Volume 89  ·   Issue 13  ·  2009

In the 28 years since the first case of AIDS was reported in the United States in 1981, human immunodeficiency virus (HIV) has spread rapidly all over the world, and AIDS has become a major infectious disease that threatens all mankind. Since the advent of highly effective combined antiretroviral therapy (HAART) in 1996, it has become the only effective treatment for AIDS at present [1]. The latest international research shows that the average life expectancy of HIV/AIDS patients can be prolonged by several decades under effective antiviral therapy. AIDS has become a chronic disease such as hypertension and diabetes which cannot be cured but can be controlled for a long time.

Objective To design the appropriate primers of gag gene for HIV-1 subtyping in molecular epidemiology survey based on the genetic characteristics derived from the main HIV-1 strains prevailing in China. Methods The gag genes of HIV-1 CRF07_BC, CRF08_BC, and subtype C, together with subtyping reference sequences, were obtained from HIV sequence database. Referring to the alignments and genetic characteristics of HIV-1 full gag sequences, new primers of gag gene for amplification and subtyping were designed. The target fragment was used to construct neighbor-joining phylogenetic tree and evaluate its reliability. The newly designed primers (GUX/GDX) were used to amplify the plasma samples to evaluate their efficiency. Results The phylogenetic tree of 306/c-gag fragments (positions 836-1507 of HIV-I strain HXB2) showed that CRFOT_BC and subtype C strains formed clusters with low bootstrap values (59% for CRFO7_BC and 70% for subtype C), and the phylogenetic tree could not distinguish the sequences of CRF07_BC, CRF08_BC, and subtype C very well. Whereas the sequences of CRF07＿BC, CRFO8_BC, and subtype C from GUX/GDX (positions 781-1861) were clustered separately with higher beotstrap values (99%, 99%, and 77% respectively). In practice, a very good amplification and sequencing efficiency with over 90% positive results on average were obtained with GUX/GDX. Five clusters of subtype B, C, CRF01_AE, CRF07＿BC, and CRF08_BC were formed with higher confidence (Bootstrap values all above 80%). The reliable phylogenetic tree could be constructed based on the fragments sequenced only with antisense primer (GDX). Conclusion Fragments obtained with GUX/GDX primers of gag gene can be used to reconstruct phylogenetic tree with high reliability to distinguish the HIV-1 swains circulating in China, especially for the major BC recombinant and subtype C swains, which provides a useful tool in HIV molecular epidemiologic research.

Objective To evaluate the impact of highly active antiretroviral therapy (HAART) on the haemorrhage status, joint function, and physical ability of the patients of hemophilia combined with acquired immunodeficiency syndrome (AIDS). Methods Thirty-nine hemophilia A/AIDS patients, all male, aged (40 ± 13), underwent HAART and followed up for 6 years from 2002 to 2008 to observe the yearly hospital visit time, bleeding time, transfusion times, amount of factor Ⅷ transfusion, Ⅷ: C level, physical ability, and joint function. Flow cytometry was used to count the CD4+ T cells, and Bdna assay was used to examine the HIV virus load. Results The average hospital visit time, bleeding time, transfusion time, and amount of factorⅧtransfusion, hemoglobin, while blood cell count, and platelet count before HAART were not significantly different from those after treatment (all P > 0. 05) ; only one case showed moderato decrease in Ⅷ:C level, and another one case showed slight decline in physical ability and joint function. The serum HIV RNA load decreased from (4.8 ± 1.0) log copies/ml before HA.ART to (2.4 ± 1. 0) log copies/ml (P < 0. 05) and the CD4+ T cell count raised from 183 ± 97/mm3 to 456 ± 157/mm3 (P <0.05) after HAART. Conclusion HAART has no obvious impact on the haemorrhage status, joint function, and physical ability in hemophilia A/AIDS patients, however, it is effective to inhibit HIV replication and raise CD4+ T cell number which indicates that HAART therapy is positive for immune recovery.

Objective To investigate the prevalence of glucose and lipid abnormalities in AIDS patients treated with highly active antiretroviral therapy (HAART) and difference thereof between the HIV-lipedystrophy (LD) and non-HIV-LD groups, and to compare the plasma levels of adiponectin (APN) and leptin (LEP) and their relationship to metabolic disturbance and fat redistribution in these 2 groups Methods Fifty-two HIV-infected patients were divided into HIV-LD group and non-HIV-LD group according to the patients' reports and doctors' evaluation. Body composition was assessed by whole body dual-energy X-ray absorptiometry Plasma samples were analyzed for cholesterol, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), insulin, APN, and LEP. The prevalence of dyslipidemia and hyperinsulinemia, the difference of adipocytokine levels, and the relationship of adiponectin, leptin with lipids, insulin as well as fat mass in different body regions were analyzed between the groups. Results The prevalence rates of hypercholesterolaemia, hypertriglyceridaemia, and low HDL-C level were 17.3%, 50, 0%, and 17.3% respectively. The rate of hyperinsulinemia and any kind of dyslipidemia were 25.0% and 59.6%. Compared with non- HIV-LD patients, HIV-LD patients had higher TG level, and lower HDL-C and APN levels. In the HIV-LD group, the APN level was correlated positively with limb/total body fat, but negatively with trunk/total body fat, and was an independent predictor of HDL-C and insulin level. However, LEP was positively correlated with the levels of total body fat, limb fat, and trunk fat in both groups. Conclusion The prevalence rates of dyslipidemia and insulin resistance are high in Chinese HIV/AIDS patients receiving HAART, especially in the HIV-LD group. The APN concentration in the HIV-LD patients is closely related to fat redistribution and independently predicts the levels of HDL-C and insulin. LEP can serve as a biomarker of total body fat mass.

Objective To investigate the long-term effects of androgen combined with low dose all-trans-retinoic acid on myelodysplastic syndrome (MDS). Methods Sixty-two MDS patients, 48 with RA, 2 of RAS, 9 with RA with excess of blasts (RAEB), 2 with RAEB-transformation (RAEB-t), and 1 with chronic myelogenous-monocytic leukemia (CMML) according to the FAB subtype standard, received stanazolol (6 mg/d) or danazol (600 mg/d) and low dose all-trans-retinoic acid (ATRA 10 mg/d). Three months later the treatment was discontinued on 22 patients that showed ineffective and 2 more patients withdrew from the treatment due to exacerbation. The remaining 36 patients were treated according to the original protocol, and the doses of these 2 drugs were reduced by half until the condition was exacerbated. Follow-up was conducted for 47 (34 -78) months. Results Mter 6 months of treatment, complete remission (CR) was seen in 1 patient, partial remission (PR) in 6 patients, and hematologic Improvement (HI)in 19 of the 60 patients evaluated with a response rate of 43.3% (26/60) in all patients, 50% (24/48) in RA/RAS group, and 16. 7% (2/12) in RAEB/RAEB-t/CMML group. There were not significant differences in cellularity, dysplastic hematopoiesis, and myeloblast before and after treatment among the RA/RAS patients. After 12 months of treatment, CR was seen in 1 patient, PR in 7, and HI in 9, with a response rate of 28.3 % (17/60) in all patients, 35.4% (17/48) in the RA/RAS group, and 0% (0/12) in the RAEB/RAEB-t/CMML group. Adverse effects were mild and did not require discontinuance of the therapy. The survival time of the 19 patients in the RA group that responded well to treatment was 54 months (41,66), significantly longer than that of the 20 patients without good outcomes [23 months (13,32) , x2= =4.72,P=0.025]. Conclusion Effective, economic, and safe, stanozolol or danazol with low-dose all-trans-retinoic acid improves the life quality and prolongs the survival time of the MDS patients who respond well.

Objective To investigate the plasma levels of nociceptin/orphanin FQ (OGQ) in patients with bipolar depression and bipolar mania and to analyze the relationship of plasma OFQ to bipolar disorders. Methods Peripheral blood samples were collected from 21 patients with bipolar Ⅱ depression (BD group), 26 patients with bipolar Ⅰ mania (BM group), and 31 health adults (control group). The concentrations of plasma OFQ were measured by radioimmunoassay (RIA). The psychological slams was examined by Hamilton Depression Scale (HAMD), Bech-Rafaelsen Mania Rating Scale (BRMS), and Montgomery and Asberg Depression Rating Scale (MADRS). Results The plasma OFQ level of the BD group was (20 ±4) ng/L, signifgcantly higher than that of the control group [(14 ±5) ng/L, t =5.28 ,P < 0. 01], and the OFQ level of the BM group was (11 ± 3) ng/L, significantly lower than that of the control group (t = -2.47 ,P <0.05). There were not significant differences in the plasma OFQ between the males and females in all groups (all P > 0.05). In the BD group the plasma OFQ level was significantly positively correlated with HAMD and MADRS scoreds (r=0. 607,P<0.01;r=0.541 ,P<0. 05). In the BM group the plasma OFQ level was significantly negatively correlated with the BRM score (r = - 0. 750, P < 0.01). Conclusion The changes of plasma OFQ level may play a role in the pathogenesis of bipolar disorder and indicate the severity of disease. Plasma OFQ may be a new biological parameter of bipolar disorder.

Objective To evaluate the application of a novel tapping mode, magnetic AC mode (MAC mode) of atomic force microscopy (AFM) in observation of the topography and mechanical properties of living chondrocytes. Methods Specimens of normal knee joint was obtained from 5 patients during amputation due to severe trauma of shank. Chondrocytes were isolated and cultured. Cell slides were prepared, underwent immunohistochemical staining, and observed under AFM by MAC mode. Force curve operation was performed at different regions, nuclear and eytoplsamic, to compare the topographic features. Results High-resolution images of the ultra-structure of cell surface were obtained under physiological condition with a resolution level to 30 nm. The cells presented a topical profile, I. E. , the protuberant nuclear region and relatively flatten cell body. The force curve showed much higher stress and adhesion in the cell body region than in the nuclear region. Conclusion MAC mode AFM is very useful in research of the ultra-structure and biomechanical properties of cells.

Objective. To investigate the clinical manifestations and imaging features of peripheral vestibular paroxysmia (PVP). Methods The clinical data, including magnetic resonance tomographic angiography (MRTA), of 7 PVP patients, 1 male and 2 females, aged 40- 72, were retrospectively analyzed. Results (1) All 7 patients had non-specific cechleovestibular symptoms, e.g. , recurrent vertigo and continuous dizziness. (2)The predominant symptom was transient vertigo or dizziness with the sudden change of head position. (3) MRTA showed cross of the cochleovestibular nerve (CNV) and blood vessel in all patients. (4) Carbamazepine and sibelium succeeded to relieve the symptoms. Conclusion Compression of the cranial nerve Ⅷ by crossing vessel thereon may be the mechanism of PVP which can beidentified and diagnosed clinically.

Objective To investigate the effects of multimodal analgesia on analgesia and sedation during emergence of general anesthesia for cleft lip and/or palate surgery pediatric patients. Methods Fifty-four pediatric patients with ASA Ⅰ and Ⅱ cleft lip and/or palate, aged 2 - 7, undergoing prosthesis were randomly allocated into 2 groups: control group (Group C, n = 28) inhaling nitrous oxide/oxygen (50%: 50%) and sevoflurane(5%) for general anesthesia, and multimodal group (Group M, n =26), injected intravenously with fentanyl and atracurium in addition to inhalation of nitrous oxide/oxygen (50%: 50%) and sevoflurane(5%). Ventilation was controlled with PCV modal to maintain end-tidal CO2 to 35 -45 mmHg. Local anesthesia at the surgical site was facilitated by the surgeon before the beginning of surgery. After intubation, rectal paracetamol was used for Group M (120 mg for 2 -4 year-olds and 325 mg for 5 -7 year-olds) and fentanyl 0. 5 μg/kg was injected for postoperative analgesia 10 rain before the end of surgery. An observer who was blinded to the protocol recorded the time from the discontinuation of sevoflurane and nitrous oxide to tracheal extubation, accessed the sedation and pain scale, recorded the time ready for discharge from post-anesthesia care unit (PACU) and the incidence of adverse effects. Results The time ready for discharge from PACU of Group M was (25 ± 4) min, significantly shorter than that of Group C [(32 ± 3) min ,t =7. 426 ,P <0. 01]. The analgesia satisfaction rate of Group M was 69.2% (18/ 26), significantly higher than that of Group C [25.0%, 7/28, P <0.05]. The severe pain rate of Group M was 7.7 %, ignificantly lower than that of Group C (35.7 %, F = 5. 333, P = 0.021). The agitation rate of Group M was 11.5%, significantly lower than that of Group C (39.3%, F = 4. 571, P = 0. 033) . Conclusion Multimodal analgesic regimen of infiltration of local anesthetic at surgical site and rectal paracetamol and intravenous fentanyl provides sufficient analgesia, minimizes the incidence of agitation after general anesthesia in cleft lip and/or palate surgery for children, increases the speed of referring patients in PACU, and ensures the safety of the postanaesthetic patients.

Objective To explore the clinical significance of detection of multiple human papillomavirus infection in cervical lesions detected by flow fluorescent hybridization technology with Luminex multi-analytic profiling (xMAP). Methods Cervical exfoliated cell specimens were collected from 301 randomly selected women accepting opportunistic screening for cervical lesions with the cytological results and hybrid capture 2 (HC-2) assay ≥atypical squamons cells of uncertain significance (ASC-US), 48 with the pathological diagnosis ≥ cervical intraepithelial neoplasia (CIN) 2 (case group) and 253 with normal histological result or only inflammation (control group), aged (34 ± 9) (21 - 59). The samples were tested with xMAP technology with blind method. The coincidence of the xMAP and HC-2 was assessed. The HPV genotype, multiple HPV infection rate, and their relationships to the patients' clinical-pathological features were analyzed. Results The rates of sensitivity, specificity, and accuracy of xMAP technology to detect ≥ GIN2 cervical lesions were 80.49%, 80. 00%, and 80. 07% respectively. The positive and negative predictive values were 47.06% and 96.30% respectively. The Kappa Index for agreement between xMAP technology and HC-2 was 0.56. The prevalence rate of high-risk HPV infection was 28.24% (85/301). The prevalence rate of multiple HPV infection was 11.30% (34/301), significantly lower than that of single type high-risk HPV infection (16.94%, P < 0. 05). The proportion of multiple HPV infection in total positive HPV results was 35.05% (34/97). The proportion of duplex and treble HPV infection were 29.90% (29/97) and 5.15% (5/97) respectively. The multiple HPV infection rate of the case group was 37.50% (18/48), significantly higher than that of the control group (6.32%, 16/253, P < 0. 01). The common duplex infection modes were 16 +51/58 (n =4), 51/58 +52/59 (n =4), 11 + 16 (n =3), and 11 +52/59 (n=3), 18 +52/59 (n =3). The common treble HPV infection modes were 11 + 16 + 52/59, 16 +18 +31, 16 +18 +52/59, 31 +33 +39, and 31 +33 +52/59 (all n = 1). HPV16, 52/59, 51/58, 18, 11, and 31 were the common types in multiple HPV infections. Conclusion Flow fluorescent hybridization technology is able to detect multiple HPV infection that is associated with cervical lesions and to identify the HPV genotypes.

Objective To summarize the post-operative complications of resection of hypothalamic hamartoma (HH) through transcallosal transseptal interforniceal approach. Methods Thirty-seven HH patients, 26 males and 11 females, aged 8.7 underwent resection of the tumor via the transcallosal transseptal interforniceal approach. The symptoms and blood electrolytes were observed. Results After operation blood electrolyte test showed that 8 cases were normal, 19 cases showed hyponatremia as prime abnormality, and 10 cases had hypernatremia primely. Among the 19 cases with hyponatremia transient apathy occurred in 2 cases, general epilepsy occurred in one patient, continuous minor epilepsy occurred in another one, 4 patients suffered minor epilepsy, 25 had fever the temperature of 3 of which were beyond 40 ℃, and 2 had transient diabetes insipidus and 1 had diabetes. Conclusion Resection of HH through the transcallosal transseptal interforniceal approach achieves significant improvement of gelastic seizures with fewer complications. The most common complication is disturbance of serum natrium, which, however, is mild and well managed.

Objective To evaluate the effect of preoperative embolization of the feeding vessels of carotid body tumor in the treatment thereof. Methods 33 patients with carotid body tumors not less than 3 cm in diameter were examined by color Doppler ultrasound. Polyvinyl alcohol particle 250 - 1000 μm indiameter were suspended in meglumine diatrizoate or Ultravist and then injected via microcatheter into the feeding vessels until detainment or reflux was seen. Operation was performed 1 day later on 23 patients and 4 days later on 10 patients. External carotid artery to internal carotid artery bypass was performed on 1 case, anastomosis of common carotid to internal carotid artery with auto-saphagenous vein interposition on 3 cases, and repair of internal carotid artery on 1 case. Results One-stage resection was completed on all tumors. One case suffered contralateral hemiplegia two times in the operative day, on the next day the cotralateral lower limb could move, but the patient could not speak clearly and his tongue was not in right position, after 3 months he was completely recovered and MRI illustrated cranial infarction. Conclusion An important adjunct in treating large carotid body tumor, preoperative embolization makes the surgical exploration proceed much smoother, blood loss become less , and morbidity lower.

Objective To explore the expression of the transcription factors LMO2 and LYL1 and the interaction between these 2 factors in myeloid leukemia cells and to analyze the significance thereof in leukemogenesis. Methods Samples of peripheral blood and bone marrow were collected form 51 AML patties, and 5 normal bone marrow donors to isolate mononuclear cells (MNCs) with high percentage of CD34 (+) cells. Western blotting (WB) was used to detect the protein expression of LMO2 and LYL1 in the cells. Human myeloid leukemia cells of the line K562 were cultured and transfected with pcDNA3-LMO2, plasmid containing LMO2, pcDNA3-LYL1, plasmid containing LYL1, or pcDNA-GFP, blankplasmid containing green fluorescent protein. RT-PCR was used to detect the mRNA expression of LMO2 and LYL1. Co-immunoprecipitation (co-IP) and WB were used to detect the binding protein of LMO2 and LYL1. Results The MNCs of 51.1% of the patients with acute myeloblastic leukemia (AML) without remission expressed higher levels of LMO2, the MNCs of 62.2% of the AML patients expressed higher levels of LYL1, and the MNCs of 31.1% of those expressed both. The K562 cells transfected with pcDNA3-LMO2 showed higher mRNA and protein expression levels of both LMO2 and LYL1, and the K562 cells transfected with pcDNA3-LYL1 showed higher mRNA and protein expression levels of both LYL1 and LMO2 too, as indicated by RT-PCR and WB, which suggested that the expression of LMO2 and the expression of LYL1 stimulated each other in the myeloid leukemia cells. Co-IP assay detected the presence of LMO2-LYL1 complex in those cells. Conclusion The abnormal expression and protein interaction of LMO2 and LYL1 may play a role in the abnormal proliferation and differentiation of myeloid hematopoietic cells.

Objective The fixation strength of the hamstring tendon graft on the tibial side is considered the weak point in anterior eruciate ligament (ACL) reconstruction. This work tested the hypotheses that some of these devices will resist graft slippage under loads better than others, and that some will have higher ultimate strength than others. Methods Fourteen flesh frozen human cadaver knees underwent fixation of the hamstring tendon harvested from the knee to be used as graft material to reconstruct the ACL and were divided into two equal groups based on the fixation methods: bioabsorbable interference screw group and Intrafix group. A MTS 858 MiniBionix Ⅱ testing machine was used to carry out tensile testing under an axial load parallel to the tibial tunnel with a velocity of 10 mm/min. Ultimate failure load, displacement of 100N, displacement of 4OON, stiffness and mode of failure were recorded respectively. Results The maximum load for the lntrafix fixation group was (719. 094 ± 160. 478) kg · m · s-2, significantly higher than that of the bioabsorbable interference screw fixation group [(476. 640 ± 64. 226) kg · m · s-2, P <0. 05]. The displacement levels of IOO kg · m · s-2 and 400 kg · m · s-2 for the Intratix fixation group was (1. 025 ±0. 326) mm and (4. 728 ± 1. 992) mm respectively, not significantly different from those of the bioabsorbable interference screw fixation [(1. 335 ±0. 539) mm and (7. 564±4. 307) mm respectively, t = 0. 2173, 0. 0944, both P > 0. 05], and the stiffness of the Intratix fixation group was (96. 770 ±36. 848) kg · m-1 · s-2 not significantly different from that of the bioabsorbable interference screw fixation group [(63. 976 ± 3 1. 003 kg · m-1· s-2), t = 0. 0967, P > 0. 05]. After randomized t-test of significance, the displacement levels of 100N and 400N of these 2 groups were not significantly different. Conclusion Both tibial site fixation with bioabsorbable interference screw and that with Intrafix in ACL reconstruction with 4-stranded hamstring tendon grafts can meet daily physiological demand. Tibial site fixation with Intrafix shows a higher failure load.

Objective To observe the change of Rho kinase activity in brain tissue in the high altitude condition and its relationship with blood brain barrier permiability and high altitude cerebral edema (HACE), and to explore the pathological mechanism of HACE. Methods 30 Wistar rats were divided randomly into 3 equal groups, high altitude (HA) group put in low pressure cabin mimicking high altitude of 7000 m for 24hr and then gradually exposed to higher pressure until the normal pressure, fasudil group undergoing intraperitoneal injection of fasudil hydrochloride 30 mg/kg, a Rho-associated coiled-coil-containing protein kinase (ROCK) inhibitor, and then treated as the HA group, and normal control group (HC group). Five rats from each were decapitated with their brains taken out. The ratio of dry brain weight and wet brain weight was calculated. Western blotting was used to detect the expression of ROCK. Another 5 rats from each groups underwent injection of sodium fluorescein into the caudal vein and then the rats were decapitated to examine the natrium (sodium) fluorescence index (NaFI) of the central brain slice so as to observe the blood brain barrier permeability. Results The ROCK activity in brain tissue, ratio of dry and wet brain weight and NaFI of the HA group were significantly higher than those of the HC group (all P < 0. 001), and ROCK activity in brain tissue, ratio of dry and wet brain weight and NaFI of the fasudil group were all significantly lower than those of the HA group (all P < 0. 001) and not significantly different from those of the HC group (all P > 0. 05). Conclusions ROCK in brain tissue is activated in high altitude condition, which may play a key role in the development of HACE.

The patient was a 34-year-old female accountant who was admitted to the hospital due to "soy sauce-colored urine, anuria, abnormal liver function and elevated serum creatinine for 10 days". The patient took "folk medicine" (black powder, name, dosage and ingredients unknown) due to sore throat 10 days ago, and felt nausea after 1 hour, and then vomited several times, which was the stomach contents.

At present, 25 antiretroviral drugs (ARVs) for the treatment of HIV-1 have been approved for marketing: 9 nucleoside reverse transcriptase inhibitors (NRTIs), 4 non-nucleoside reverse transcriptase inhibitors (NNRTIs), 9 protease inhibitors (PIs), 1 fusion inhibitor, 1 CCR5 inhibitor and 1 integrase inhibitor. The first CCR5 inhibitor and integrase inhibitor were approved in 2007. Some fusion inhibitors, CCR5 inhibitors and integrase inhibitors are collectively referred to as invasion inhibitors (EIs).