Lung injury was one of the most complications after extracorporeal circulation. As a result of blood exposure to the surface of the extracorporeal circulation circuit, the complements and leukocytes were activated. The activated neutrophil adhered to endothelial cells and released many inflammatory mediators, as protease, oxygen free radicals, arachidonic acid metabolites. All of these inflammatory mediators caused lung injury. In vivo and in vitro, many studies demonstrated that leukocyte depletion in extracorporeal circulation of heart operation could reduce lung injury and improve lung function. Leukocyte depletion could reduce pulmonary resistance, particularly effective in patients with a low preoperative oxygenation capacity and in those for whom an extended period of extracorporeal circulation was required.

Objective To explore the clinical feature and prognosis of multiple myeloma with heart failure as initial manifestations.Methods 12 patients of multiple myeloma with heart failure as initial manifestations were analyzed and followed up.Results Twelve patients,9 men and 3 women,with mean age of 48～69(58.4?5.2)years older were enrolled.The first symptoms of the patients were almost the same,with different degree of dyspnea and tachypnea.Anaemia and proteinuria were 83.3% and 75% respectively in 12 patients.ECG showed that 8 patients had low voltage in the limb leads,with present poor R wave progression in the precordial leads and ST-T changes in 6 patients.UCG showed that 10 patients had enlarged left atrium(41.6?4.2)mm,8 patients had increased thickness of the interventricular septums and left ventricular walls as well as diffuse weakness of the wall motion.Followed up for(4.0?3.7)months,all of the patients(100%)died.Conclusion Multiple myeloma with heart failure as initial manifestations is rare clinically,but has fast aggravation and bad prognosis.Pro-brain natriuretic peptide(Pro-BNP)and cardiac troponin are subtile markers for judging the prognosis of patients with multiple myeloma.

Objective To study the extraintestinal lesions induced by rotavirus(RV)infection and explore the pathogenesis.Methods Simian rotavirus SA11 was cultured in MA-104 cells.After inoculation,the pathological changes in brain,lung,heart,liver,pancreas and kidney tissues were observed,the RV antigens detected,and the apoptotic cells observed.Besides,we stained the filamentous actin(F-actin)with Phalloidine-TRITC,and then quantified the F-actin amount.Results Several pathological changes,inclusive of myocardial interstitial edema,granular degeneration in cardiacytes,hepatic congestion,and hepatocellular vacuolar degeneration,were found,but not found in the brain,lung,and pancreas tissues.Meanwhile,several ultrastructural changes,inclusive of dissolved myocardial F-actin,extended smooth endoplasmic reticulum,swollen mitochondria,and widened perinuclear space,were found.No difference was found in the quantity of myocardial F-actin.Apoptosis was found in liver cells,but not in myocardial cells.RV RNA was detected in tissues such as brain,lung,heart,liver and pancreas tissues.Conclusion All the results suggest that RV may spread from the intestine to various extraintestinal organs and hence induce injury.Filamentous actin depolymerization,cytoskeleton damage and apoptosis induced by RV infection are the important mechanism not only in intestinal damages,but also in extraintestinal lesions.

Objective To study the pathogenesis of rotavirus(RV) diarrhea.Methods Simian rotavirus(SA-11) was grown in cultured MA-104 cell.The viral titers of the culture supernatant were determined by plaque forming assay.KM mice aged 7 days were inoculated with the viral supernatant via feeding tube(gavage).Histological and ultramicrostructure changes of the small intestines were observed under light microscope and electron microscope.The values of crypt depth and villi height were measured with software(image pro plus 5.1,IPP5.1).The distribution of the RV antigen in small intestine and the filamentous actin of the small intestine chorioepithelium were observed with immunohistochemical techniques.The apoptosis of the small intestine epithelium cells was observed with an in situ apoptosis detection kit.Results There were mild hyperemia,dropsy and extensive vacuolar degeneration of small intestine villi under light microscope.Plenty of lipid droplet-like structure at the top of the villi,microvilli malalignment or defluxion and enterocyte defluxion could be seen by electron microscope,but no obvious structure changes at the cell junctions were seen.The RV antigen mainly distributed at the top of the villi.The quantity of small intestine filamentous actin decreased and enterocyte apoptosis increased after RV infection.Conclusion RV mainly infects the mature villous epithelium.The presentation of RV diarrhea relates to the lesion of cytoskeleton,the microvilli lesion of the small intestine,enterocyte apoptosis and defluxion,villi atrophy,etc.,but may have no relationship with the structural changes of cell junctions in the small intestine epithelium.

Human Immunodeficiency Virus Type 1 exists in vivo as quasispecies, and one of the genome's characteristics is its diversity. During the antiretroviral therapy, drug resistance is the main obstacle to effective viral prevention. Understanding the molecular evolution process is fundamental to analyze the mechanism of drug resistance and develop a strategy to minimize resistance. Objective: The molecular evolution of drug resistance of one patient who had received reverse transcriptase inhibitors for a long time and had treatment which replaced Nevirapine with Indinavir was analyzed, with the aim of observing the drug resistance evolution pathway. Methods: The patient, XLF, was followed-up for six successive times. The viral populations were amplified and sequenced by single-genome amplification. All the sequences were submitted to the Stanford HIV Drug Resistance Database for the analysis of genotypic drug resistance. Results: 149 entire protease and 171 entire reverse transcriptase sequences were obtained from these samples, and all sequences were identified as subtype B. Before the patient received Indinavir, the viral population only had some polymorphisms in the protease sequences. After the patient began Indinavir treatment, the variants carrying polymorphisms declined while variants carrying the secondary mutation G73S gained the advantage. As therapy was prolonged, G73S was combined with M46I/L90M to form a resistance pattern M46I/G73S/L90M, which then became the dominant population. 97.9% of variants had the M46I/G73S/L90M pattern at XLF6. During the emergence of protease inhibitors resistance, reverse transcriptase inhibitors resistance maintained high levels. Conclusion: Indinavir- resistance evolution was observed by single-genome amplification. During the course of changing the regimen to incorporate Indinavir, the G73S mutation occurred and was combined with M46I/L90M.

Objective: To learn the epidemiological characteristics of coronavirus disease 2019(COVID-19)clusters in Nanning,Guangxi Province,so as to provide reference for the prevention and control of COVID-19. Methods: The data of COVID-19 clusters from January to February,2020 in Nanning were collected through the Public Emergency Response System of National CDC. Descriptive epidemiological analysis were conducted to analyze the time,space and population distribution, source of infection,transmission chain, ways of detection and the scale of clusters. Results: Eleven clusters were reported,with 36 confirmed cases and 293 exposed persons. The average attack rate was 12.29%. There were ten family clusters. The epidemic scale was small,with an average of 3.27 cases. The onset of cases peaked on January 23,while the reporting time was mainly from February 10 to February 18. The cases were distributed in two cities and one county. The attack rate of Qingxiu District and Xixiangtang District was 16.95%,which was higher than 5.17% of Mashan County(p<0.05). The recurrence rate of family contacts was 25.42%,which was higher than that of other ways of contacts(p<0.05). Of eleven clusters,nine were caused by imported cases or related cases;five developed secondary cases or above,and the median interval between the first and secondary cases was three days. Conclusions The COVID-19 clusters in Nanning occurred mainly in families with small scales and most were caused by imported cases. The majority of the cases were reported during mid February. The attack rate in urban areas was higher than that in rural areas.

Objective To clarify the serological characteristics and predictive value of HIV antibody indeterminant and to evaluate the efficiency of 3 assays to discriminate HIV antibody indeterminant.Methods Three hundred and ninety-four HIV antibody indeterminant serum samples were collected and the Western blot pattern were analyzed.Ninety-seven HIV antibody indeterminant individuals were followed up,and the development of HIV antibody were observed.The initial serum samples of 67 followed individuals were tested by viral load,line immunoblot assay and ELISA for HIV-1 p24,with the golden standard of follow up,the efficiency of 3 kinds of assay to discriminate HIV antibody indeterminant were evaluated.Results There were 38 patterns among 394 HIV antibody indeterminant,the proportions of env,pol and gag indeterminant were 37.54%,4.04%and 58.37% respectively.Five HIV antibody indeterminant cases were converted to HIV antibody positive among 97 followed individuals,they were all env indeterminant and HIV antibody developed rapidly.HIV viral load was an ideal assay to discriminate HIV antibody indeterminant with best sensitivity.Conclusion The indeterminant of gag were most common,but were unspecific reaction.Env indeterminant were with the greatest predictive value of HIV infection,especially the gp160p24 and gp160.Viral load assay can be applied to discriminate HIV antibody indeterminant.

Objective To characterize 5 gpl20 sequences from mainly circulating clades in China and expression of their gp120 glycoproteins. Methods gp120 genes were amplified from the PBMCs of 5 HIV-1 infected individuals in different provinces using nest PCR and their DNA sequences were determined. Sequence characteristics were analyzed and gp120 genes were sub-cloned into the mammalian expression vec-tor to produce gp120 glycoproteins. Results Sequence characteristics indicated these sequences belong to the clade Thai-B, CRF_BC and CRF_AE, respectively. There were some conservative N-linked glycosyla-tion sites and primary Furin protease cleavage motifs in the same positions within gp120 amino acid se-quences although these gp120 sequences were categorized into different clades. In comparison with referen-tial strains, amino acids deletions were found in the V1, V2, V4, V5 regions except for the V3 loop; above all, V3 tip motifs of Thai-B exhibited the more polymorphic forms than those of CRF_BC and CRF_AE. These 5 gp120 sequences were cloned into the eukaryotic expression vector and gpl20 glycoproteins were produced successfully. Conclusion Hyper-variable nature of Env should be considered while designing HIV-1 vaccine or test reagent, and gpl20 expression in vitro is helpful to further research on the Env patho-genesis and vaccine development against the mainly circulating HIV-1 isolates in China.