Objective To study the clinical features of a heterogeneous immunodeficiency disease,common vailable immunodeficiency(CVID),and to enhance the understanding of it.Methods 12 cases of CVID treated in Peking Union Medical College Hospital from January 1990 to March 2007 were analyzed retrospectively,including the clinical characteristics,laboratory results,treatment and prognosis.Results Among the 12 patients,the ratio of male to female Was 2:1,the average onset age(26±9)years old and the median time from onset to diagnosis 18 months.The main symptoms were fever(with a percentage of 67.0%),recurrent Cough and expectoration(58.3%)and diarrhea(41.6%).Anemia and leukocytopenia were the common laboratory changes.All the cases were diagnosed due to the presence of hypo- immunoglobulinemia.The tests available for subtypes of lymphocytes in 9 patients showed that B cells and CD4+ T cells decreased obviously,with an inverse ratio of CD4/CD8,indicating T cell dysfunction.Clinical improvement was demonstrated after treatment with intravenously administered immunoglobulin(IVIG)in 10 cases.Conclusions CVID is a heterogeneous group of immunologic disorders of unknown etiology,characterized by impaired antibody responses and recurrent airway and/or gastrointestinal infection and accompanied with autoimmune diseases or cancer.Hypo-immunoglobulinemia is the main evidence of its diagnosis.IVIG as a replacement therapy is an effective way of management.

ObjectiveTo analyze the clinical characteristics of Behcet's disease with intracardiac thrombus.MethodsThe data of 8 patients diagnosed as Behcet's disease with intracardiac thrombus in Peking Union Medical College Hospital from January,1990 to January,2011 were studied retrospectively.ResultsBehcet's disease with intracardiac thrombus was found in 8 patients (5 men and 3 women) with a median age of 28.5 years.Most of them were young men.Thrombus was mostly found in the right side of the heart.Most of the patients had pulmonary thromboembolism with negative anticardiolipid antibody and basically normal C-reactive protein and erythrocyte sedimentation rate.ConclusionIntracardiac thrombus associated with Behcet's disease most commonly occurs in young men and usually involves the right side of the heart.

Objective To improve the diagnosis and treatment of infective endocarditis(IE)by exploring its causes,pathogenic microorganism and clinicsI characteristics.Methods The clinical data of 120 IE patients treated in Peking Union Medical College Hospital from October 1997 to September 2007 were analyzed retrospectively.Results Of the 120 consecutive cascs diagnosed as IE according to the Duke's new criteria,79 were male and 41 female with a average age of(43.2±16.7)years old.Twelve cases were prosthetic valve endocarditis(PVE)and 108 cases native valve endocarditis(NVE)and there were no previously known heart diseases in 29 of the cases.Seventy-nine of the 108(73.1%)NVE patients had basic cardiac abnormalifies before IE diagnosis,such as congenital cardiovascular disease(30 cases),idiopathic mitral valve prolapse(23 cases)and rheumatic heart disease(11 cases).Fever(100.0%),anemia(54.2%)and embolism(48.3%)were the most common clinical manifestations in the IE development.Of the 83 patients who had a positive blood culture result,Streptococcus vividaus(51.8%)was the most common isolated microorganism.Conclusions Congenital cardiovascular diseases and idiopathic mitral valve prolapse are the two most commonly heart diseases in IE.Blood culture and echocardiogram should always be done to exclude IE,especially presenting with fever of unknown reasons.

Objective To evaluate clinical features,predisposing factors,therapeutic regimen and prognosis of non-traumatic rhabdomyolysis.Methods Clinical picture,therapeutic regimen and prognosis were investigated in 39 cases with non-traumatic rhabdomyolysis by retrospective analysis.Results Non-traumatic rhabdomyolysis mostly presented fever,asthenia,myalgia and/or muscular tenderness,swelling of involved muscles,red urine and oliguria or anuria.The complications and comorbidity of rhabdomyolysis included acute renal failure(ARF),disorders of metabolites and electrolytes,compartmental syndrome,infection,and multiple organ dysfunction.Infection(33.3%)was the most common etiology of non-traumatic rhabdomyolysis,followed by drugs(25.6%),metabolite or electrolyte derangements(10.3%)and alcohol intoxication(7.7%)etc.Therapeutic regimen covered treatment of the underlying diseases,volume repletion,alkalization and dealing with the complications.For the patients with established renal failure,renal replacement therapy was essential.Overall mortality was 15.4%,while the mortality in the patients with ARF was 20.7%.If surviving ARF,the patients' renal function promised to be normalized consequently.Conclusion Non-traumatic rhabdomyolysis is a syndrome with a variety of causes,different clinical presentations and versatile combination of complications,which confounds the diagnosis.However,if treated properly and in time,the survivors in all probability will recover from ARF.

Objective] To investigate the clinical features of amebic liver abscess, the causes of misdignosis and the effect of medical and surgical therapy on patient′s prognosis. [Methods] The clinical features of 36 patients with amebic liver abscess admitted from 1982 to 1997 in our hospital were retrospectively reviewed. [Results] The major clinical manifestations were: abdominal pain (86 1%), fever (86 1%),hepatomegaly with tenderness (83 3%) and right intercostal tenderness(58 3%). Leukocytosis was observed in 61 1%, and increased of ESR in 88 5% (23/28). Serologies against Entamoeba histolytica were noted in 92 6%. Ultrasonography showed single lesions in 75% and right\|lobe involvement in 75%. All patients were treated with metronidazole and 27 patients received treatment with needle aspiration or draining at the same time. After treatment, 10 patients were cured, 25 patients were improved significantly and effective rate was 97 2%. One patient died of hepatic failure. [Conclusion] Medical therapy alone was excellent for small abscesses, while percutaneous needle aspiration or draining was a successful approach in patients with large abscesses.

Objective To evaluate the pharmacokinetic profiles of lopinavir(LPV) in Chinese HIV-infected patients.Methods A total of 16 patients were enrolled in the LPV pharmacokinetic study.Blood samples were collected before LPV intake and 0.5,1.0,1.5,2.0,2.5,3.0,4.0,6.0,8.0,10.0,12.0 h after administration.Serum level of LPV was determined by the developed high performance liquid chromatography (HPLC) method.The pharmacokinetic profiles were assessed by WinNonlin software.Results The non-compartment model pharmacokinetic (PK) parameters were as follows:the peak time of LPV (Tmax) (3.88 ± 0.23) h,maximum plasma concentration (Cmax) (10.36 ± 3.42) mg/L,minimum plasma concentration (Cmin) (2.18 ± 0.34) mg/L,the 24 h area under plasma-concentration-time curve (AUC0-24) (116.22 ± 15.68) mg · h · L-1,half life(T1/2) (4.5 ± 0.13) h,and clearance rate (CL/F) (3.44 ± 1.34) L/h respectively.Conclusions The pharmacokinetic profiles of LPV in Chinese HIV-1 infected patients demonstrate lower Cmin than those of reported studies,while other parameters are similar.Patients should be educated for compliance based on the narrow gap between Cmin and minimum effect concentration.

Objective:To analyze the epidemiological characteristics of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) co-infected patients in Beijing and investigate the associated factors.Methods:The clinical data of patients with HIV infection who were treated in HIV/AIDS designated hospitals (Peking Union Medical College Hospital, Beijing Ditan Hospital and Beijing Youan Hospital) were retrospectively analyzed.Results:A total of 11 572 patients were finally included in the study, among whom 532 patients (4.6%) were co-infected with HIV and HBV. Most of the co-infected patients were young male adults (28~48 years old), accounting for 85.9%. The main transmission route was homosexual behavior (74.8%). There were 87.4% co-infected patients treated with two anti-HBV drugs, including lamivudine (3TC) and tenofovir (TDF). From 2013 to 2018, the annual prevalence of HIV and HBV co-infection decreased gradually, with the rate of 6.37%, 4.55%, 3.92%, 4.68%, 4.24% and 2.74%, respectively. In our study, The main influencing factors of HIV and HBV co-infection were age older than 28 years old versus<28 years old ( OR=2.807, 95% CI 1.241-6.345) and marriage status (married versus unmarried, OR=1.259, 95% CI 1.004-1.579). Conclusions:The proportion of HBV infection in HIV-infected patients is 4.60% (532) in our cohort. From 2013 to 2018, the prevalence of HIV and HBV co-infection in Beijing shows a decreasing trend. The risk of co-infection is higher in married young adults (28~48 years old).

ObjectiveTo evaluatethe microbial spectrum and clinical characteristics of microbiological diagnosed bloodstream infections ( BSI ) with identified infective sources. Methods The hospitalized patients microbiologically diagnosed as BSI with identified infective sources were included in this study from January 2008 to December 2009.Data were collected retrospectively and analyzed by software SPSS 17.0.ResultsIn this 2-year study,301 strains of microbes were isolated from 249 patients.There were 205 ( 82.33％ ) patients with monomicrobial BSI,while the other 44 ( 17.67％ ) patients with polymicrobial BSI.The most common identified source of bloodstream infections was lower respiratory tract infection (125,41.5％ ),followed by intraabdominal infection (55,18.3％ ) and intravascular devices related infection (54,17.9％ ).The four most common isolated pathogens were Acinetobacter species (60,19.9％ ),Escherichia coli (50,16.6％ ),Pseudomonas species (35,11.6％ ) and Staphylococcus Aureus (34,11.3％ ).Eighty-eight (35.3％) patients died during hospitalization due to all causes,out of which 62(24.9％ ) patients died owing to BSI.The patients with BSI originated from lower respiratory tract had a higher crude in-hospital case-fatality ratio than those with BSI originated from other resources ( OR =2.186 ; 95％ CI 1.260-3.792; x2 =7.879,P =0.005). In the multivariate regression,age ≥ 65,invasive mechanical ventilation, reservation of central line and polymicrobial BSI during hospitalization were independent risk factors of death due to all causes. Conclusions Lower respiratory tract is the most common originated source of BSI with microbiological identified sources. Gram-negative bacillus taking advantage,the microbial spectrum of BSI with identified sources in our study is different from those reported before both in primary and secondary BSI.The patients with BSI originated from respiratory tract have a higher crude in-hospital case-fatality ratio.

Objective To study the profile of peripheral natural killer cells(NK cells)and γδT lymphocytes in human immunodeficiency virus(HIV)infected patients with different disease status and to explore the pathogenesis of acquired immunodeficiency syndrome(AIDS).Methods Three hundred and eleven HIV/AIDS patients without antiviral treatment were enrolled in this study.The percentages and absolute numbers of CD4+T lymphocytes,NK cells,and γδT ceils were measured by flow cytometry.The patients were divided into 3 groups based to their CD4+T lymphocytes counts:low CD4+T lymphocytes group(L),patients with CD4+T lymphocytes <0.20×109L;middle CD4+T lymphocytes group(M),CD4+T lymphocytes counts between 0.20×109and 0.35×109L;high CD4+T lymphocytes group(H),patients with CD4+T lymphocytes counts >0.35×109L.Rank sum test of independent samples of two-group and multiple-group was performed using Mann-Whitney U test and Kruskal-Wallis test.Correlation analysis was done by Spearman and Pearson test. Results The median percentage and cell counts of NK cells(8.4%,103×106L) and γδT cells(3.4%,41×106L)in HIV/AIDS patients were all significantly lower than those of healthy individuals(Z=-5.029,Z=-7.723,Z=-2.437,Z=-6.063;all P<0.01).The median cell counts of CD4+T lymphocytes in L,M,H groups were 0.062×109L,0.276×109L and 0.482×109L,respectively.The median cell counts of NK cells in these 3 groups were 89×106L,97×106L and 146×106L,respectively.NK cell counts were not significantly different between L and M groups,whereas both of them were much lower than that of H group(Z=-3.392,P=-0.001,Z=-4.849,P<0.01,respectively).The median γδT cell counts of L,M and H group were 29×106L,43×106L and 59×106L,respectively.The differences between any 2 groups were not significant.Conclusion These data suggest that the decreasing levels of peripheral NK cells and γδT cells are different after HIV infection.

To investigate the different reconstitutional profiles for acquired(CD4+ T cell)and innate(NK cell,γδT lymphocyte)immunity after highly active antiretroviral therapy(HAART).Methods The CD4+ CD4+,CD3+ CD4- CD8-,CD3- CD16/CD56+,CD4+ CD45 RA+ CD62 L+ and CD4+ CD45 RA- subsets were measured by flow cytometry.The dynamic changes of these subsets after HAART initiation were assessed in 59 patients who were followed for 12 months in resular 3-month visits.Results At baseline the cell counts of CD4+ T cells including its na(I)ve and memory subsets,NK cell and γδT cells in HIV/AIDS patients were all significantly lower than those of healthy individuals.There was a decrease of 2.33 lg copies/ml in HIV-1 RNA from baseline noted 1 month after initiation of treatment which was sustained through 12 months.CD4+ T cell count showed a bi-phase increase during treatment.The first rapid increase was mainly memory CD4+T cells and this followed by the second slow but steady increase of na(I)ve CD4+ T cells.Increases in NK cell and γδT cell were noted at 3 months of HAART and this restoration were different quantitatively when compared with the oge in CD4+ T cells.Conclusion HAART could induce a different quantitative restorational patterns in peripheral CD4+ T cells,NK cells and γδT cells.