Survival of people living with HIV after treatment with Traditional Chinese Medicine in Henan province of China： a retrospective cohortstudy

OBJECTIVE： To provide survival estimates of people living with human immunodeficiency virus（PLHIV） after treatment with Traditional Chinese Medicine（TCM） in rural China, to identify the prognostic factors at enrollment, and to explore the effectiveness of TCM intreating PLHIV.METHODS： PLHIV who enrolled in national TCM HIV treatment trial program in October 2004 were analyzed in this study and followed up to October 2010. Survival time was estimated by the Kaplan-Meier curve and hazard ratios, and identifying prognostic factors were computed through Cox proportional hazard models.RESULTS：A total of 1666 PLHIV were included with 102 591 person-months of follow-up. Overall, 312（18.7%） patients died. The total mortality rate over the study period was 3.6 per 100 person-years,which was lower than the worldwide rate. The cumulative survival rate was 95.9% at 1 year[95% confidence interval（CI）（94.8-96.8）] and 80.4% at 6years [95% CI（78.4-82.3）]. Elevated death risks emerged among males, older individuals, and thosewithlowerCD4＋T-cellcounts.CONCLUSION： TCM could increase survival and lengthen the life span of PLHIV in Henan province of China, as shown by our retrospective cohort study. Factors such as sex, age, education, and CD4＋ T-cell counts correlated to survival. However,retrospective cohorts bias the data, so more prospective studies should be performed to confirm our primary results.     

Molecular evolution of emerging Banna virus

Banna virus (BAV) is an emerging pathogen that causes human viral encephalitis and has been isolated from types of blood-sucking insects and mammals in Asia. However, there are no reported systematic studies that describe the origin and evolution of BAV. Here, a phylogenetic analysis of BAVs isolated from a variety of potential vectors and vertebrate hosts worldwide revealed that BAVs emerged in the beginning of the 20th century and do not exhibit a species barrier. The mean substitution rate of BAVs was 2.467 × 10^− 2 substitution/site/year (95% HPD, 1.093 × 10^− 3 to 5.628 × 10^− 2). The lineage is mainly composed of BAVs from high-latitude regions, which are the most recently emerged viruses with significantly higher substitution rates compared with the lineage comprised of the isolates from middle or low-latitude regions. The genetic differences between BAV strains are positively correlated with the geographic distribution. Strains from the same latitude regions are almost 100% identical, whereas the differences between strains from long distance regions with different latitudes could be > 60%. Our results demonstrate that BAV is an emerging virus at a stage that involves rapid evolution and has great potential for introduction into non-endemic areas. Thus, enhanced surveillance of BAV is highly recommended worldwide.     

Phylogenetic analysis of hepatitis delta virus isolated from HBsAg positive patients in Shahrekord,Iran

ObjectiveTo find out the phylogenetic background of hepatitis delta virus (HDV) samples isolated in Shahrekord, Iran.MethodsA total of 350 hepatitis B surface antigen (HBsAg) positive sera samples were found from blood donors and HBsAg positive patients in blood transfusion center and clinical laboratory in Shahrekord, Iran. HDV RNA was extracted using RNXPlus (CinnaGen, Iran). A total of 421 bp corresponding to hepatitis delta antigen have been isolated from HDV in Shahrekord, then were amplified in polymerase chain reaction system, sequenced for determining nucleotide sequence and compared with identified nucleotide sequences of these genes in other countries.ResutlsAmong 350 HBsAg positive samples, we could detect HCV RNA in only two samples. After sequencing, the nucleotide sequences had a variability of 1/7-3/0 for HD Ag gene. The greatest sequence similarity existed between Iranian HD Ag sequence and JF694493-Iran, U25667-China with a sequence similarity of 99.7% and the least relationship between Iranian HD Ag sequence and AF008420-USA with a similarity of 92.9%.ConclusionsIt is suggested that precise genotype of HDV circulating in the region can be determined by more expansive sampling from different parts of Chahar mahal and Bakhtiari province and neigh bouring provinces (Esfehan and Khoozestan).     

Practitioner-based complementary and alternative therapies in the management of asthma in children and adolescents: a systematic review and meta-analysis

BackgroundAsthma is a chronic inflammatory disorder affecting 334 million people worldwide. Conventional medicines are effective for managing asthma in children, but important concerns exist about potential side-effects, such as increased heartbeat, muscle shake, and hyperactivity. Consequently, many patients turn to complementary and alternative therapies to seek care with a more holistic approach. We systematically reviewed the available evidence on effectiveness of complementary therapies in the management of asthma in children and adolescents (<18 years old).MethodsWe searched Medline, Embase, CINAHL, AMED, and the Cochrane Database of Systematic Reviews to identify articles in English published between Jan 1, 2000, and Dec 13, 2014. Keywords included 57 names of practitioner-based complementary therapies and were combined with “asthma” and either “randomised controlled trial” or “quasi-randomised trial”. Identified abstracts were double screened. Primary outcome of interest was forced expiratory volume in 1 second (FEV₁). Heterogeneity was assessed with the I² statistic. Fixed-effect meta-analysis was done with RevMan software (version 5.2). Quality of the studies was assessed with the Cochrane Collaboration Risk of Bias Assessment Tool.Findings1187 non-duplicate records were found, of which 62 full text articles were assessed for eligibility. 20 additional studies were identified from the bibliographies of studies found. Of these 82 articles screened, 12 trials covering eight therapies were eligible. The trials involved 605 patients, aged 5–17 years. Ten of the 12 studies were assessed to be at high risk of bias. Pooled data from two studies indicated that, compared with standard treatment, massage therapy significantly improved lung function (FEV₁) (standardised mean difference 0·43, 95% CI 0·04–0·82), and that, compared with placebo or standard treatment, acupuncture significantly improved quality of life (0·43, 0·05–0·81). The data could not be pooled for other outcomes. Results from individual trials showed that tai chi and osteopathy were beneficial for improving lung function, and art therapy for quality of life. Only one study assessed adverse events and found laser acupuncture to be safe and well tolerated.InterpretationAlthough meta-analysis from a small number of studies on massage and acupuncture showed some benefit for improving lung function and quality of life, most studies were small and of poor quality. Therefore, the evidence is insufficient to recommend that any of the practitioner-based complementary therapies should be used in the management of asthma in children and adolescents.FundingNone.     

Advantages of Chinese Medicine for Patients with Acquired Immunodeficiency Syndrome in Rural Central China

Objective

To analyze the effect of Chinese medicine (CM) on mortality and quality of life (QOL) of acquired immunodefificiency syndrome (AIDS) patients treated with combined antiretroviral therapy (cART).

Methods

A random sample of AIDS patients enrolled in the National Chinese Medicine Treatment Trial Program (NCMTP) that met the inclusion criteria was included in this study. NCMTP patients were included as the CM+cART group, and those not in the NCMTP were included as the cART group. Survival from September 2004 to September 2012 was analyzed by retrospective cohort study. QOL was analyzed by cross-sectional study.

Results

The retrospective cohort study included 528 AIDS patients, 322 in the CM+cART group and 206 in the cART group. After 8 years, the mortality in the CM+cART group was 3.3/100 person-years, which was lower than the cART group of 5.3/100 person-years (P<0.05). The hazard ratio (HR) for mortality in the cART group was 1.6 times that of the CM+cART group by Cox proportional hazard model analysis. After controlling for gender, age, marital status, education, and CD4⁺ T-cell count, the HR was 1.9 times higher in the cART group compared with the CM+cART group (P<0.05). The cross-sectional study investigated 275 AIDS patients. The mean scores of all QOL domains except spirituality/personal beliefs were higher in the CM+cART group than in the cART group (P<0.05).

Conclusions

For AIDS patients, CM could help to prolong life, decrease mortality, and improve QOL. However, there were limitations in the study, so prospective studies should be carried out to confifirm our primary results.