Objective To study the ExacTrac X-ray image guide system for patients with head and neck cancer.Methods Ten patients were chosen foe this study.It was immoblized using the head mask and frame fixtures.The two KV X-ray units were matched with the digitally reconstructed radiographs after positioning with the infrared markers.Then the setup errors on x (horizontal axis),y (vertical axis) and z (up-down) directions and rotation errors were obtained.Paired t-test between any two direction difference errors.Results The setup errors with ExacTrac X-ray image guide system for the patients in x,y,z directions and rotation errors were (0.57 ± 0.24) mm,(0.68 ± 0.19) mm,(1.54 ± 0.29) mm,(0.54 ±0.13) °,(0.60 ± 0.23) °,(0.51 ± 0.15) °.The z-axis direction have slightly larger error (P =0.02,0.01).The others have not statistical significance (P =0.06,0.10-0.41).Conclusions To use ExacTrac X-ray image guide system cooperating with the six degree of freedom treatment couch in image guided radiotherapy for is feasible,the motion errors ＜ 2 mm,the rotation errors ＜ 2°.Reduced of the setup errors with replace the sphere or to reduce pollution of the sphere,improve the accuracy,it could provide a better quality assurance in radiation therapy.

Objective To compare the ExacTrac X-ray and CBCT image guide system for the head and neck cancer patients in radiotherapy. Methods Twenty head and neck cancer patients were randomly chosen and divided two Group. In group A ( 10 patients) ,the cross X-ray radiation photos were matched with the DRR after positioning with the infrared markers. Obtain the setup errors on three directions and rotation errors. Then adjustment of error with 6D treatment bed,record time set-up and registration. In group B ( 10 patients) ,the CBCTimages were matched with reference CT data after manual positioning. Obtain the setup errors on three directions and around the vertical axis direction errors. Then adjustment of error,record the time of set-up and registration. Groups were compared using the paired t-test. Results For group A and B group,the translation errors were (0.59±0. 25) mm,(0.62±0. 25) mm,(1.56±0. 28) mm,and (0.52± 0. 31) mm,(0.74±0. 17) mm,(1.58±0. 34) mm on horizontal,vertical,up-down directions,respectively (P=0.43,0.21,0.90).For group A,the rotation errors were (0.54±0.17)°,(0.72±0.27)°,(0.44± 0. 22)°,respectively;with (1.26±0. 33)°on vertical directions on B group (P=0. 01).The time of set-up registration on group A was significantly less than group B ( 108. 0 s vs . 165. 8 s , P= 0. 00 ) . Conclusions For the head and neck cancer patients in raditherapy,the image guide systems is feasible. The rotation errors of ExacTrac X-ray slightly less than CBCT.The time of set-up and registration of ExacTrac X-ray significantly less than CBCT,but the image resolution of ExacTrac X-ray inferior for CBCT.

The pathogenesis of nonalcoholic fatty liver disease (NAFLD) remains unclear. Many studies have shown that Toll-like receptors are involved in the development and progression of NAFLD, especially nonalcoholic steatohepatitis. This article reviews the role of Toll-like receptors in the pathogenesis of NAFLD from three aspects: interactions between Toll-like receptors and inflammatory factors, interactions between Toll-like receptors and free fatty acids, and Toll-like receptor gene polymorphism.

OBJECTIVETo evaluate the therapeutic effects and influencing factors of common antiviral therapy (low-dose interferon plus ribavirin, IFN+RBV) in patients with hepatitis C virus (HCV)-decompensated cirrhosis following splenectomy.

METHODSTwelve patients were treated post-surgery with low-dose IFN (300-500 MIU QOD) or pegylated (Peg)-IFN (50 mug/w) and RBV (0.6-0.9 g/d) for 72 weeks if carrying the lb genotype or 48 weeks if carrying the 2a genotype. All patients were followed-up for 24 weeks after treatment completion to determine the virological response (VR) rates, measured as rapid (R)VR, complete early (cE)VR, 24 hr (24)VR, and sustained (S)VR. Statistical comparisons were made using the t-test or rank sum test, and correlation analyses were made using the Chi-square test. Differences were considered significant at P less than 0.05.

RESULTSAll 12 patients completed the treatment course and follow-up. Three patients could not tolerate the Peg-IFN and were switched to IFN, and six patients developed hemolysis that required RBV dose adjustment. The VR rates were: 25.0%, RVR; 50.0%, cEVR; 16.7%, 24VR; 86.0%, SVR. Only one patient was a non-responder, and only one relapsed. Of the patients who achieved SVR, 100% had shown RVR, 83.3% showed cEVR, and 50.0% showed 24VR, suggesting that RVR and cEVR may effectively predict SVR.

CONCLUSIONSome HCV-decompensated cirrhosis patients may benefit from antiviral therapy following surgical resolution of hypersplenism. The occurrence of RVR and cEVR in these patients is positively correlated with achieving SVR. Physician-patient communication during early antiviral treatment and close clinical monitoring accompanied by psychological counseling throughout promotes success of the treatment approach.

Antiviral Agents ; therapeutic use ; Female ; Hepatitis C, Chronic ; complications ; drug therapy ; Humans ; Interferons ; therapeutic use ; Liver Cirrhosis ; drug therapy ; etiology ; Male ; Middle Aged ; Postoperative Period ; Ribavirin ; therapeutic use ; Splenectomy ; Treatment Outcome

OBJECTIVESTo study the relationship between liver pathology and clinical characters of chronic HBV carriers.

METHODSAnalyze the age, sex, grade of liver inflammation and stage of liver fibrosis among patients with chronic HBV carriers (n = 58) and non-active HBsAg carriers (n = 32), and compare the grade of liver inflammation and stage of liver fibrosis in different groups according to age, ALT levels and with/without HBeAg. The data was processed by using t test or Chi-square test for statistical analysis, respectively.

RESULTS(1) No differences existed in gender composition ratio between chronic HBV carriers and non-active HBsAg carriers. However, the ages of non-active HBsAg carriers group (35.2+/-7.6) were much older than that of the HBV carriers group (24.7+/-4.8) (t = 2.576, P = 0.017). (2) The stage of liver fibrosis in non-active HBsAg carriers group was more aggravated than that of the chronic HBV carriers group (Chi-square = 23.231, P less than 0.01), whereas no significant differences existed between these 2 groups (Chi-square = 0.058, P = 0.972). (3) As to the grade of liver inflammation and the stage of liver fibrosis, significant differences existed between the groups with higher level of serum ALT (20-40 U/L) and lower level ( is less than or equal to 20 U/L) (Chi-square = 7.827, P = 0.008; Chi-square = 14.303, P = 0.001), and similar results also existed between elder group (more than 40) and younger group (is less than or equal to 40) (Chi-square = 10.949, P = 0.001; Chi-square = 21.271, P less than 0.01); (4) Among the chronic HBV carriers, significant differences existed in grade of liver inflammation between groups with HBeAg positive and negative patients (Chi-square = 10.275, P = 0.002), and the latter was more aggravated; however, there was no difference in stage of liver fibrosis between them (Chi-square test = 3.457, P = 0.178).

CONCLUSIONLiver histopathology can be recommended to guide the clinical diagnosis and treatment, especially for the chronic HBV carriers, with elder age, ALT close to normal and HBeAg negative.

Adolescent ; Adult ; Age Factors ; Biopsy ; Carrier State ; pathology ; Female ; Hepatitis B e Antigens ; blood ; Hepatitis B virus ; Hepatitis B, Chronic ; pathology ; virology ; Humans ; Liver ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

A massive depletion of CD4+ T lymphocytes has been described in early and acute human immunodeficiency virus (HIV) infection, leading to an imbalance between the human microbiome and immune responses. In recent years, a growing interest in the alterations in gut microbiota in HIV infection has led to many studies; however, only few studies have been conducted to explore the importance of oral microbiome in HIV-infected individuals. Evidence has indicated the dysbiosis of oral microbiota in people living with HIV (PLWH). Potential mechanisms might be related to the immunodeficiency in the oral cavity of HIV-infected individuals, including changes in secretory components such as reduced levels of enzymes and proteins in saliva and altered cellular components involved in the reduction and dysfunction of innate and adaptive immune cells. As a result, disrupted oral immunity in HIV-infected individuals leads to an imbalance between the oral microbiome and local immune responses, which may contribute to the development of HIV-related diseases and HIV-associated non-acquired immunodeficiency syndrome comorbidities. Although the introduction of antiretroviral therapy (ART) has led to a significant decrease in occurrence of the opportunistic oral infections in HIV-infected individuals, the dysbiosis in oral microbiome persists. Furthermore, several studies with the aim to investigate the ability of probiotics to regulate the dysbiosis of oral microbiota in HIV-infected individuals are ongoing. However, the effects of ART and probiotics on oral microbiome in HIV-infected individuals remain unclear. In this article, we review the composition of the oral microbiome in healthy and HIV-infected individuals and the possible effect of oral microbiome on HIV-associated oral diseases. We also discuss how ART and probiotics influence the oral microbiome in HIV infection. We believe that a deeper understanding of composition and function of the oral microbiome is critical for the development of effective preventive and therapeutic strategies for HIV infection.
Dysbiosis ; Gastrointestinal Microbiome ; HIV Infections/drug therapy* ; Humans ; Microbiota ; Mouth

OBJECTIVETo investigate the effects of pegylated interferon a-2a (Peg-INFa-2a) treatment on expression of CD8 and CD38 surface molecules on lymphocytes from peripheral blood of inactive hepatitis B surface antigen (HBsAg) carriers.

METHODSForty-four patients with hepatitis B virus (HBV) chronic infection (CHB) received a 48-week course of Peg-INFa-2a treatment, with 30 administered 135 mug/week and 14 administered 180 mug/week. Every 12 weeks of treatment, the subjects were assessed for HBsAg titer, presence of anti-hepatitis B e (HBe) antibody, serum alanine amino transaminase (ALT) levels, and lymphocyte surface expression of CD8 and CD38 molecules. Patients were classified as responders and non-responders according to standard parameters. Dynamic differences between the two groups over time were assessed by multivariate repeated measures ANOVA with Greenhouse-Geisser correction and differences at single time points were assessed by univariate ANOVA. Linear regression analysis was performed to evaluate the relationship of two variables.

RESULTSThe responders showed a significantly higher increase in ALT at week 12 (60.75+/-24.95 U/L vs. non-responders: 37.03+/-18.45 U/L; t = 2.905, P less than 0.01) and significantly higher proportion of CD8+CD38+ cells at week 24 (71.20+/-11.70% vs. non-responders: 56.79+/-7.72%; F = 23.941, P less than 0.01). The decline in level of HBsAg at week 24 was positively correlated with the increase in ALT level at week 12 (r = 0.386, P less than 0.01) and with expression levels of CD8 and CD38 molecules on lymphocytes at week 24 (r = 0.397, P less than 0.01).

CONCLUSIONLower baseline levels of HBsAg correlated to better Peg-INFa-2a-related HBsAg clearance. Increased expression of CD8 and CD38 on lymphocytes is suggestive of intensive cellular immunity in CHB patients and may be related to HBV-induced hepatocyte damage and may promote the HBsAg clearance.

ADP-ribosyl Cyclase 1 ; metabolism ; Adult ; Aged ; Antiviral Agents ; administration & dosage ; therapeutic use ; CD8-Positive T-Lymphocytes ; Carrier State ; Hepatitis B Surface Antigens ; blood ; Hepatitis B, Chronic ; blood ; drug therapy ; Humans ; Interferon-alpha ; administration & dosage ; therapeutic use ; Middle Aged ; Polyethylene Glycols ; administration & dosage ; therapeutic use ; Recombinant Proteins ; administration & dosage ; therapeutic use ; T-Lymphocyte Subsets

OBJECTIVETo observe the clinical efficacy of combination therapy with peg-IFNalpha and adefovir (CPIA) in women who were hepatfis B virus (HBV) carriers and had just given birth and received telbivudine (LdT) during pregnancy for prevention of mother-to-child transmission.

METHODSOne-hundred-and-fifty third trimester-pregnant women who were HBV carriers with highly-viremic were treated with LdT until time of birth. After delivery, those women with alanine aminotransferase (ALT) level exceeding two times the upper limit of normal and HBV DNA level that had decreased more than 31 gIU/mL or hepatitis B e antigen (HBeAg) titer that had decreased more than 50% were switched to CPIA for 96 weeks.

RESULTSFollowing delivery, 45 of the women were switched to the CPIA treatment, of which 91.1% (41/45) achieved virological response, 55.6% (25/45) achieved HBeAg clearance or seroconversion, and 26.7% (12/45) achieved hepatitis B surface antigen (HBsAg) clearance or seroconversion.The immediate post-delivery (and pre-CPIA) levels of HBeAg and HBV DNA were negatively associated with HBeAg clearance. Ninety-eight of the total study participants stopped the LdT treatment and there were no cases of significant deterioration of liver function.

CONCLUSIONPregnant women who are HBV carriers and receive LdT for protection against mother-to-child transmission, and who show significant ALT elevation and decreased HBeAg titer and/or reduced HBV DNA after delivery, may be good candidates for the CPIA therapy following delivery.

Adenine ; analogs & derivatives ; therapeutic use ; Alanine Transaminase ; blood ; Antiviral Agents ; therapeutic use ; Carrier State ; virology ; DNA, Viral ; blood ; Drug Therapy, Combination ; Female ; Hepatitis B Surface Antigens ; blood ; Hepatitis B e Antigens ; blood ; Hepatitis B, Chronic ; drug therapy ; Humans ; Infectious Disease Transmission, Vertical ; prevention & control ; Interferon-alpha ; therapeutic use ; Organophosphonates ; therapeutic use ; Polyethylene Glycols ; therapeutic use ; Pregnancy ; Pregnancy Complications, Infectious ; drug therapy ; virology ; Pregnancy Trimester, Third ; Recombinant Proteins ; therapeutic use ; Thymidine ; analogs & derivatives ; therapeutic use

OBJECTIVETo investigate the effect of proliferation and differentiation of CD8 T cells on the progression in patients co-infected with HIV and HCV.

METHODSTo address this issue, the presences of CD57 and CD28 in the surface of CD8+ T-cell were monitored using flow cytometry in 20 patients co-infected with HIV and HCV and 20 patients infected with HCV alone. The proliferation and differentiations of CD8+ T cell were compared hetween patients co-infected with HIV and HCV and ones with HCV infection alone, to clarify the association hetween the function of CU and the progression of disease.

RESULTSA high presence (28.84 +/- 4.49)% of CD57 in the surface of CD8+ T-cell in the patients with HIV/HCV co-infections was found, comparing with a low presence (8.24% +/- 5.05%) of CU57 in the patients with HCV infection alone, the difference hetween these two groups is significant (P < 0.001). Moreover, A clear linear regression hetween the percentage of CD57CD8t T and HCV viral load (log) was identified (P = 0.023, R2 = 0.21). In addition, the differentiations of CD8 T cells were compared between patients with HIV/HCV co-infection and mono-HCV infection: the dominant cells in patients with mono-HCV infection were ones in intermediate stage, while, a late differentiation process of CU8 T cells might he associated with HIV/HCV co-infection.

CONCLUSIONThe differences of proliferation and differentiation of CTL. are significant, between HIV/HCV co- infection and mono-HCV infection. Lower proliferation and late stage of differentiations of CD8 T cell might affect the clearance of hepatitis C virus, weaken CU immunological response and induce chronic inflammation, finally will accelerate the progression of HCV infection.

Adult ; CD8-Positive T-Lymphocytes ; cytology ; immunology ; Cell Differentiation ; Cell Proliferation ; Cells, Cultured ; Disease Progression ; Female ; HIV Infections ; complications ; immunology ; pathology ; physiopathology ; HIV-1 ; immunology ; physiology ; Hepacivirus ; immunology ; physiology ; Hepatitis C ; complications ; immunology ; pathology ; physiopathology ; Humans ; Male ; Middle Aged ; T-Lymphocytes ; immunology ; Young Adult

Objective: To analyze the therapeutic effect on HBeAg-negative chronic hepatitis B patients treated with Peg-IFNα-2a combined with NAs to obtain the influencing factors for predicting HBsAg clearance. Methods: A retrospective study was conducted to investigate the effect of pegylated interferon alpha-2a combined with nucleoside analogues (lamivudine/adefovir dipivoxil) on HBeAg-negative chronic hepatitis B. The treatment course was 96 weeks. Patients were followed up 120 weeks after the treatment. HBsAg clearance at 120 weeks was taken as the objective of the study. Logistic regression and receiver operating characteristic curve analysis screened the related factors affecting HBsAg clearance. χ ² test was used to compare count data. Results: 111 patients were treated with pegylated interferon alpha-2a combined with nucleoside analogues, and 107 patients completed the scheduled course of treatment and follow-up. HBsAg clearance rate at120 week was 29.0% (31/107). The influencing factors for analysis were: (1) gender had no effect on HBsAg clearance rate; age and baseline levels of HBV DNA and alanine aminotransferase had no significant effect on HBsAg clearance; low baseline level of HBsAg (< 3.023 lgIU/ml) was beneficial to HBsAg clearance. The area under the working characteristic curve of the subjects was 0.746, the positive predictive value was 44.4%, and the negative predictive value was 86.8%. (2) HBsAg quantification or decline in 24 weeks and 48 weeks of treatment had a good predictive effect on HBsAg clearance, and the 48 weeks predicted value was higher than 24 weeks. When the HBsAg quantification was≤2.070 lgIU/ml at 48 weeks, the area under the receiver operating characteristic curve was 0.931, the positive predictive value was 52.8%, and the negative predictive value was 94.4%. When HBsAg decreased from baseline to≥0.991 lgIU/ml, the area under the receiver operating characteristic curve was 0.888, the positive predictive value was 50.8%, and the negative predictive value was 97.9%. (3) The analysis of HBsAg subgroup levels at 48 weeks suggested that the "interval analysis" can forecast HBsAg clearance more exactly than "nodal analysis" .The final HBsAg clearance rate of 100 IU/ml < HBsAg≤1 000 IU/ml, 10 IU/ml < HBsAg≤100 IU/ml and HBsAg≤10 IU/ml groups reached 6.7%, 31.8% and 67.7%, respectively. (4) The ALT abnormal group in the course of treatment obtained a higher HBsAg clearance rate (48.0%, 12/25). Conclusion 96-weeks long-term treatment with pegylated interferon-alpha -alpha-2a combined with nucleoside analogues for HBeAg-negative chronic hepatitis B has a good predictive value for HBsAg clearance at baseline and during treatment. The "interval level" of HBsAg at 48-weeks is more accurate in predicting HBsAg clearance, suggesting that HBeAg-negative chronic hepatitis B patients with low HBsAg levels at 48-weeks are the advantageous populations with HBsAg clearance. These patients are worthy of prolonged treatment to pursue "clinical cure".