibited significant different among them (p ＜ 0.05). The flavor analysis showed that a total of 54 compounds were detected. 1-Octen-one, ethyl 3-methylbutanoate, 3-methylbutanal, n-nonanal, hexanal, amyl acetate, ethanol and 2-pentyl furan were the key volatiles among them. The bacterial analysis showed that Leuconostoc and Lactococcus were the core bacteria at the genu level of all samples. Amyl acetate, 2-butanone and methyl-2-methylpropanoate were positively related to Lactococcus while ethanol was negatively correlated with Lactococcus. And Leuconostoc was positively related to 3-methylbutanal and acetone, while was negatively correlated with hexanal. Results indicated that key volatiles and textural properties of different fresh fermented rice noodle samples were associated with bacterial composition.

[Effects of Salvia przewalskii Maxim. on high-altitude pulmonary hypertension in rats and its mechanism].

OBJECTIVE: To investigate the interventive effects of Salvia przewalskii Maxim.(SPM)on high-altitude pulmonary hypertension(HAPH)in rats and possible mechanism. METHODS: The male SD rats were randomly divided into the control group, the hypoxia group and SPM(0.5 g/kg,1 g/kg and 2 g/kg) group. There were 14 rats in each group. The rats in control group were feed in Xining(with an altitude about 2 260 m), and the other group rats were all feed in Maduo county people's hospital(with an altitude about 4 260 m). The rats in SPM groups were treated with SPM at the doses of 0.5 g/kg,1 g/kg and 2 g/kg by gavage respectively (100 g/ml). The rats in control and the hypoxia groups were received equal volume of distilled water, once a day. After 4 weeks, the mean pulmonary artery pressure (mPAP) of rats was measured and the same part of lung tissue of each rat was collected and stored in liquid nitrogen. Then the relative mRNA expression levels of the proliferation cell nuclear antigen(PCNA), the cell cycle dependent kinase 4(CDK4), CyclinD1, RhoA, ROCK1, ROCK2 in lung tissues of each group rats were all tested by RT-PCR. RESULTS: Compared with the control group, the mPAP and the relative mRNA expression levels of PCNA, CDK4, CyclinD1, RhoA, ROCK1 and ROCK2 were increased significantly in the hypoxia group(P＜0.01). Compared with the hypoxia group, the mPAP and the relative mRNA expression levels of PCNA, CDK4, CyclinD1, RhoA, ROCK1 and ROCK2 in the lung tissues of the SPM group rats were all decreased significantly(P＜ 0.05 or P＜0.01). CONCLUSION: SPM can prevent the HAPH in rats, and the mechanisms may be related to the inhibition of the excessive proliferation of smooth muscle cells in pulmonary artery and the excessive activation of the RhoA/Rho kinase(ROCK) signaling pathway.

Psychometric properties of the Chinese version of the Self-Efficacy for Appropriate Medication Use Scale in patients with stroke.

BACKGROUND: It has been reported that stroke has a higher incidence and mortality rate in the People's Republic of China compared to the global average. These conditions can be managed by proper medication use, but ensuring medication adherence is challenging. OBJECTIVE: To translate the Self-Efficacy for Appropriate Medication Use Scale into Chinese and test its validity and reliability in patients with stroke. METHODS: Instrument performances were measured from January 15, 2015 to April 28, 2015 on a convenience sample of 400 patients with stroke recruited at four neurology departments of the First Affiliated Hospital of Zhengzhou University. Questionnaires included the Chinese versions of the Self-Efficacy for Appropriate Medication Use Scale (C-SEAMS) and the General Self-Efficacy Scale (C-GSE). Construct validity, convergent validity, internal consistency, and test-retest reliability were measured. RESULTS: Item analysis showed that item-to-total correlations were in the range of 0.362-0.672. Exploratory factor analysis revealed two factors (which accounted for 60.862% of total variance), with factor loading ranging from 0.534 to 0.756. Confirmatory factor analysis was performed to support the results, with an acceptable fit (χ (2)=73.716; df=64; P<0.01; goodness-of-fit index =0.902; adjusted goodness-of-fit index =0.897; comparative fit index =0.865; root-mean-square error of approximation =0.058). The convergent validity of the C-SEAMS correlated well with the validated measure of the C-GSE in measuring self-efficacy (r=0.531, P<0.01). Good internal consistency (Cronbach's alpha ranged from 0.826 to 0.915) and test-retest reliability (Pearson's correlation coefficient r=0.642, P<0.01) were found. CONCLUSION: The C-SEAMS is a brief and psychometrically sound measure for evaluating self-efficacy for medication adherence in the Chinese population with stroke.

Synthesis and biological evaluation of hydroxycinnamic acid hydrazide derivatives as inducer of caspase-3.

In order to generate compounds with superior antitumor activity and reduced toxicity, twelve new hydroxycinnamic acid hydrazide derivatives were synthesized and evaluated for their antiproliferative activities against two cancer cell lines (H1299 lung carcinoma cells and MCF-7 breast cancer cells), and compared to two normal counterparts (NL-20 lung epithelial cells and H184B5F5/M10 breast cells) by MTT method. The results demonstrated that some of these compounds possessed good antiproliferative activity against the two cancer cell lines. Among them, compound 2c was active against the growth of H1299 lung carcinoma cells with IC50 values of 1.50 µM, which was more active than the positive topotecan (IC50 = 4.18 µM). Simultaneously, it showed lower cytotoxic effects on normal NL-20 lung epithelial cells (IC50 > 10 µM). Mechanism studies indicated that it induced cell cycle arrest at G2/M phase followed by activation of caspase-3, and consequently caused the cell death. Further studies on the structure optimization are ongoing.

Major causes of fever of unknown origin at Peking Union Medical College Hospital in the past 26 years.

BACKGROUND: Despite the recent advances in medicine, fever of unknown origin (FUO) remains a diagnostic and therapeutic challenge even to expert physicians. To increase the knowledge of FUO, we conducted a retrospective study to investigate the causes of FUO and the change of major causes of FUO during the past 26 years. METHODS: The clinical data were retrospectively analyzed from 997 patients with FUO hospitalized at the Peking Union Medical College Hospital (PUMCH) between January 2004 and October 2010. Furthermore, the results were compared to that reported in previous studies of FUO in PUMCH since 1985. RESULTS: Of the 997 FUO cases, definite diagnosis was eventually achieved in 797 (79.9%) patients. The most common cause of FUO was infectious diseases (479 cases, 48.0%), with tuberculosis accounting for 45.3% (217/479) of the cases of infections. One hundred and sixty-eight (16.9%) patients were diagnosed with connective tissue diseases, with Still's disease and vasculitis accounted for 31.5% (53/168) and 24.4% (41/168) of this category, respectively. Neoplasms and miscellaneous causes were found in 7.9% (79/997) and 7.1% (71/997), respectively. However, no definite diagnosis had been made in the remaining 200 (20.1%) cases until they were discharged from the hospital. CONCLUSIONS: During different periods, infectious diseases, especially tuberculosis, were the leading etiology of FUO and the proportion of tuberculosis had no significant difference. While the frequency of neoplasms was descending, the proportion of lymphoma in neoplasm was ascending; the frequency of undiagnosed cases was increasing, but in most FUO cases the causes can be diagnosed eventually after careful analysis of clinical data.

[The microbiological and clinical analysis of bloodstream infections with identifiable sources].

OBJECTIVE: To evaluate the microbial spectrum and clinical characteristics of microbiological diagnosed bloodstream infections (BSI) with identified infective sources. METHODS: The hospitalized patients microbiologically diagnosed as BSI with identified infective sources were included in this study from January 2008 to December 2009. Data were collected retrospectively and analyzed by software SPSS 17.0. RESULTS: In this 2-year study, 301 strains of microbes were isolated from 249 patients. There were 205 (82.33%) patients with monomicrobial BSI, while the other 44 (17.67%) patients with polymicrobial BSI. The most common identified source of bloodstream infections was lower respiratory tract infection (125, 41.5%), followed by intraabdominal infection (55, 18.3%) and intravascular devices related infection (54, 17.9%). The four most common isolated pathogens were Acinetobacter species (60, 19.9%), Escherichia coli (50, 16.6%), Pseudomonas species (35, 11.6%) and Staphylococcus Aureus (34, 11.3%). Eighty-eight (35.3%) patients died during hospitalization due to all causes, out of which 62 (24.9%) patients died owing to BSI. The patients with BSI originated from lower respiratory tract had a higher crude in-hospital case-fatality ratio than those with BSI originated from other resources (OR = 2.186; 95%CI 1.260 - 3.792; χ(2) = 7.879, P = 0.005). In the multivariate regression, age ≥ 65, invasive mechanical ventilation, reservation of central line and polymicrobial BSI during hospitalization were independent risk factors of death due to all causes. CONCLUSIONS: Lower respiratory tract is the most common originated source of BSI with microbiological identified sources. Gram-negative bacillus taking advantage, the microbial spectrum of BSI with identified sources in our study is different from those reported before both in primary and secondary BSI. The patients with BSI originated from respiratory tract have a higher crude in-hospital case-fatality ratio.

[Clinical analysis of adult primary bloodstream infection].

OBJECTIVE: Evaluate the microbiological and epidemiological characteristics of primary bloodstream infections as well as the associated patients' clinical features at Peking Union Medical College Hospital. METHOD: Microbiological and clinical data of the adult patients with primary bloodstream infections during January 1, 2008 and December 31, 2009 were retrospectively collected and evaluated. Pearson χ(2) test was used to compare the difference between proportions and Logistic regression was used in multivariate analysis. RESULT: Five hundred and eighty-six strains of microbes were isolated from 494 adult patients with primary bloodstream infections. There were 80 patients with polymicrobial primary bloodstream infection of the 586 isolates, coagulase-negative staphylococci (175, 29.9%) was the most common, followed by Escherichia coli (93, 15.9%), Enterococcus species (60, 10.2%), Streptococcus species (41, 7.0%), and Staphylococcus Aureus (39, 6.7%). Central-line was the leading suspected infective source among the suspected infective source involving 108 (18.4%) isolates. Excluded the 108 isolates with suspected sources, 77 (45.3%) out of 167 patients with the primary bloodstream infections caused by coagulase-negative staphylococci or Staphylococcus Aureus had a central-line, with a higher proportion of the patients with a central-line than the patients with bloodstream infection caused by other pathogens (χ(2) = 10.419, P = 0.001). One hundred and fourteen patients died during hospitalization, with the crude mortality rate 23.0%. Fifty-nine patients (11.9%) died due to primary bloodstream infection. The patients with polymicrobial bloodstream infection were with a higher attributable mortality (OR = 2.159;95%CI 1.165 - 4.002; χ(2) = 6.194, P = 0.013). In the multivariate analysis, the independent risk factors of crude mortality rate to primary bloodstream infections were elderly patients, central neurological disorder, mechanical ventilation, and reservation a central-line. CONCLUSION: The most common microbe causing primary bloodstream infections was G+ cocci. Polymicrobial primary bloodstream infection added risk to attributable in-hospital fatality ratio. Elderly patients, neurological disorder, reservation of central-line, and mechanical ventilation were the independent risk factors of crude in-hospital fatality ratio.

Tyrosine sulfation in N-terminal domain of human C5a receptor is necessary for binding of chemotaxis inhibitory protein of Staphylococcus aureus.

AIM: Staphylococcus aureus evades host defense through releasing several virulence proteins, such as chemotaxis inhibitory protein of staphylococcus aureus (CHIPS). It has been shown that extracellular N terminus of C5a receptor (C5aR) forms the binding domain for CHIPS, and tyrosine sulfation is emerging as a key factor in determining protein-protein interaction. The aim of this study was to evaluate the role of tyrosine sulfation of N-terminal of C5aR in its binding with CHIPS. METHODS: Expression plasmids encoding C5aR and its mutants were prepared using PCR and site-directed mutagenesis and were used to transfect HEK 293T cells using calcium phosphate. Recombinant CHIPS protein was purified. Western blotting was used to examine the binding efficiency of CHIPS to C5aR or its mutants. RESULTS: CHIPS exclusively binds to C5aR, but not to C5L2 or C3aR. A nonspecific sulfation inhibitor, sodium chlorate (50 nmol/L), diminishes the binding ability of C5aR with CHIPS. Blocking sulfation by mutation of tyrosine to phenylalanine at positions 11 and 14 of C5aR N terminus, which blocked sulfation, completely abrogates CHIPS binding. When tyrosine 14 alone was mutated to phenylalanine, the binding efficiency of recombinant CHIPS was substantially decreased. CONCLUSION: The results demonstrate a structural basis of C5aR-CHIPS association, in which tyrosine sulfation of N-terminal C5aR plays an important role. Our data may have potential significance in development of novel drugs for therapeutic intervention.

[A clinical analysis of 25 cases of prosthetic valve endocarditis].

OBJECTIVE: To report the clinical characteristics of prosthetic valve endocarditis (PVE). METHODS: All 25 cases of definite PVE (Duke criteria) diagnosed at our hospital between January 1992 to December 2008 were retrospectively analyzed. Among them, 7 cases were pathologically confirmed and the others were clinically confirmed with either 2 major criteria or 1 major and ≥ 3 minor criteria. Their clinical characteristics, underlying heart diseases, previous heart operations, presenting manifestations, causative microbes, echocardiographic findings and prognosis, were studied. RESULTS: (1) Although most cases underwent valve transplantations for underlying heart diseases of rheumatic heart diseases and congenital heart diseases, 10 patients were complicated with infectious endocarditis (IE) prior to the operations, 4 of them were PVE. (2) Eleven of them developed PVE within 2 months postoperatively. Fever (100%), major vessel embolism (48%), and anemia (36%) were the most frequently manifestations. Fourteen cases (56%) had positive culture results with 15 causative pathogens, including 5 coagulase-negative Staphylococcus (CNS, 3 were methicillin-resistant coagulase-negative Staphylococcus, MRSCoN), 4 fungi, 2 Enterococcus faecalis, 2 Burkholderia cepacia, 1 Stenotrophomonas maltophilia, and 1 Streptococcus. (3) Prosthetic valve vegetations, periannular leakage, regurgitation, were the main echocardiographic findings. Transesophageal echocardiography (TEE) revealed 13 PVE who had no positive findings on previous transthoracic echocardiography (TTE). (4) Eighteen PVE (72%) developed peri-annular complications (12 leakage, 3 dehiscence, 2 abscesses, 1 fistula), major vessel embolism, congestive heart failure (16%) were frequently observed, 9 of the 17 patients died in hospital, in spite of intensive managements. CONCLUSIONS: PVE has a high mortality and is a severe complication for patients who underwent heart surgery. Its causative pathogen spectrum is quite different from that of native valve endocarditis. TTE is not sensitive for some PVE cases.

Longitudinal observation of an interferon gamma-released assay (T-SPOT.TB) for Mycobacterium tuberculosis infection in AIDS patients on highly active antiretroviral therapy.

BACKGROUND: T-SPOT.TB is a novel test for tuberculosis infection with higher sensitivity and specificity than the traditional tuberculin skin test (TST). However, there are no longitudinal data in the literature evaluating T-SPOT.TB for Mycobacterium tuberculosis in patients with acquired immune deficiency syndrome (AIDS) on highly active antiretroviral therapy (HAART). The objective of this study was to assess the value of T-SPOT.TB longitudinally in AIDS patients on HAART without prophylaxis for tuberculosis. METHODS: A prospective observational study was conducted in 50 AIDS patients on HAART. None of the subjects had evidence of active tuberculosis. T-SPOT.TB, a T-cell-based interferon gamma released assay, was performed at the onset of the study and repeated 24 months thereafter. Subjects were evaluated every 6 months during the 36-month follow-up. RESULTS: Twenty-one (42%) AIDS patients on HAART tested positive by T-SPOT.TB (95%CI 28.3% - 55.7%). The pooled spot-forming cells of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) peptides were 68/million peripheral blood mononuclear cell (PBMC) (interquartile range 44 - 220). The average number of CD4 cells in subjects was (305 +/- 152) cells/microl, and there was no significant difference in T-SPOT.TB response rates between subjects with CD4 cell counts < 200 cells/microl (7/15 (46.7%), 95%CI 21.5% - 71.9%) and those with CD4 cell counts >/= 200 cells/microl (14/35 (40.0%), 95%CI 23.8% - 56.2%, P = 0.662). In the 32 subjects who completed the 24-month follow-up, 10 underwent T-SPOT.TB reversion, one had T-SPOT.TB conversion, six remained positive and 15 remained negative. None of them advanced to active tuberculosis during the 36-month follow-up. CONCLUSION: The inactive status of tuberculosis infection may be maintained for a long period in AIDS patients on HAART.

[Clinical significance of positive sputum culture for filamentous fungi].

OBJECTIVE: To investigate the clinical significance of positive sputum culture for filamentous fungi. METHODS: The medical data of 140 patients positive for filamentous fungi in sputum culture at Peking Union Medical College Hospital were reviewed retrospectively. Based on the diagnostic criteria by European Organization for Research and Treatment of Cancer/Mycoses Study Group, invasive pulmonary fungal infection (IPFI) was diagnosed. The clinical characteristics of cases with and without IPFI were analyzed respectively. RESULTS: Among all 140 cases positive for filamentous fungi in sputum culture, only 22 cases could be diagnosed as IPFI. Two of 22 IPFI cases were confirmed by post-operative pathology, 1 case was confirmed by positive blood culture for filamentous fungi and the remaining 19 cases were diagnosed clinically according to the nature of hosts, characteristics of pulmonary infections and microbiological evidence (positive sputum culture for filamentous fungi, 2 - 5 times for each case). Most of etiological fungi in IPFI patients belonged to Aspergillus. And the identity of isolated fungal strain was mostly one strain for each patient. In IPFI group, patients who had been treated with broad-spectrum antibiotics (100%), steroids (13, 59.1%) or immunosuppressant (7, 31.8%) or who had pulmonary X-ray imaging changes (100%), primary diseases (21, 95.5%), hypoalbuminemia (18, 81.8%) or hemoptysis (10, 45.5%), were significantly more than those in non-IPFI group (66.9%, 34.7%, 18.6%, 79.7%, 72.0%, 45.8% and 4.2% respectively; P < 0.05 for each item). In IPFI group, itraconazole, amphotericin B and/or voriconazole were administrated, 8 patients (36.4%) were cured and 14 patients (63.6%) passed away. In non-IPFI group, the patients were treated with antibiotics, fluconazole, anti-tuberculosis, steroids or combined with immunosuppressant, chemotherapy or bronchoalveolar lavage; 96 cases (81.4%) were cured or showed improvement, and 22 cases (18.6%) died or gave up further treatment. CONCLUSIONS: The clinical significance of positive sputum culture for filamentous fungi are associated with the times of positive culture, the number and species of isolated fungal strains. Meanwhile it is important to determine whether there is IPFI according to the nature and clinical characteristics of patients.

[An analysis of 100 cases of tuberculosis first presenting as fever of unknown origin in a general tertiary hospital].

OBJECTIVE: To investigate the clinical characteristics of tuberculosis (TB) first presenting as fever of unknown origin (FUO). METHODS: The clinical data of 100 cases of FUO, diagnosed as TB finally, among in-patients in Peking Union Medical College Hospital were analyzed retrospectively. RESULTS: (1) Sites of TB:there were 39 patients with merely pulmonary TB, 28 patients with merely extrapulmonary TB, and 33 patients with both pulmonary and extrapulmonary TB. (2) CLINICAL MANIFESTATIONS: depending on the different sites of tuberculous lesion, the clinical symptoms varied accordingly. The common laboratory findings included anemia, hypoalbuminemia, elevation of the level of ESR and C-reactive protein (CRP). (3) Methods for diagnosis: 34 cases were diagnosed by sputum smear- or cultivation-positive for acid-fast bacilli; 8 cases by histopathology; 49 cases by clinical diagnosis of TB with an effective anti-TB therapy; and 9 cases by effective diagnostic anti-TB therapy. (4) Responses to treatment: among 73 cases with complete follow-up data, only 2 cases (2.7%) died and the other cases were cured or alleviated. Fifty-five cases (77.5%) showed marked efficacy after less than 4 weeks of regular anti-TB therapy, 37 cases (52.1%) suffered adverse effects of anti-TB agents, and all of them had improved after modifying anti-TB therapy and supporting treatment. CONCLUSIONS: The diagnosis of TB that presents as FUO is quite difficult, and the median interval time for making diagnosis is 14 weeks (3 - 77 weeks). Investigating clinical manifestations comprehensively, reviewing radiology data carefully, and eliciting microbiological and pathologic evidence of TB, are extremely important for making the correct diagnosis. In some cases, a therapeutic trial of anti-TB therapy is necessary.

Gold-catalyzed reaction of enynols by a dimerization-fragmentation process: an expeditious assembly of enyne molecular architecture.

Intermolecular condensation reaction of 1,3,5-triarylenynols catalyzed by gold as Lewis acid was reported for the first time; the products with unique structures have potential applications in materials chemistry, and tandem reaction product has been used to detect mercury ions as an organic molecular probe.

New metal-free one-pot synthesis of substituted allenes from enones.

A new metal-free, one-pot synthesis of substituted allenes from enones was discovered for the first time, in which a tertiary amine as a base was found to be an effective promoter in such novel transformations. The present synthetic protocol proceeded readily with high compatibility of sensitive functional groups, and it provides a new efficient way to access a series of synthetically important allenes without the use of metallic reagents or catalysts.

[A clinical analysis of 9 cases of actinomycosis].

OBJECTIVE: To study the clinical features of actinomycosis and to increase the understanding of it. METHODS: To review the clinical data of 9 cases of actinomycosis retrospectively in Peking Union Medical College Hospital from January 1990 to June 2006. RESULTS: (1) Nine patients including 7 female and 2 male, with age ranging from 30 to 50 years (mean age 39.8 years) were studied and they suffered from the disease for a mean period of 13.1 months (2 - 36 months). (2) Three of the 9 patients had cervicofacial actinomycosis, 2 pelvic actinomycosis, 2 thoracic actinomycosis, 1 breast and 1 intestinal actinomycosis. In 3 cases the lesion spread to many other organs from the primary site. (3) The diagnosis was made with biopsy in 6 cases, sputum or sulphur granules in 2 and clinical as well as laboratory examination in one. (4) All the 9 patients accepted appropriate therapy of antibiotics and the treatment was effective in 8. The one failed to respond to antibiotics died. CONCLUSION: Actinomycosis is infrequent clinically. It usually presents as chronic abscess and may be misdiagnosed as malignant tumor. Clinical doctors should be vigilant of it, in order to diagnose and treat it in good season and to greatly improve the prognosis.

[The clinical outcome and immune reconstitution in 45 advanced AIDS patients undergoing highly active antiretroviral therapy for 12 months].

OBJECTIVE: To investigate the efficacy and side effects of highly active antiretroviral therapy (HAART) in Chinese AIDS patients. METHODS: 45 antiretroviral drug-naive AIDS patients were enrolled and divided into two groups by their baseline CD(4) count < 100/microl or > or = 100/microl. Clinical, virological and immunological outcomes as well as side effects were followed at baseline and at the end of month 1, 3, 6, 9, 12 after receiving HAART. RESULTS: Among the 45 HIV/AIDS patients included, by the end of 12 months of HAART, the plasma viral load (VL) got a mean reduction by 2.8 lg copies/ml, CD(4) count had a mean gain of 187/microl, among which the naive phenotype increased by 68/microl and the memory phenotype by 119/microl. The CD(4)(+)CD(28)(+) T cell percentage went up from (62.5 +/- 25.8)% to (82.6 +/- 15.6)% (P < 0.001); and there was a significant reduction of CD(8)(+) T-cell activation. In the 31 patients with their baseline CD(4) count < 100/microl, 11 had a VL < 50 copies/ml, and 14 had fluctuations in their VL; while in 14 patients with their baseline CD(4) count > or = 100/microl, 10 had a VL < 50 copies/ml and 2 had fluctuations in their VL, respectively, with statistic significance between the two groups. CD(4) count showed a bi-phase increase during HAART and there was significant positive correlation between the change of CD(4) count and plasma VL. Throughout the 12 months of HAART, 39 patients had gastrointestinal side effects, 15 peripheral neuritis, 3 hepatic lesions, 4 hematological side effects and 1 renal calculus. 9 patients had adjustment of their initial therapy because of side effects. CONCLUSIONS: Immune reconstitution as well as significant therapeutic effect was observed in advanced Chinese AIDS patients after HAART. Side effects were common during HAART, so close clinical attention is needed.

[Abnormal changes of CD28 expression on CD4 + T cells in treatment-näive and highly active antiretroviral therapy-treated HIV/AIDS patients].

OBJECTIVE: To study the alteration of the expression of CD28 on CD4 + T cells in HIV/AIDS patients and observe the dynamics of CD28 expression under highly active antiretroviral therapy (HAART). METHODS: The expression of CD28 on CD4 + T cells, CD4 counts, and plasma viral load were measured by flow cytometry and bDNA assays in 278 treatment-naïve HIV/AIDS patients and 56 healthy controls. In addition, the evolution of these parameters was assessed in 59 patients who initiated HAART and were followed for 12 months in regular 3-month visits. RESULTS: The median level of CD28 on CD4 + T cells decreased dramatically in treatment-naïve HIV-positive individuals than in HIV-negative controls (P <0.001). The expression rate of CD28 molecule was positively correlated with CD4 counts (r = 0.484, P < 0.001), and negatively correlated with plasma viral load (r = -0.300, P <0.001). In patients who had received one month of standard HAART, the level of CD28 on CD4 + T cells increased rapidly from 75.0% to 90.0% (P < 0.001). Moreover, there was a negative correlation between the median CD28 expression and the median viral load (r = - 0.829, P = 0.042). CONCLUSIONS: The level of CD28 expression on CD4 + T cells is down-regulated in treatment-naïve HIV/AIDS patients. HAART can successfully restore the lymphocyte subsets of CD4 + CD28 + T cells. The up-regulation of CD28 expression after HAART may be closely correlated with the suppression of the viral replication.

[Clinical characteristics of 143 Chinese HIV/AIDS patients].

OBJECTIVE: To investigate the clinical characteristics of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients in China. METHODS: Totally 143 HIV/AIDS patients who were first diagnosed in Peking Union Medical College Hospital form January 1988 to April 2006 were enrolled in this study. Clinical characteristics were retrospectively analyzed. RESULTS: Among 143 HIV/ AIDS patients, 57 patients had no clinical symptoms and were confirmed by routine examinations; 86 patients had clinical symptoms, including fever (n = 50), weight loss (n = 18), and discomforts involving respiratory system (n = 34), gastrointestinal system (n = 16), and derma and mucosa (n = 17). Opportunistic infections (OIs) such as pneumocystis jiroveci pneumonia (PCP) (n = 27), oropharyngeal candidiasis (n = 16), tuberculosis (n = 15) , and cytomegalovirus (CMV) infection (n = 9) were also observed in patients whose CD4 + T cell counts were less than 200/mm3. Most CMV infection and cryptococcal meningitis occurred in patients whose CD4 + T cell counts were less than 100/mm3. CD4 + T cell count was negatively correlated with plasma viral load (r = -0.420, P = 0.001). CONCLUSIONS: Fever, dyspnea, and weight loss are the most common symptoms in the patients of this study. The respiratory system, gastrointestinal system, derma and mucosa are the most commonly affected areas by OIs, and PCP is the most common OI. The occurrence of OIs corelates with CD4 + T cell count.