Objective To investigate the effects of pretreatment with different inhalational anesthetic agents on myocardial Bcl-2, Bax and p53 gene expression during ischemia-reperfusion ( I/R) in rabbits. MethodsForty New Zealand white rabbits of both sexes were anesthetized with intramuscular ketamine 70 mg kg-1 tracheotomized and mechanically ventilated with 100% O2. PETCO2 was maintained at 4.0-4.5 kPa. Carotid artery and external jugular vein were cannulated for BP monitoring, fluid administration and medication. Anesthesia was maintained with midazolam 0.05-0.1 mg kg-1?h-1 , ketamine 2-5 mg? kg-1?h-1and vecuronium 0.05-0.1 mg? kg -1 ? h-1 . Myocardial ischemia was induced by occlusion of anterior descending branch of left coronary artery. Ischemia was confirmed by cyanosis of local myocardium and elevation of S-T segment. The animals were randomly allocated to one of five groups with 8 animals in each group : group C sham operation; group I/R; group I isoflurane pretreatment; group S sevoflurane pretreatment and group D desflurane pretreatment. In guoup C animals underwent no I/R. In group I/R animals were subjected to 3h of ischemia followed by 3 h reperfusion. In group I, S and D animals inhaled 1.1% isoflurane or 2% sevoflurane or 6% desflurane for 30 min followed by 15 min of wash-out before I/R. Intravenous anesthetic infusion was suspended while inhalational anesthetic was being inhaled. Myocardium 100 mg was obtained from marginal zone of ischemic area and made into cell suspension for determination of apoptosis index ( AI) and expression of Bcl-2, Bax and p53 genes, using flow cytometry.ResultsAI was (14)% in group I/R and was significantly reduced to (6.7 ? 1.8)% ( group Ⅰ ), (6.7 ? 1.6)% ( group S) and (7.4?2.0)% ( group D) (P

Objective To analyze the risk factors for healthcare-associated pneumonia (HAP) in patients with orthopedic injury,provide the basis for making prevention and control measures.Methods HAP occurred in patients with orthopedic injury and admitted to the department of orthopedics of a hospital from June 2011 to May 2015 were investigated retrospectively,risk factors were analyzed by univariate and multivariate logistic regression methods.Results A total of 2 578 patients with orthopedic injury were investigated,92 patients developed HAI,incidence of HAP was 3.57％.107 strains of pathogens were detected,the major were Klebsiella pneumoniae (n =22,20.56％),Escherichia coli (n =14,13.08％),and Acinetobacter baumannii (n =13,12.15％).Risk factors for HAP in patients with orthopedic injury were length of hospital stay≥15 days,smoking history≥3 years,bedridden ≥7 days,associated with underlying diseases,complications,indwelling catheter≥7 days,surgical operation,mechanical ventilation,admitted to intensive care unit,open injury,blood sugar≥11 mmol/L,plasma albumin＜30 g/ L,hemoglobin concentration＜90 g/L,and use of glucocorticoid≥4 days (all P＜0.05).Multivariate logistic regression analysis showed that smoking,bedridden,surgery,mechanical ventilation,glucocorticoid use,and anaemia were independent risk factors for HAP in patients with orthopedic injury.Conclusion The occurrence of HAP in patients with orthopedic injury is related with multiple factors,the major are surgical operation,mechanical ventilation,glucocorticoid use,long term smoking,bedridden,and anaemia.

Objective To investigate the effect of hepatitis C virus (HCV) genotype on antiviral therapy in patients with human immunodeficiency virus (HIV)/HCV coinfection in Henan province.Methods A total of 129 patients were coinfected with HIV and HCV, among whom, 70 were HCV 1b genotype and 57 HCV 2a genotype.And 131 patients were HIV single infection.Immunological failure rate, virological suppression, CD4+ T lymphocyte counts and liver and renal function after antiretroviral therapy (ART) were compared among the three groups.Flow cytometry was used to count CD4+ T lymphocytes and polymerase chain reaction amplification was used to detect HIV RNA.The liver and renal function were tested by automatic biochemical analysis.Statistical analysis was conducted by χ2 test, analysis of variance and LSD-t method.ResultsImmunological failure rate in HCV 1b group, HCV 2a group and HIV single infection group were 7.14% (5/70), 15.79% (9/57) and 9.92% (13/131), respectively.There was no significant statistical difference among the three groups (χ2=2.59, P>0.05).The CD4+ T lymphocyte counts in three groups were (614±258), (529±245), and (518±243) cells/μL, respectively.The difference was statistically significant (F=3.17, P<0.05).The virus inhibition rates of three groups were 87.0% (HCV 1b), 78.2% (HCV 2a), and 82.3% (HIV single infection).The HIV virus failure rates were 8.6% (HCV 1b), 14.5% (HCV 2a), and 13.1% (HIV single infection).There was no significant difference among three groups (χ2=1.967, P>0.05).The levels of aspartate transaminase, alanine aminotransferase and total bilirubin in HCV 1b group and HCV 2a group were all significantly higher than those in HIV single infection group (F=27.38, 15.22 and 7.33, respectively, all P<0.05), while there was no significant difference between HCV 1b and HCV 2a groups (t=1.27, 0.29 and 1.59, respectively, all P>0.05).Conclusions The main HCV genotypes in patients with HIV/HCV coinfection by blood transmission are HCV 1b and HCV 2a in Henan province.HIV/HCV coinfection does not affect the effect of ART, but could aggravate the liver damage in acquired immune deficiency syndrome patients.

Objective To analyze the distribution and antimicrobial resistance of pathogenic strains in wound infec-tion,and provide scientific evidence for rational use of antimicrobial agents in treatment of wound infection as well as reducing the emergence of drug-resistant organisms.Methods Data about pathogenic strains isolated from wound specimens of patients with wound infection in a hospital between June 2011 and April 2014 were analyzed retrospectively.Results A total of 965 pathogenic strains were isolated from wound specimens,the main infection sites were limbs(50.47%);infected patients mainly distributed in department of orthopaedic surgery(44.97%);trauma and incisional wound infection were the major infection types(47.98%,36.48%,respectively).Among iso-lated pathogens,gram-positive bacteria,gram-negative bacteria,and fungi accounted for 37.20%,59.59%,and 3.21 % respectively.The main gram-positive bacteria were highly susceptible to vancomycin,teicoplanin,and linezolid,the main gram-negative bacteria were highly resistant to most commonly used antimicrobial agents except cefoperazone/sulbactam,piperacillin/ tazobactam,imipenem,and meropenem.Conclusion Patients with wound infection are mainly distributed in department of orthopedics,the main infection types are trauma and surgical site infection,antimicrobial resistant rates of the major gram-positive and gram-negative bacteria are both high.Sur-geons,especially orthopedics surgeons,should pay attention to the culture of pathogens and monitoring of antimi-crobial susceptibility,use antimicrobial agents rationally,and strengthen the prevention and control of surgical site infection,so as to reduce the infection incidence and occurrence of drug-resistant organisms.

Objective To evaluate the effect of second-line antiretroviral treatment (ART) on human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and provide reference for subsequent HIV/AIDS treatment.Methods Two hundred and twenty-eight HIV/AIDS patients received second-line ART during January 2011 and December 2015 in Zhengzhou were included.Two hundred and forty-eight who received first-line ART during this period were randomly enrolled as control group.CD4+ T cell count and HIV RNA load before and after treatment were compared with x2 test and t test when appropriate.Results There were 228 patients (137 male and 91 female) in the second-line ART group and 248 patients (176 male and 72 female) in the control group.In second-line ART group, CD4+ T cells increased from (274±200)/μL to (476±261)/μL after an average treatment of (39.5±18.8) months.The difference was statistically significant (t=12.91, P<0.05).In control group, CD4+T cells increased from (251±199)/μL to (470±233)/μL after an average treatment of (35.7±14.7) months.The difference was statistically significant (t=14.60, P<0.05).CD4+ T cells showed no statistical difference between two groups regardless of treatment (t=1.25 and 0.26, respectively, both P>0.05).During the treatment, the rates of immunological failure were 9.6% (22/228) in second-line ART group and 12.9% (32/248) in the control group.There was no statistical difference between two groups (x2=1.251, P>0.05).Complete viral inhibition rates were 83.3% (190/228) in second-line ART group and 88.7% (220/248) in control group with no statistical difference (x2=2.881, P>0.05).Conclusions Second-line ART regimen has equivalent treatment efficacy with first-line ART.To achieve a better outcome, second-line ART regimen should be selected as an alternative option when first-line regimen fails.Compliance is the key to guarantee the success of antiviral therapy.

Objective To discuss the epidemiology and clinical characteristics of AIDS in some part of Henan regions.Methods Retrospective analysis was conducted based on the clinical and epidemic information collected from AIDS patients who were treated in the Sixth People's Hospital of Zhengzhou between 2006 and 2015 in He'nan province.Results Between 2006 and 2015,the number of hospitalization increased every year.The average growth rate was 20.31％.The average age of patients was (43.91 ± 13.56) years old.The patients from 40 to 60 years old group occupied 54.06％ of total patients,and 71.12％ of patients were farmers.During 2006 to 2015,the propagation path changed a lot.Before 2008,blood transmission was the major propagation path (72.72％),but after 2013,the major propagation path was sexual activity (59.69％).40.41％ of patients were infected by two or more opportunistic infections.The top five opportunistic infections were bacterial pneumonia (32.68％),tuberculosis (19.29％),fungal infection (18.65％),pneumocystis carinii pneumonia (12.96％),extra pulmonary tuberculosis (7.45％).The death rate was 5.79％.The number of CD4 cells in peripheral blood was closely related to the severity of illness.Conclusion Early anti-virus treatment and opportunistic infection control are key factors to relieve the severity of illness and reduce the death rate.

Objective To study the survival status and the prognostic factors of aquired immune deficiency syndrome (AIDS) patients under the highly active antiretroviral therapy (HAART) in He'nan Province.Methods Survival data of AIDS patients were collected from the National HAART reporting system between 2005 and 2015,and analyzed using SPSS 23.0 software.Results A total of 38 143 AIDS cases were enrolled in this study.The cumulative survival rate of patients under antiretroviral therapy after 1-5 years were 95％,91％,89％,86％ and 85％,respectively.The cumulative death cases were 5 704 and the total mortality was 3.68/100 person years (5 704/155 060 person years).A total of 1 975 cases died within a year with a percentage of 34.62％.Cox proportional hazard regression model analysis indicated that the hazard ratioc (HR [95％CI]) of death in patients with age of 40-49 years,50-59 yrears,60-69 yrears and ≥70 years groups compared to those with age ＜30 years group were 1.49 (1.22-1.80),1.88 (1.55-2.28),2.82 (2.32 3.42) and 4.60 (3.75-5.65),respectively.The HR (95％ CI) of death in patients with CD4 T cell counts ＜50 cells/μL,50-199 cells/μL,200-349 cells/μL groups compared to those of ≥350 cells/μL group were 3.28 (2.98-3.61),2.30 (2.09-2.53) and 1.39 (1.25-1.54),respectively.Male (HR-1.35,95％CI:1.28-1.42) and not switching to second line therapy (HR=4.41,95％CI:4.12-4.73) were the risk factors of death.Compared to sex transmission,blood transmission was the risk factors of death in AIDS patients.Conclusions The initiation of early HAART and timely switching to second line therapy for AIDS patients are key to prolong the survival time and to reduce AIDS related death.

Objective:To investigate the drug resistance of patients with acquired immunodeficiency syndrome (AIDS) who failed antiviral therapy.Methods:A total of 156 AIDS patients with antiviral therapy failure at the Sixth People′s Hospital of Zhengzhou from October 2017 to December 2018 were selected. The human immunodeficiency virus (HIV)-1 ViroSeq? genotyping method was used for the detection of HIV resistance, and Stanford University HIV drug resistance database (http: ∥hivdb.stanford.edu/) was used for testing results comparison.Results:Among the 156 AIDS patients with antiviral therapy failure, 122(78.21%) developed drug resistance. One hundred and six (67.95%) cases were multi-resistant to nucleoside reverse transcriptase inhibitor (NRTI), among which, 104 (66.67%) were resistant to lamivudine, emtricitabine and abacavir. One hundred and eighteen (75.64%) were resistant to non-nucleoside reverse transcriptase inhibitor (NNRTI), and 118 (75.64%) were multi-resistant to efavirenz and nevirapine. And seven (4.49%) were resistant to protease inhibitor (PI). There were 16 resistant sites for NRTI, with 87 (71.31%) most frequent M184V/I mutations. There were 13 resistant sites for NNRTI, with 49 (40.16%) K103N/R mutations. There were 11 resistant sites for PI, with 49 (40.16%) A71V/T mutations. The antiviral drugs lamivudine and emtricitabine were moderately and highly resistant in 102 (83.61%) cases, efavirenz and nevirapine were moderately and highly resistant in 117 (95.90%) cases. Once drug resistance developed, these drugs were likely to be moderate or high resistance. There were 29 (23.77%), 48 (39.34%), and five (4.10%) cases were resistant to zidovudine, tenofovir and lopinavir/ritonavir, respectively. The resistance barrier of these drugs was relatively high.Conclusion:The incidence of drug resistance in patients with AIDS treatment failure is high, and multi-drug resistance is serious with various sites of drug resistance.

Objective:To analyze the correlation between human immunodeficiency virus (HIV)-1 reservoir and poor immune reconstitution of HIV/acquired immunodeficiency syndrome (AIDS) patients, and to investigate the influence of HIV-1 reservoir on the immune reconstitution.Methods:Cross-sectional survey was conducted to measure HIV-1 RNA and T lymphocyte subsets from 219 patients with HIV/AIDS who had been treated with anti-retroviral therapy (ART) for more than two years with HIV RNA lower than the limit of detection. Among them, there are 195 patients from the Sixth People′s Hospital of Zhengzhou, 12 patients from Shangqiu Municipal Hospital and 12 patients from Zhoukou Infectious Diseases Hospital. Peripheral blood mononuclear cells (PBMC) were collected and HIV-1 DNA was detected. The measurement data of normal distribution were analyzed by two independent sample t-test. The measurement data of skewness distribution were analyzed by rank sum test. Spearman′s rank correlation was used for correlation analysis. Receiver operating characteristic curve (ROC) was used to predict the predictive value of occurrence of poor immune reconstitution AIDS patients. Results:There were 121 patients with poor immune reconstitution and 98 patients with healthy immune reconstitution. HIV-1 DNA was (2.50±0.52) copies/1×10 6 PBMC in the group with poor immune reconstitution, which was significantly higher than the healthy immune reconstitution group ((2.11±0.66) copies/1×10 6 PBMC, t=4.78, P<0.001). The CD4 + T lymphocyte counts in the group with poor immune reconstitution was 192(139, 227)/μL, which was lower than that in the healthy immune reconstitution group (573(457, 730)/μL). The difference was statistically significant ( Z=12.68, P<0.001). HIV-1 DNA was reversely correlated with CD4 + T lymphocyte counts and CD4 + /CD8 + T lymphocyte ratio (after adjusting the influence of age and ART time, r=-0.277 and -0.316, respectively, both P<0.001). The area of ROC curve for HIV-1 DNA to predict poor immune reconstitution was 0.679(95% confidence interval ( CI) 0.604 to 0.750). The HIV-1 DNA threshold value was 100 copies/1×10 6 PBMC with the sensitivity of 90.13% and specificity of 42.91%. The area of ROC curve of CD4 + /CD8 + T lymphocyte ratio to predict poor immune reconstitution was 0.905 (95% CI 0.863 to 0.942). The threshold value of CD4 + /CD8 + T lymphocyte ratio was 0.536 with the sensitivity of 77.68% and specificity of 89.84%. Conclusions:There is correlation between HIV-1 DNA and poor immune reconstitution in HIV/AIDS patients. The value of HIV-1 DNA higher than 100 copies/1×10 6 PBMC and CD4 + /CD8 + T lymphocyte ratio lower than 0.536 could be used as predictor of poor immune reconstitution.

Objective To analyze and investigate the survival time of dead HIV/AIDS patients after antiretroviral therapy (ART) and related factors in Henan province. Methods The database of national integrated management system of HIV/AIDS was used to collect the information of dead patients who received ART between January 2003 and December 2015. Software SPSS 23.0 was used to analyze the survival time of dead patients and related factors. Result A total of 6267 AIDS patients died after ART and the average survival time was 23.85 months (QR: 6.87-50.46 months). Within 6 months, 7-12 months and 13-24 months after ART, the numbers of dead patients were 1441 (23.00%), 652 (10.40%) and 1052 (16.79%), respectively. The number of dead cases decreased after 24 months of ART. The number of AIDS-related deaths was 5085 (81.1%);and 799 (12.7%) deaths were due to other causes, in which 179 (2.9%) were caused by accidents and 109 (1.7%) were caused by suicides. The differences in annual composition ratio of death causes during 2003-2015 had significance ( χ2=864.27, P<0.01). Twelve months, 36 months, 60 months and 120 months after ART, the survival ratios were 66.59%, 36.62%, 19.24% and 0.64% respectively. Compared with patients infected through blood donation, the HR of the patients infected through sexual transmission was 1.602 (95%CI: 1.483-1.732). Compared with patients with initial level of CD4+T lymphocyte≥350 unit/μl, the HR of patients with initial level of CD4+T lymphocyte<50 unit/μl was 2.320 (95%CI: 2.119-2.539). Compared with patients receiving second line ART, the HR of patients receiving no second line ART was 3.312 (95%CI: 3.083-3.558). Conclusion The AIDS related deaths mainly occurred in the first six months after ART. As the increase of duration of ART,the death rate decreased. Sexual transmission, low initial level of CD4+T lymphocyte and receiving no second line ART were the risk factors for the deaths of HIV/AIDS patients.