Volume 92  ·   Issue 17  ·  2012

highly active antiretroviral therapy (HAART), commonly known as "cocktail therapy", is the most effective treatment for HIV infection [1]. The latest international research shows that the average life span of HIV/AIDS patients can be prolonged by decades under effective antiviral therapy, and AIDS has become a chronic disease such as hypertension and diabetes that cannot be cured but can be controlled for a long time. Since China started free antiviral therapy in 2003, about 150,000 AIDS patients have received treatment. Because of the development of antiviral therapy, the mortality rate of AIDS patients in China has decreased significantly in recent years [2]. However, with the increase of the number of patients treated, the cost of antiviral therapy has become a serious social burden. According to statistics, 80% of the annual cost of more than 2 billion AIDS prevention and treatment in China is used for antiviral therapy, and it is increasing year by year. As we all know, China is still a developing country, and there are more than 100 million people living below the poverty line. Therefore, the author believes that in the future, the antiviral treatment in China should fully consider the national conditions, rely on the scheme composed of domestic drugs as much as possible to carry out the treatment, popularize and apply the optimal treatment scheme of domestic drugs, and not unrestricted use of imported drugs to treat patients.

Objective To evaluate the status of drug resistance among treat-naive HIV-1 infected men who have sex with men (MSM) in Shenzhen during the period of 2008-2010.Methods Plasma samples of 227 treatment-naive HIV-1 infected MSM were collected in Shenzhen.HIV-1 pol genes ( RT and PR) were amplified by nested-polymerase chain reaction (PCR) from RNA.Phylogenetic and drug resistance analyses were performed on the nucleotide sequence data.Results A total of 164 pol gene sequences were amplified.The prevalence of primary genotypic drug resistance was 14.6％.The overall prevalence of drug-resistant mutations was 22.6％,corresponding to 8.54％ for protease inhibitors ( PI )minor drug resistance mutation,1.22％ for nucleotide reverse transcriptase inhibitors (NRTI) drug resistance mutation and 13.41％ for non-nucleotide reverse transcriptase inhibitors (NNRTI) drug resistance mutation.The prevalence of drug-resistant mutations was 30.88％ for CRF01_AE strain and 19.23％ for B strain.Conclusion The prevalence of drug resistance is relatively moderate in the treat-naive HIV-1 infected MSM in Shenzhen.The prevalence of drug-resistant HIV-1 among MSM in Shenzhen should raise a high alert.

Objective To explore the human leukocyte antigen (HLA) -associated mutations in Gag protein of B′ clade (human immunodeficiency virus-1 ) HIV-1 infected Han Chinese people and evaluate the impact of HLA associated Gag mutations on the disease progression of HIV infection.Methods A total of 95 B′ clade HIV-1 infected Han Chinese cases were recruited.The gag sequences were amplified from viral RNA and sequenced directly.HLA- Ⅰ genotypes were detected with the assay of polymerase chain reaction-sequence specific primer (PCR-SSP). HLA-associated mutations were identified and the relationships between HLA-associated mutations and CD4 + T cell counts or plasma viral loads analyzed.Results Forty-seven kinds of mutations at 28 sites(15,18,26,30,34,46,62,67,81,84,90,102,118,121,122,125,146,147,173,176,252,357,374,376,437,470,471,478 ) of Gag protein were significantly associated with particular HLA class Ⅰ allelotypes ( P ＜ 0.05 ).Among which,9 sites (26,30,81,84,125,146,147,357,437) were located within 13 known cytotoxic T-lymphocyte (CTL) epitopes or flanking regions.The number of HLA-associated mutations was significantly associated with both CD4 T cell counts (r =-0.318,P =0.002) and viral loads ( r =0.360,P =0.003 ).Conclusion HLA-associated mutations may have a significant impact on HIV disease progression in B′ clade HIV-1 infected Han Chinese population.

Objective To evaluate the influence of highly active antiretroviral therapy (HAART) on bone mineral density (BMD) in HIV/AIDS patients and correlating clinical factors.Methods 149 HIV patients were divided into 3 groups:untreated group with 41 patients,HAART for 1 -2 years group with 60 patients,HAART over 5 years group with 48 patients; 20 healthy individuals included as a control group.BMD-T score and BMD-Z score were measured by dual-energy X-ray absorptiometry (DXA).Results BMD-Z score of right hip was significantly lower in HAART over 5 years group (0.16 ± 0.82) than untreated group (0.61 ± 1.09 ) ( P =0.039).BMD-Z score of right femoral neck was significantly lower in HAART over 5 years group ( -0.002 ±0.87) than untreated group(0.55 ± 1.08) ( P =0.012).BMD-Z score of HAART for 1 -2 years group was not significantly decreased.BMD-Z score of right hip and right femoral neck were correlated negatively with HAART duration.The incidence of osteopenia/osteoprosis in HAART for 1 -2 years group (31.7％) and HAART over 5 years group (31.3％) were significantly higher than untreated group ( 12.2％ ) ( P ＜ 0.05 ).Body weight was revealed as a risk factor of osteopenia/osteoporosis.Conclusion BMD of right hip and right femur neck were significantly lower in HAART over 5 years group.The incidence of osteopenia/osteoprosis were significantly higher in patients receiving HAART.BMD were correlated negatively with HAART duration.Patients in long-term HAART combined with risk factors such as old age or lower body weight should be checked by DXA regularly.

Objective To summarize the experience in anesthetic management for correction of Ebstein's anomaly.Methods A total of 79 patients with Ebstein's anomaly who underwent surgical repair in our hospital during the time from March 2004 to September 2010 were retrospectively summarized for their anesthetic management.Anesthesia was done for the patients undergoing correction of Ebstein's anomaly.The adults patients were premedicated with intramuscular morphine 0.2 mg/kg and diazepam 0.05 mg/kg.The children patients were premedicated with intramuscular ketamine 5 -8 mg/kg and atropine 0.05 -0.20 mg.General anesthesia was induced with midazolam 0.1 - 0.2 mg/kg,etomidate 0.2 - 0.3 mg/kg,sulfentanil 1.0 - 1.5 μg/kg,pipecuronium or vecuronium 0.1 - 0.2 mg/kg,and maintained with isoflurane inhalation and intermittent iv.midazolam and sulfentanil.Results Anesthetic course was smooth.The symptom in all cases was improved significantly after operation.No patients died during perioperative period.Conclusion The key points for the anesthetic management of Ebstein's anomaly include precise preoperative evaluation,steady hemodynamic,proper maintenance of suitable oulmonary vascular resistance and cardiac function.

Objective To study and compare the clinical efficacies and characteristics of VCu intrauterine device (IUD) and TCu380A IUD in childbearing-aged women with previous cesarean section so as to provide rationales for an informed choice of contraceptive methods.Methods According to their physical status,a total of 400 women undergoing previous cesarean section were randomly provided VCu IUD and TCu380A IUD from February 2008 to August 2009.These healthy women were had no contraindication to IUD.The volunteers required voluntarily the placement of IUD.Then all of them were followed up for 3,6 and 12 months.Results At Month 12,the pregnant rate with IUD in situ of VCu and TCu380A IUD were 1.02％ and 4.64％,expulsion rate 0 and 3.1％ and withdrawing rate 1.02％ and 4.13％ respectively.The pregnant rate was significantly different ( P ＜ 0.05 ) ; VCu showed a lower expulsion and withdrawing rate than that in TCu380A (P＜0.05) ; the continuation rate of VCu was higher than that of TCu380A ( P ＜ 0.05).Conclusion VCu offers a better efficacy of contraception with a lower expulsion and withdrawing rate,a higher continuation rate and a simpler placement method.

Objective To evaluate the therapeutic outcomes of freshly torn Achilles tendon by turning over aponeurosis of gastrocnemius and holding its rough surface to contact with sutured tendons.Methods Thirty-two patients with torn Achilles tendon received surgeries at our department.There were 20 males and 12 females with an age range of 22 -45 years.All patients were injured during movement.The surgical techniques involved applying medial straight incision of tendon about 5 cm,under the help of long tractors,turning over aponeurosis of gastrocnemius and holding its rough surface to contact with sutured tendons.All patients were motivated to accept early motion exercises after surgery.The follow-up was carried out during May 2007 to January 2010 with an average period of 18 months.Based upon the Arner Lindholm score,their therapeutic outcomes were evaluated.Results Incisions were healing well in all patients.All patients removed long plaster and changed into short plaster when they received operation for 3 weeks.After 6 weeks,plaster was removed and they began to exercise movement of ankle.At Week 8,their ankle functions were close to normal.At Week 12,they could jog.The final outcomes were as follows:excellent ( n =24),good ( n =6) and poor (n =2).The excellent ratewas over 93.75％.Conclusion Turning over aponeurosis of gastrocnemius and holding its rough surface to contact with sutured tendons is an excellent therapeutic method for freshly torn Achilles tendon so that the patients may be motivated to execute early motion exercises.Early motion exercise is essential for an earlier recovery of postoperative function.

Objective To retrospectively analyze the interactions between the clinical symptoms and surgical options and evaluate the surgical efficacies for adult degenerative scoliosis (DS).Methods A total of 35 adult DS patients underwent operations at Tianjin hospital from May 1996 to December 2008.There were 23 females and 12 males with a mean age of 59.1 years (range:45 -74).Clinical symptoms,physical examinations and radiological findings for all patients were recorded at different stages,at 1 week,3 months,6 months,1 year post-operation and per year respectively.According to different surgical options,they were classified into 3 groups:A:limited decompression; B:selective decompression & short-segment fusion; C:selective decompression & long-segment correction & fusion.Results All patients had complete records with a mean follow-up period of 42.4 months (range:24 -168).Firstly,9 patients in group A had no complaint of a low-back pain at pre-operation.The average coronal Cobb's angles were 15.6 ±2.3° at pre-operation and 17.1 ±3.3° at the latest follow-up.The radicular symptoms became greatly relieved at 1 year.Three cases complained of the aggravation of back pain.Secondly,15 patients in group B mainly complained of a low-back pain at pre-operation.It was combined with lower-limb radiation pain in 6 patients and nerve claudication in 9 cases.The average coronal Cobb's angles were 14.1 ±4.6° at pre-operation and 24.4 ± 6.7° at the latest follow-up.However,12 patients experienced the progression of scoliosis.Thirdly,11 patients in group C experienced a low-back pain at pre-operation while 5 cases with lower-limb radiation pain and 6 with claudication.The mean coronal Cobb's angles were 22.3 ±9.2° at pre-operation and 12.2 ±4.7° at the latest follow-up.Among 4 patients with residual pains,none required revision.Conclusions For the DS patients,it is quite important for the surgical options to comprehensively analyze the neurological signs,imaging data and clinical symptoms.However,the fusion end vertebrae should always avoid the vicinity or apex of curve if the short-segment fusion is selected.

Objective To explore the three-dimensional movement of atlantoaxial joint,complete transverse ligament and cracked transverse ligament after posterior atlantoaxial fixation.Methods The fresh upper cervical cadaveric specimens were collected from 6 males dead from active craniocerebral injury.The average age was 39.7 years old ( range:26 - 57 ).The specimens were divided into 3 groups of intact (Group Ⅰ),transverse ligament cracked (Group D) and posterior atlantoaxial fixation (Group F).They were tested consecutively.Results The range of sagittal movement increased when the transverse ligament became cracked.And it had significant difference compared with the Group Ⅰ ( P ＜0.05 ).But the ranges of lateral flexion and rotation showed no significant difference. When posterior atlantoaxial fixation was performed,all three-dimensional movements decreased.And significant differences existed as compared with Group Ⅰ (P ＜ 0.05 ).Conclusion Under normal conditions,the main movement of atlantoaxial joint is rotation with lesser sagittal movement and lest lateral flexion.The range of sagittal movement increases significantly when transverse ligament is cracked (P ＜0.05),especially so for anteflexion movement.The increase of lateral flexion and rotation has no significant difference compared with Group Ⅰ.When posterior atlantoaxial Fixation is performed,all three-dimensional movements decrease significantly as compared with Group Ⅰ ( P ＜ 0.05 ),especially loss of rotation function.

Objective To evaluate risk factors associated with emergence agitation (EA) in pediatrics after general anesthesia.Methods A prospective cohort study was conducted in 268 pediatric patients aged 2 -9 years,who received general anesthesia for various operative procedures in our hospital between January 2008 and October 2011.The incidence of EA was assessed.Difficult parental-separation behavior,pharmacologic and non-pharmacologic interventions,and adverse events were also recorded.Univariate and multivariate analysis were used to determine the factors associated with EA.A p-value of less than 0.05 was considered significant.Results One hundred and sixteen children (43.3％) had EA,with an average duration of 9.1 ± 6.6 minutes.EA associated with adverse events occurred in 35 agitated children (30.2％ ).From univariate analysis,factors associated with EA were difficult parental-separation behavior,preschool age (2 -5 years),and general anesthesia with sevoflurane.However,difficult parental-separation behavior,and preschool age were the only factors significantly associated with EA in the multiple Logistic regression analysis with OR =3.091 (95％ CI:1.688,5.465,P ＜ 0.01 ) and OR =1.965 (95％ CI:1.112,3.318,P =0.024),respectively.Conclusion The present study indicated that the incidence of EA was high in PACU.Preschool children and difficult parental-separation behavior were the predictive factors of emergence agitation.

Objective As a rare benign lung tumor,pulmonary sclerosing hemangioma (PSH)occurs predominantly in Asian women in their fifth and sixth decades of life.PSH is considered to be evolved from primitive undifferentiated respiratory epithelium.In this study,we summarized our experience in 89 cases of PSH.Method There were a total of 89 patients who received surgical resection and were histopathologically diagnosed as PSH during the period January 2001 to December 2010 in department of thoracic surgery,Cancer Institute and Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences. The clinical data of these patients including symptoms,disease courses,image characteristics and surgical procedures were collected and reviewed retrospectively.Results The PSHs were most frequently (50.6％ ) found in the patients aged 41 to 60 years with a median age of 51 years ( range:24 -71),and the sex ratio (male/female) was approximately 1:7 in this series.In the 89 patients,53 (59.6％ ) were asymptomatic while the other 36 (40.4％ ) had some non-special symptoms such as cough (30.3％ ),hemoptysis(24.7％ ).There were only 3 cases (3.4％ ) with multiple PSHs,4 cases (4.5％ )combined with synchronous primary lung cancer,and 13 cases ( 14.6％ ) with lesions located in the hilar region.The median diameter of the 92 lesions was 2.3 cm (range:0.3 -6.0 cm ),of which 38 ％ located in the right lower lobe and 26.1％ in the right middle lobe,and only about 1/3 were assumed as PSHs preoperatively based on CT imaging. One of the five patients who underwent PET-CT scan had been misdiagnosed as malignant.Of the 92 lesions,47 were resected by enucleation,29 by wedge resection,14 by lobectomy,and 2 by pneumonectomy.Conclusion PSH frequently occurs in the middle-aged women.Most individuals with PSH are asymptomatic or have some non-specific symptoms.Their lesions are usually found accidentally by chest imaging.Although PSH often shows typical imaging characteristics of benign neoplasm of the lung,it is difficult to establish a defined pathological diagnosis preoperatively. The significant error or deferred rate of intraoperative frozen-section evaluation for PSH may result in some unnecessarily extensive surgical procedures.The complete surgical resection is considered the only effective treatment for PSH,and the normal pulmonary tissue should be reserved as possible.

Objective To assess the significance of intraluminal ultrasound in the diagnosis of developmental status and treatment effect in normal and idiopathic precocious puberty (ICPP) girls.Methods Endorectal ultrasonography was used to measure the parameters of uterine length,width,thickness,cervix length,ovarian volume and maximum follicular length in normal girls and compare their differences between pre- and post-treatment by gonadotropin-releasing hormone analogues (GnRHa) in idiopathic precocious puberty girls.Results The ultrasonic parameters of uterus and ovary in normal girls significantly increased in average 9-year-old girls( 1.87 ±0.58) ml of uterine volume in 9-year-old group vs (1.03 ±0.24) ml in 7-year-old group; ovarian volume( 3.01 ±2.73) ml of uterine volume in 9-year-old group vs 0.98 ± 0.36 ml in 7-year-old group. They were much greater in ICPP girls and decreased significantly at post-treatment,( 1.16 ± 0.19 )ml of uterus volume pre-treatment vs ( 1.02 ± 0.15 )ml post-treatment; (2.11 ± 0.48) ml of ovarian volume pre-treatment,( 1.72 ± 0.55 ) ml post-treatment; ( 1.36 ± 0.25)cm of the biggest follicular diameter pre-treatment,(1.16 ± 0.36) cm post-treatment.Conclusion Endosonography is an important tool of evaluating the development status and treatment effect in normal and ICPP girls.

Objective To examine the correlation between hypertension with hyperhomocysteinemia and prognosis of ischemic stroke.Methods A total of 634 patients with acute ischemic stroke confirmed by computed tomography or magnetic resonance imaging were recruited at Department of Neurology,First Affiliated Hospital,Zhengzhou University from January 1,2007 to May 30,2010.Their NIHSS ( National Institute of Health Stroke Scale ) scores were evaluated on admission. And their baseline profiles and probable prognostic factors were recorded.Recovery was assessed by modified Rankin score (MRS) during a 6-month follow-up.Multivariate Logistic regression was performed for statistical analysis.Results Among them,32 became lost to follow-up.There were 197 females ( 32.7％ ) and 405 males ( 67.3％ ) with an average age of (59 ±13) years (range:19 -92).The average level of homocysteine was (19 ±11) μmol/L.There were 343 (57％) patients with hypertension and MRS ≥3 was in 145 (31％) patients.Logistic regression analysis showed that significant correlations existed between H-type hypertension and 6-month MRS (P=0.012,OR =2.566,95％ CI:1.299 -5.357) when homocysteine ≥ 15 μ mol/L was defined for hyperhomocysteinemia. And there was a total sum of interaction between hypertension and hyperhomocysteinemia.The parameters of relative excess risk of interaction ( RERI),attributable proportion due to interaction (AP) and synergy index (S) were 0.683,26.61％ and 1.59 respectively.Other parameters with significant prognostic correlations included age,history of stroke,NIHSS score on admission and diastolic blood pressure on admission.Conclusion At the homocysteine level of ≥15 μmol/L,H-type hypertension and 6-month MRS have significant correlations.And H-type hypertension is a risk factor for the prognosis of ischemic stroke.When hypertension and hyperhomocysteinemia coexist,there is a total sum of interaction.

Objective To evaluate the application,effectiveness and safety of stenting in venous sinus stenosis for intractable pulsatile tinnitus via endovascular treatment.Methods From January 2010 to July 2011,12 cases with intractable pulsatile tinnitus originating from cerebral venous sinus stenosis underwent steuting treatment.All of them were diagnosed by digital subtraction angiography (DSA).There was ipsolateral stenosis in junction segment of sigmoid and transverse sinuses.The diverticulum of sigmoid sinus was found in 6 cases.Eleven patients underwent stenting placement and angioplasty for venous sinus stenosis.Results All pulsatile tinnitus symptoms disappeared immediately after stenting. No related complication was found during stenting and over a follow-up period of 3 - 22 months. There was no recurrence of pulsatile tinnitus.Conclusions Stent placement is a safe and effective procedure for pulsatile tinnitus with cerebral venous sinus stenosis.

Objective To explore the roles and mechanisms of E2F-1 and PAC1 in signaling apoptosis of Saos-2 cells under oxidative stress.Methods siRNAs were used to construct the cell clones of expressing siE2F-1 and siPAC1. E2F-1/PAC1-mediated induction of apoptotic cell death in response to H2O2 were examined by trypan blue exclusion and the expression levels of related target factors detected by Western blot.Results The cell viabilities of Saos-2/siE2F-1 and Saos-2/siPAC1 increased markedly comparing with the control cells after the treatment of H2O2. And the expression level of p-ERK1/2 was higher than that of the control cells.Conclusions The pathway of E2F-1/PAC1/MAPKase is a specific cascade for apoptotic signaling.

Objective To explore the expression of δ subunit-containing γ-aminobutyric acidA (GABA)A receptors in insular electrical kindled rats and analyze the significance of the findings.Methods A total of 48 male Sprague-Dawley rats were divided randomly into 3 groups:kindled,sham-operated and control. Kindled group:chronic insular electrical kindled models of rats established by electrical stimulation.Sham-operated group:the same method of the kindled group without electrical stimulation.Control group:without surgery.The number of hippocampal neurons of rat epilepsy,sham-operated and control groups were detected by Nissl staining.The hippocampal expressions of δ subunit of these groups were tested by immunohistochemistry.The mRNA of δ subunit of hippocampus of these groups was detected by quantitative-polymerase chain reaction (q-PCR).Results The findings of Nissl staining showed that there was no significant difference of the number of hippocampal neurons between epileptic and normal rats (P ＞0.05).The findings of q-PCR showed that mRNA of δ subunit of the hippocampus of sham-operated and control groups represented much more than that of kindled group at Day 7 post-kindling ( P ＜ 0.01 ).The findings of immunohistochemistry showed that the hippocampal expression of δ subunit of sham-operated and control groups represented much more than that of kindled group at Day 7 post-kindling ( P ＜ 0.01 ).Conclusion The hippocampal expression of δ subunit-containing GABAA receptors decreases in insular epilepsy.It may play an important role in the occurrence and development of insular epilepsy.

Neurological paraneoplastic syndrome (PNS) is caused by the remote effect of systemic or systemic malignant tumors in the central and peripheral nerves. Two cases admitted to our hospital are reported as follows. Case 1: A 65-year-old female was admitted to the hospital again because of "progressive numbness and fatigue of both lower limbs for half a year and slow response for one month". The patient developed intermittent numbness of both lower limbs without inducement six months ago, and the numbness was persistent four months ago, accompanied by limb weakness and neck pain. No abnormalities were found in local head CT and cervical MRI. Two months ago, she was admitted to the neurological department with "peripheral neuropathy". Physical examination showed mild intelligence loss, low tendon reflex of the limbs. Lumbar puncture pressure was normal, white blood cells were 5×106/L, cerebrospinal fluid glucose and chloride were normal, and protein was 919 mg/L. Cerebrospinal fluid anti-Hu antibody titer 1:10.MMSE score 17 points (primary school education). Electrophysiological examination showed extensive neurological damage. Chest X-ray, abdominal and urinary tract B-ultrasound showed no abnormalities. Sural nerve biopsy showed chronic axonal peripheral neuropathy. In the past month, walking was more unstable, response was more dull, accompanied by euphoria, giggle, memory loss to the point of not recognizing family members. Weight loss 5kg. No history of cough, expectoration and cardiopulmonary diseases.

A 4-month-old male was seen in June 2011 due to "scleral yellowing for 1 month". The child was pregnant and delivered 1, delivered naturally at full term, with a birth weight of 2.7 kg and a height of 51 cm. There was no abnormality in the skin test of bilirubin at 3 days after birth.The sclera was yellowed at the age of 3 months, the stool was pale, and the growth and development of the child was not significantly different from that of the same age.The parents of the child were not intimate marriage.The family history was denied.Physical examination:The child was clear, reacted well, "fat round face", mild yellowing of the skin and sclera of the whole body, no rash, pharyngeal congestion, coarse breathing sounds in both lungs, no dry and wet rales, heart rate 120 beats/min, strong heart sounds, regular rhythm, no murmur.The abdomen was soft, the liver was 2 cm under the costs, the spleen was not large, there was no mass in the abdomen, the intestinal sounds were normal, and the limb movement was acceptable.Laboratory examination:Blood biochemistry: alanine aminotransferase 43 U/L, aspartate aminotransferase 162 U/L, alkaline phosphatase 554 U/L, γ-glutamyltransferase 133 U/L, total bilirubin 116.6 μ mol/L, direct bilirubin 75.4 μ mol/L, indirect bilirubin 41.2 μ mol/L, total bile acid 345.7 μ mol/L, blood glucose 2.02 mmol/L. Blood ammonia: 52.7 μ mol/L. Ceruloplasmin 0.11g/L. Hepatitis B five items