Objective Probe the value and the operation risk for HIV/AIDS patients with surgical compli-cations. Methods Investigated 27 HIV-infected patients(male 26, female 1, age 27-74 years) were investi-gated. All patients had pre-operative detection of immune function, standardized surgical procedures, careful surgical process to reduce the operation damage, continuous infusion of coagulation factors for haemophilia during operation, conventional application of antibiotics to prevent infection and prompt treatment of compli-cations. Results No incision infected in 8 cases of class one incision, 1 incision infected in 6 cases of class two incision, 3 cases were not healed in 30 days after operation in 13 cases of class three incision. One case died of severe sepsis 12 days after operation, the others discharged with recovery or improvement. Conclu-sion Suitable operation and treatment method may obtain curative effect for HIV-infected patients.

ObjectiveTo study the clinical value and efficacy of intracranial hemorrhage smashpuncture needle with YL-1 type disposable under CT monitoring in treatment of hypertensive intracerebral hemorrhage.MethodsThe data of 80 cases with hypertensive intracerebral hemorrhage patients who accepted the transcranial puncture under CT monitoring application of YL-1 type disposable intracranial hemorrhage smash puncture needle and drainage of hemorrhage,punctuated with urokinase washout and drainaged residual blood clot.Evaluation criteria:hemorrhage volume reduction,average operation time,preoperative and postoperative Glasgow coma scale(GCS) score,the clinical effect of long-term follow-up.ResultsOperation time was 15-45 (25.0 ± 2.8) minutes;hemorrhage volume was reduced by an average of 30％-80％ (56.8 ± 3.2)％,the average increase of GCS was(2.3 ±0.3) scores,10 cases death in 80 patients,70 survivors' activities of daily living (ADL) assessments:grade ADL 1 in 17 cases ( 24.3 ％ ),grade ADL2 in 36 cases( 51.4％ ),grade ADL3 in 13 cases ( 18.6％ ),grade ADL4 in 3 cases(4.3％ ),grade ADL5 in 1 case ( 1.4％ ).ConclusionsYL-1 type disposable intracranial hemorrhage smash puncture needle under CT monitoring in the treatment of hypertensive intracerebral hemorrhage is a simple,fast and accurate positioning,without craniotomy and blood transfusion,safe and effective operation,but should pay attention to operation indications.

Objective To investigate the characteristics of opportunistic infections in acquired immunodeficiency syndrome (AIDS) patients.Methods A comprehensive retrospective chart review study was conducted of 603 AIDS patients with different opportunistic infections in a special hospital authorized for AIDS patients.Results In all 603 patients,327 cases (54.2％) were infected with Pneumocystisjiroveci,251 cases (41.6％) were infected with fungus and 210 cases (34.8％) were infected with mycobacterium.Totally 367 cases (60.9％) had only one pathogen and 236 cases (39.1％) were co-infected with more than one pathogen.A total of 390 cases (64.7％) had a single site of infection with the respiratory tract being most frequently involved (271 cases,69.5％),and 213 cases (35.3％) had more than one infected site.The most common coinfected sites were oropharynx and respiratory tract (111 cases,52.1％).Conclusions AIDS patients are usually coinfected with multiple pathogenic organisms and multi-systems involved.Most of the opportunistic infections can be cured by timely diagnosis and effective treatment to prolong life and improve the quality of life of AIDS patients.

Objective To realize the optimization of image quality and radiation dose by correcting mammography automatic exposure,according to automatic exposure controlled mode of mammography film-screen system . Methods The film-screen system(28 kV) was applied to perform automatic exposure of plexiglass(40 mm) and get the standard dose of exposure, the exposure mode of CR base on LgM =2.0 was rectified, which was divided into 10 steps. Mammary glands pattern(Fluke NA18-220) were examined with CR( 26,28, and 30 kV ) by the automatic exposure mode corrected. The exposure values(mAs) were recorded. CR image was diagnosed and evaluated in double blind way by 4 radiologists according to American Collage of Radiology(ACR) standard. Results Based on the standard of CR automatic exposure with the dose higher than the traditional exposure of film-screen system, the calibration of mammography automatic exposure was accomplished. The test results of the calibrated mode was better than the scoring system of ACR. Conclusions Comparative study showed improvement in acquiring high-quality image and reduction of radiation dose. The corrected mammography automatic exposure mode might be a better method for clinical use.

Objective To investigate the correlation between the human chemokine type 1 chemokine ligand 3 (CCL3L1) and chemokine ligand 4 (CCL4L) gene expression and the immune reconstitution of acquired immunodeficiency syndrome (AIDS) patients after antiretroviral therapy.Methods The gene copy numbers of CCL3L1 and CCL4L were detected by real time polymerase chain reaction in 217 AIDS patients before antiretroviral therapy.And the correlation between CCL3L1 and CCL4L gene copy numbers and the level of CD4+ and CD8+ T lymphocytes were analyzed.The changes of CD4+ and CD8+ T lymphocytes were defined as mean change value per month after 48 months treatment.The change rates of CD4+ and CD8+ T lymphocytes were defined as the logarithm of the ratio of the value after 48 month to that at baseline.Comparison between groups was conducted using analysis of variance.Results The median of gene copy numbers of CCL3L1 and CCL4L were 2 (range:0-8) and 3 (range:0-7),respectively.After antiviral treatment,there were significantly different changes of CD8+ T lymphocyte level (F=3.054,P＜0.05) and change rate of CD4+/CD8+ (F=3.520,P＜0.05) among groups of high (gene copy 4-8),median (gene copy 2-3) and low (gene copy 0-1) CCL3L1 gene copy numbers.The changes of CD8+ T lymphocyte levels (P=0.023) and change rates (P=0.038) in high and low CCL3L1 gene copy groups were both significantly different.There were significant differents changes rate of ratio of CD4+/CD8+ T lymphocyte among high and median (P=0.010),high and low CCL3L1 gene copy numbers (F=4.397,P＜0.05).The significant difference of the change rates of CD4+/CD8+ were found between the gene copy 3 group and gene copy 4-7 group CCL4L (P=0.005) and between the gene copy 4-7 group and gene copy 0-2 group of CCL4L (P=0.030).The change ratio of CD4+/CD8+ T lymphocytes increased with the increase of copy numbers of CCL4L gene.Conclusions The gene expressions of CCL3L1 and CCL4L might be associated with the ability of immune reconstitution of AIDS patients after antiretroviral therapy.

A liquid chromatographic-tandem mass spectrometric (LC-MS/MS) method was developed for the determination of lopinavir and ritonavir in human plasma. Analytes were separated from plasma by a combination of alkalinized protein precipitation and liquid-liquid extraction with ethyl acetate. Chromatographic separation was performed on a Agilent ZORBAX Eclipse XDB-C18 column with the mobile phase consisted of methanol-0.1% formic acid in water (80:20). A tandem mass spectrometer equipped with electrospray ionization source was used as detector and operated in the positive ion mode. Quantification was performed using multiple reaction monitoring (MRM) of the transitions m/z 629.6 --> 155.2, m/z 721.4 --> 268.2, and m/z 515.2 --> 276.2 for lopinavir, ritonavir and telmisartan (internal standard), respectively. The method showed a good linearity in a concentration range of 62.5 - 10000 ng mL(-1) for lopinavir, and 12.5 - 2000 ng mL(-1) for ritonavir. The lower limits of quantification were 15 pg mL(-1) and 8 pg mL(-1) for lopinavir and ritonavir, respectively. The intra- and inter-day precision was less than 15% and the absolute recovery was above 75%. This method was selective and rapid, sensitive for investigating blood drug concentrations in clinics.

ObjectiveTo find specific biomarkers related to HAART treatment in plasma samples of AIDS patients for clinical therapeautic efficacy evaluation and guidance for the prognosis of HIV treatment.MethodPlasma samples of AIDS patients were collected from Infectious Disease Department 1 of Shanghai Public Health Clinical Center in June of 2008 to February of 2009,including 11 successfully HAART treated cases (HIV load ＞ 50 copies/ml) and 11 unsuccessfully HAART treated cases (HIV load ＜50 copies/ml).Patients' age ranged from 22 to 63.Plasma samples were treated by Bio-rad AurumTM Serum Protein Mini Kit to remove high abundant proteins:albumin and immunoglobulin were removed.The treatedplasmaproteinswereseparatedbytwo-dimensionalelectrophoresisandanalyzedby electrophoretogram using Imagemaster software to find differentially-expressed proteins related to therapeutic efficacy.After digestion by trypsin,the differentially-expressed proteins were identified by online reversed-phasenano-flow liquid chromatography coupled with electrospray ionization ion trap mass spectrometry.ResultsLow abundant proteins were efficiently enriched after the AurumTM Serum Protein Mini Kit treatment.Six differentially-expressed proteins were detected while comparing successfully and unsuccessfully HAART treated group.These proteins were accurately identified by tandem Mass spectrometry (MS), including serum transferrin, serum β-fibrinogen, etc.ConclusionsOur proteomic research revealed that the differentially-expressed proteins such as transferrin,which is related to plasma virus loading in AIDS patients in the process of treatment,might be potential biomarkers evaluating HAART therapeutic efficacy.

Objectives Occult HBV infection is defined by positive HBV DNA in individuals with undetectable levels of HBsAg.The objective of this study was to assess the prevalence of occult HBV infection in HIV-infected patients.Methods Serum samples were obtained from 105 HBs Ag-negative HIV patients who were hospitalized and were not giyen anti-virus treatment at Shanghai Public Health Clinical Center.Microparticle enzyme immunoassay(MEIA)was used to detect HBV serologic markers(HBsAg,anti-HBs,HBeAg,anti-Hbe and anti-HBc).EUSA was used to detect HCV antibody.CD4+ T cell count was examined with flow cytometry.Nested PCR was used to amplify surface protein region of HBV.Results 32(30.5%)patients(27 men,5 women)were HBV DNA positive in the 105 HBsAg-negative HIV-infected patients(92 men and 13 women).22 patients(including 5 patients with HBV DNA+)were in 16-30 years group,44 patients(including 15 patients with HBV DNA+)were in 31-49 years group and 39 patients(including 12 patients with HBV DNA+)were in 50-75 years group.5 patients were negative for all HBV serologic markers and 27 patients detected with at least one of anti-HBc.anti.Hbe or anti-HBs.14 patients (29.8%)with HBV DNA+in 47 HIV-infected patients were coinfected with HCV,18 patients(31.0%)were HBV DNA+in 58 HIV-monoinfected patients.The median absolute CD4+T eell count was 145.1cells/μ1(4-623 cells/μ1),26 patients(34.7%)were HBV DNA+in 75 AIDS patients with CD4+T cell＜200 cells/μ1 and 6 patients(20.0%)HBV DNA+in 30 HIV-infected patients with CD4+ T cell＞200cells/μ1.No statistical significant association could be established between the above factors.Conclusions It is found tIlatoccult HBV did occur in HIV-infected patients.No statistical significant association could be established between occult HBV infection and gender,age,HBV serologic markers,coinfected HCV and CD4+T cell count.

Objective To analyze the causes of death for 89 HIV/AIDS patients,and the association of CD4+ T lymphocyte counts with the mortality.Methods Data were collected from 89 deceasedpatients who were admitted to Shanghai Public Health Clinical Center from Jan 1996 to Sep 2007,and wereretrospectively analyzed with t-test.Results Heterosexual,blood transfusion and blood products were themajor transmission routs for 89 deceased HIV/AIDS patients.The primary causes of death varied with different levels of CD4+ T lymphocyte counts.With higher CD4+T lymphocyte counts,patients were more likelyto die from non-AIDS-related opportunistic infections such as upper digestive tract hemorrhage.Serious pulmonary infection induced by various etiologies was the primary cause of death.Co-infections of multiple etiologics were often seen in these death cases.Conclusion Opportunistic infection is the primary cause of death for HIV/AIDS patients.Appropriate therapies should be based on CD4+ T lymphocyte counts and patients' specific conditions to reduce the mortality.

Objectives To investigate the markers of endothelial injury, adipocytokine and thrombotic activity and explore whether there are cardiovascular disease risk factors in antiretroviral-naive HIV patients. Methods Clinical data and venous blood samples were collected from 43 anti-retroviral naive HIV-infected patients during February -October 2009 in our center, and compared with 17 healthy subjects.Plasma leptin, adiponectin, soluble intercellular adhesion molecule-1 ( sICAM-1 ), D-dimer were measured by ELISA. Four markers and cholesterol, triglyceride, fasting plasma glucose were compared between the two groups. The CD4+ T cells and percentages of CD38, HLA-DR on CD8+ T were determined by flow cytometry and plasma HIV copies were detected with bDNA analyzer among HIV-infected participants.Spearman correlations between the significant markers and CD4+ T cells, CD8+ CD38+/CD8+, CD8+ HLA-DR +/CD8+, HIV viral load were examined among HIV-infected participants. Analyses were conducted by using Stata version 7. Results Thirty-eight of the 43 patients were sexually infected by HIV and the median absolute CD4+ T cell count was ( 133 ± 82 ) cells/μl, HIV RNA was (4. 42 ± 0. 66 ) lg copies/ml. HIV-infected patients, compared with healthy subjects, had lower leptin [11.41 (7.91,14. 53 )μg/L vs 55.31( 16. 49,229.65 ) μg/L, P= 0. 0005], adiponectin [1.79 ( 1.40,4. 00 ) mg/L vs 3.36 ( 2. 92,4. 18 ) mg/L,P =0. 003] and higher sICAM-1 [1.71 (1.11,2.40) mg/L vs 0. 69 ( 0. 57, 0. 80 ) mg/L, P = 0. 0000].No significant differences exist in cholesterol, triglyceride, fasting plasma glucose. For HIV-infected participants, sICAM-1 tended to correlate with CD8+ CD38+/CD8+ and HIV viral load ( r= 0.3378, P= 0.0267;r = 0.3904,P = 0.0096). Conclusion Patients with untreated HIV infection have lower leptin, adiponectin and higher sICAM-1 levels and the relationship of these markers to HIV-mediated atherosclerotic risk requires further study.