Acquired immune deficiency syndrome (AIDS), a great epidemic t hreatening disease, is caused by the human immunodeficiency virus (HIV), particu larly the strain known as HIV-1. Nevirapine, a novel non-nucleoside reverse tr anscriptase (RT) inhibitor combined with nucleoside analogue RT inhibitors or pr otease inhibitors, can be used in treatment of patients with HIV infection. AS a n agent used alone, nevirapine can prevent vertical transmission or HIV infectio n.

Objective To investigate the relation between serum level of fibroblast growth factor (FGF)-23 and left ventricular hypertrophy in non dialysis patients with chronic kidney disease (CKD). Methods One hundred and twenty-four non dialysis patients with CKD were selected. Among them 34 cases were CKD 1-2 stage (CKD 1-2 stage group), 50 cases were CKD 3-4 stage (CKD 3-4 stage group), and 40 cases were CKD 5 stage (CKD 5 stage group). Thirty-two subjects of healthy people were selected as control group. The serum FGF-23, urea nitrogen, creatinine, calcium, phosphorus, intact parathyroid hormone (iPTH) and hemoglobulin levels were measured. The cardiac structural parameters were assessed by Doppler echocardiography, which included left ventricular end-diastolic diameter (LVDd), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT) and left ventricular ejection fraction (LVEF). Left ventricular mass index (LVMI) was calculated by Devereux formula. The patients were diagnosed as left ventricular hypertrophy according to LVMI (male ≥ 125 g/m2, female ≥ 110 g/m2). The relation between FGF-23 and left ventricular hypertrophy was analyzed. Results Among the patients with CKD, left ventricular hypertrophy was in 46 cases (hypertrophy group), non left ventricular hypertrophy was in 78 cases (hypertrophy group), and the incidence of left ventricular hypertrophy in patients with CKD was 37.1% (46/124). The lgFGF- 23, lgiPTH and phosphorus levels in hypertrophy group were significantly higher than those in non hypertrophy group:1.69 ± 0.33 vs. 1.50 ± 0.27, 1.98 ± 0.45 vs. 1.74 ± 0.32 and (1.50 ± 0.59) mmol/L vs. (1.27 ± 0.39) mmol/L, the calcium, albumin, hemoglobulin and LVEF levels were significantly lower than those in non hypertrophy group:(2.06 ± 0.24) mmol/L vs. (2.17 ± 0.20) mmol/L, (35.76 ± 4.18) g/L vs. (39.74 ± 5.73) g/L, (96.65 ± 22.66) g/L vs. (117.15 ± 27.67) g/L and (59.62 ± 12.02)%vs. (67.76 ± 6.69)%, and there were statistical differences (P<0.01 or<0.05). There were no statistical differences in systolic blood pressure and diastolic blood pressure between hypertrophy group and non hypertrophy group (P>0.05). The incidences of left ventricular hypertrophy and LVMI in CKD 1-2 stage group, CKD 3-4 stage group and CKD 5 stage group were significantly higher than those in control group:11.8%(4/34), 36.0%(18/50) and 60.0% (24/40) vs. 3.1% (1/32), (91.18 ± 16.17), (111.25 ± 27.89) and (124.82 ± 24.80) g/m2 vs. (84.41 ± 13.77) g/m2, those indexes in CKD 3-4 stage group, CKD 5 stage group were significantly higher those in CKD 1-2 stage group, and those indexes in CKD 5 stage group were significantly higher than those in CKD 3-4 stage group, and there were statistical differences (P<0.01 or<0.05). The LVMI was positively correlated with lgFGF-23, lgiPTH and history of hypertension in CKD patients (r=0.297, 0.327 and 0.229; P = 0.019, 0.009 and 0.026). The LVMI had negative correlation with calcium, hemoglobulin and LVEF (r=-0.280,-0.432 and-0.432;P=0.028, 0.000 and 0.000). The LVMI had no correlation with phosphorus, systolic blood pressure, diastolic blood pressure, gender and age (P>0.05). Multiple linear regression analysis result showed that LVMI (Y) was negatively correlated with hemoglobulin (X1) and LVEF (X2), and the regression equation was Y = 255.201- 0.424 X1- 1.092 X2. Conclusions The incidence of left ventricular hypertrophy increases gradually with the decline of renal function in non dialysis patients with CKD. The serum level of FGF-23 is related to left ventricular hypertrophy and the degree of heart failure in non dialysis patients with CKD. Anemia and cardiac function state are closely related to left ventricular hypertrophy in non dialysis patients with CKD.

Objective To explore the reasons and clinical characteristics of gastrointestinal bleeding in maintenance hemodialysis patients.Methods Clinical data of 28 hemodialysis patients combined with gastrointestinal bleeding were retrospectively analyzed.The reasons and clinical characteristics of gastrointestinal bleeding were analyzed.Results The incidence rate of gastrointestinal bleeding in hemodialysis patients was 20.9%,hemorrhage of upper digestive tract in 23 cases (82.1%)and hemorrhage of lower digestive tract in 5 cases (17.9%).The reasons of hemorrhage of upper digestive tract were mucosal erosion bleeding of gastric esophagus duodenum in 15 cases (65.2%)and peptic ulcer in 8 cases (34.8%).The positive rate of helicobacter pylori infection was 66.7%(12 /18).In 10 cases (35.7%),gastrointestinal bleeding happened within three months after hemodialysis.Vascular access for hemodialysis were used by central venous catheterization in 13 cases (46.4%)and arteriovenous fistula in 15 cases (53.6%).The prognosis of gastrointestinal bleeding in hemodialysis patients were continuing hemodialysis in 23 cases (82.1%),turned to peritoneal dialysis in 2 cases (7.2%)and death in 3 cases (10.7%).Conclusion The major reason of gastrointestinal bleeding in hemodialysis patients is hemorrhage of upper digestive tract.Mucosal erosion bleeding of gastric esophagus duodenum is major in hemorrhage of upper digestive tract.The positive rate of helicobacter pylori infection is higher.More than 1 /3 gastrointestinal bleeding happens within three months after hemodialysis.The prognosis of the majority of patients is good by internal medicine combined therapies and no heparin hemodialysis.

ObjectiveTo observe the morphological changes of enteric nerve-interstitial cells of Cajal (ICC) network in rats with the bacterial peritonitis, and to investigate the main cause of gastrointestinal dysfunction and gastrointestinal failure with the bacterial peritonitis. Methods Sixty Wistar rats of both sexes were randomly divided into two groups. The model of the bacterial peritonitis was established.To record the frequency and amplitude of slow wave in myoelectricity of intestine in vivo to assess the function of the intestine motility. The proximal 10.0 cm segment of jejunum beginning 2 cm distal to the pylorus from each group was studied using c-Kit and vesicular acetylcholine transporter (VAChT)/ neuronal nitric oxide synthase (nNOS) immunohistochemical double-staining with whole-mount preparation technique and laser scanning confocal microscopy(CLSM). Results Compared the result of the bacterial peritonitis group with the normal group, it was found that the frequency and amplitude of slow wave in myoelectricity of intestine of the bacterial peritonitis group were slower and lower than the normal group, CLSM scanned ICC network showed that compared with the control group, the distributions and densities of ICC of intestine in the bacterial peritonitis group decreased significantly(P<0.01), the number of ICC synapse decreased, the cell junction between ICC and the ICC network was disrupted, and the fluorescence intension of cell decreased. CLSM scanned enteric nerve-ICC network indicated that compared with the control group, in the bacterial peritonitis group, the distributions and densities of cholinergic nerves (P<0.01)/ nitrergic nerves(P<0.01)and ICC(P<0.01)of intestine significantly decreased respectively, the cell junction between enteric nerve and enteric nerve -ICC network was disrupted, and the fluorescence intension of enteric nerve -ICC network decreased. The network of cholinergic/nitrergic nerve-ICC was disrupted. Conclusion The number of cholinergic nerves and nitrergic nerves were reduced, and the enteric nerve-ICC network was damaged in rats with bacterial peritonitis. Gastrointestinal motility dysfunction can be caused by the bacterial peritonitis.

Objective Observe the fine distribution and morphologic feature of the intramural lymphatics in rats' rectum and to provide the morphological evidence for studying the mechanism of lymphous metastasis of rectum carcinoma.Methods The intramural lymphatics of rectum in rats were studied by light and electron microscopy to obtain some data regarding their fine distribution.Results The intramural capillary lymphatics of rats' rectum were observed in deep lamina propria of tunica membrane and the dermal papilla layer of anal pectin. The intramural capillary lymphatics and lymphatics were both observed in tela submucosa, reticular layer, hypodermis and intermuscular and serosa. The capillary lymphatics in rectums' wall have the similar ultrastructure feature to normal ones. Three kinds of endothelial cells junctions are overlapping-junctions, embedding-junctions and end-to-end-type junctions. About 21% of cell-junctions are opening types. There are normal organelles and many vesicals in the endothelial of capillary lymphatics. Conclusion The distribution of lymphatics in every layer of dentate line upwards are similar to other digestive tubes'. The distribution of lymphatics in anal pecten of rats' rectum are similar to cutis. The results show that big molecule substance and tissue hydrolysate are transporting mainly by opening-junction of endothelial cells and the vesicle system.

Objective To investigate the impact of thyrotropic hormone (TSH) on recurrence rate of common bile duct stone (CBDS).Methods The clinical data of 268 cases of primary or recurrent CBDS undergoing surgery was analyzed.According to whether screening preoperative TSH level routinely,we assigned the patients into two groups,unchecked group with 171 cases and screened group with 97 cases.The postoperative recurrence rates in 36 months between two groups were compared.Results The recurrence rates of unchecked group and screened group were 3.5％,12.9％,16.9％ and 0.0％,5.2％,8.2％ respectively in 12-,24-,36-months,there was statistically significant difference between two groups (x2 =4.029,P ＜ 0.05).In unchecked group,patients ≥ 60 years had a significant higher recurrence rate than ＜ 60 years patients (x2 =6.485,P ＜ 0.05).In screened group,there was no statistically significant difference between ≥60 and ＜ 60 patients (x2 =0.142,P ＞ 0.05).In those 34 patients with a high TSH level in the screened group,normalizing the level from (6.23 ± 1.44) μIU/ml to (2.91 ±0.74) μIU/ml by oral intake of thyroid hormone postoperatively,led to the recurrence rates of 0％,5.9％,8.8％ in 12-,24-,36-months,which was not significantly different from those with normal TSH (x2 =0.022,P ＞ 0.05).And that,there was not statistically different between the young and elder patients in those 34 cases for the 12-,24-,36-month recurrence rates (x2 =0.086,P ＞ 0.05).Conclusions Some CBDS patients may be with high level of TSH.Normalizing TSH level may be conducive to a reduced postoperative recurrence rate of CBDS.

OBJECTIVE To survey the distribution of the pathogenic microorganisms in biles collected from cholelithiasis patients and their susceptibility to antibiotics,to guide the selection of reasonable antibiotics.METHODS Totally 546 bile samples were cultured and tested for antibiotics susceptibility.RESULTS Bacteria were cultured from 332 samples with a positive rate of 60.81%,the first three were Escherichia coli(32.96%),Enterococcus faecalis(12.74%),and Klebsiella pneumoniae(9.97%).The pathogenic microorganisms were more sensitive to the third and fourth generation cephalosporins,antibiotic/?lactamase inhibitor combination,carbopenems and aminoglycosides antibiotics,while less sensitive to the first and second generation cephalosporins,penicillins,macrolide antibiotics and fluoroquinolones.CONCLUSIONS The pathogenic microorganisms in bile are very various,E.coli,E.faecalis and K.pneumoniae are usually cultured,fungous and anaerobic infections cannot be ignored.Doctors should pay more attention to analyze the bacterial resistance profile and use the antibiotics properly.

Objective To explore the association between circulating endothelial cells (CECs)and atherosclerosis in maintenance hemodialysis(MHD)patients. Methods A crosssectional study was performed to investigate the association between CECs and carotid atherosclerotic change in 65 MHD patients,25 non-hemodialysis patients with chronic kidney disease(CKD)of stage 4 or 5(CKD-non-HD)and 24 age-and Sex-matched healthy controls. CECs in peripheral blood were determined by multiparametrie flow cytometry(FCM).CECs were labeled with CD3-PerCP and CD146-PE before FCM and identified as CD3dim,CD146bright.Atherosclerosis in both groups Was assessed by the measurement of common carotid arery intimamedia thickness (CCA-IMT)and plaque of the common carotid arteries with ultrasound scanner. Results CECs were significantly higher in pre-dialysis patients[(151.52±98.24) cell/ml]and CKD-non-HD patients[(183.00±81.38)cell/ml ] compared with control group[(106.50± 24.14)cell/ml](P<0.05 and P<0.01,respectively).But the number of CECs was not significantly different between MHD and CKD-non-HD patients.CCA-IMT was also significantly higher in MHD patients[(0.94±0.36)mm]and CKD-non-HD patients [(1.02±0.37)mml compared with control group[(0.75±0.15)mm](P<0.05 and P<0.01,respectively).The number of pre-dialysis CECs was positively correlated with CCA-IMT in MHD patients(r=0.328,P<0.01).Multivariate analysis showed that CEC level was a strong independent risk factor of CCA-IMT. Conclusion InMHD patients, CEC level is associated with carotid atherosclerosis and may be used as a marker to evaluate the endothelial damage.

Objective To investigate the relationship between the incidence and grade of diabetic nephropathy (DN) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus. Methods A total of 154 patients with type 2 diabetes mellitus (80 males and 74 females) were investigated, ocular fundus were examined after mydriasis, at the same day, blood urea nitrogen, creatinine, glycosylated hemoglobin, blood fat, serum albumin were determined, the microalbuminuria and the glomerular filtration rate were performed. Results The incidences of DR with each stage were significantly different according to different DN stages. Univariate analyses revealed that the disorder of DR was positively correlated with the duration of diabetes, microalbuminuria, blood cholesterol (P<0.01 or <0.05), and negatively correlated with the glomerular filtration rate (P<0.01). Conclusion The incidence OFDN and DR has the highly concordance, and their lesions have some parallel relationship.

ObjectiveTo evaluate the modified Barcelona Clinic Liver Cancer (BCLC) staging system for predictability of intrahepatic recurrence for patients with hepatocellular carcinoma (HCC) following curative hepatectomy.MethodsA retrospective study was conducted on 197 consecutive patients with HCC who underwent curative hepatectomy in our department from Jan.2008 to Jan.2011.Univariate and multivariate analyses using Cox proportional hazard model were used to evaluate possible association between clinicopathologic factors and early postoperative intrahepatic recurrence (ER).Receiver operating characteristics (ROC) analysis with calculation of the area under the curve (AUC),sensitivity,and specificity were applied to define the cutoff point values for possible meaningful continuous variables where appropriate.A comparison between the differences in AUC was used to assess BCLC and a modified BCLC (M-BCLC) staging system for their predictive ability of ER.Risk stratification according to calculated M-BCLC was applied to find differences of ER at various time points after curative hepatectomy.ResultsDuring follow-up,111 patients developed ER.The 6-,9-,12-,18- and 24-month cumulative recurrent rates were 26.9％ (53/197),37.6％ (74/197),45.2％(89/197),53.8％ (106/197) and 56.3％ (111/197),respectively.Multivariate analysis revealed thatthe severity of concomitant cirrhosis,elevated AFP≥185.6 μg/L and BCLC staging were risk factors of ER.A M-BCLC was proposed based on the results of multivariate analysis.The severity of cirrhosis and elevated AFP values were included in the BCLC staging.This M-BCLC exhibited better performance.It predicted at different time points of ER at postoperative 9,12,18 and 24 months to be significantly better with M-BCLC than BCLC using AUC drawn from ROC.No significant difference was found with ER prediction at 6 months.The M-BCLC also demonstrated a ER prediction with AUC of 0.710 (95％ CI,0.630-0.790) and achieved a sensitivity of 83.0％,a specificity of 51.9％as calculated from ROC with M-BCLC≥2.913.Further risk stratification according to the M-BCLC at various cutoff point values revealed the ER occurrence rates amongst the different risk groups to be significantly different when compared with the median ER time (17.9 mons,9.9 mons vs 5.7 mons,x2=25.770,P=0.000,Log-Rank test).ConclusionA modified BCLC staging system based on multivariate analysis improved the predictability of ER following curative hepatectomy for HCC.