Decline in the rate of oral opportunistic infections following introduction of highly active antiretroviral therapy

In recent years the management of human immunodeficiency virus (HIV)-positive individuals has been based on highly active antiretroviral therapy (HAART) comprising a combination of nucleoside analogues or the combination of these agents with protease inhibitors. The aim of the present study was to describe the prevalence of oral lesions in a cohort of 103 HIV-seropositive patients on HAART, to compare these data with the prevalence of lesions prior to HAART and to correlate these finding with the immunologic data. A total of 103 HIV-seropositive patients on HAART were selected. Oral lesions associated with HIV infection and immunological parameters were registered. On re-examination 6 months after the first evaluation, 61/103 patients were available. Comparing the prevalence of oral lesions before and after the onset of HAART, the number of oral lesions was significantly lower (P=0.001). The number of CD4+ cells increased and the viral load decreased significantly after initiation of HAART (P=0.001 and P= 0.0001). On re-examination 6 months later, the prevalence of lesions again decreased significantly (P=0.001). The immunological benefits of HAART may prevent HIV-associated oral lesions in patients with advanced HIV disease. Our results showed that oral manifestations decrease on HAART, but in four patients the immunological effects of therapy did not provide sufficient protection against human papillomavirus (HPV)induced lesions.     

Abnormal Neurological Exam Findings in Individuals with Mild Traumatic Brain Injury (mTBI) Versus Psychiatric and Healthy Controls

In those with a history of mild traumatic brain injury (mTBI), cognitive and emotional disturbances are often misattributed to that preexisting injury. However, causal determinations of current symptoms cannot be conclusively determined because symptoms are often nonspecific to etiology and offer virtually no differential diagnostic value in postacute or chronic phases. This population-based study examined whether the presence of abnormalities during neurological examination would distinguish between mTBI (in the chronic phase), healthy controls, and selected psychiatric conditions. Retrospective analysis of data from 4462 community-dwelling Army veterans was conducted. Diagnostically unique groups were compared on examination of cranial nerve function and other neurological signs. Results demonstrated that individuals with mTBI were no more likely than those with a major depressive disorder, generalized anxiety disorder, posttraumatic stress disorder, or somatoform disorder to show any abnormality. Thus, like self-reported cognitive and emotional symptoms, the presence of cranial nerve or other neurological abnormalities offers no differential diagnostic value. Clinical implications and study limitations are presented.     

临床抗菌药物使用与主要病原菌分离率变化之间关系的探讨

目的：探讨临床药物使用强度与主要病原菌临床分离率之间的量化关系。方法：收集解放军总医院第一附属医院2007～2008年24个月抗菌药物使用和各类临床标本病原菌分离情况的相关数据，将抗菌药物的使用总剂量换算为每100住院人天所消耗的限定日剂量（DDD／100人天），并计算每月主要病原菌的分离率，进行相关分析。结果：有4类抗菌药物的使用强度分别与4种病原菌分离率相关：喹诺酮类与鲍氏不动杆菌（r=-0．443，P〈0．05），糖肽类与肺炎克雷伯菌（r=0．517，P〈0．05），青霉菌类与金黄色葡萄球菌（r=0．429，P〈0．05），青霉素＋酶抑制剂类与肺炎克雷伯菌和鲍氏不动杆菌（r=-0．547，P〈O．01;r2=0．460，P〈0．05）。结论：喹诺酮类、糖肽类、青霉素类和青霉素＋酶抑制剂类药物使用强度的变化对病原菌临床分离率的影响可能较大；有针对性地调整这几类药物的使用强度有可能降低这些病原菌的临床分离率。     

Significance of Laboratory and Clinical Manifestations of Antiphospholipid Syndrome

##正##Clinical features of antiphospholipid syndrome Antiphospholipid syndrome(APS) is a form of immune mediated thrombophilia,characterized by thrombosis, recurrent fetal death and the presence of circulating antiphospholipid(aPL) antibodies directed against anionic phospholipids or protein-phospholipid complexes. Almost every vascular bed can be involved by thrombosis     

Clinical Spectrum of Vulva Metastatic Crohn’s Disease

Crohn’s disease is a chronic granulomatous disorder that may involve any segment of the gastrointestinal tract. Extraintestinal manifestations of Crohn’s disease such as erythema nodosum and pyoderma gangrenosum are well recognized and appreciated. However, metastatic Crohn’s disease (MCD), defined as the same granulomatous inflammation seen in Crohn’s disease but at a skin site distant to the gastrointestinal tract, is less well recognized. We report three cases of MCD involving the perianal and vulvar skin that initially presented with vulvar pain.     

Multisystem manifestations of mitochondrial disorders

Mitochondria are cytoplasmic organelles in eukaryotic cells that accomplish several distinct vital functions, including oxidative phosphorylation, metabolic anaplerotic and degradative pathways, and integration of signaling for apoptosis. Impaired oxidative phosphorylation, the common final pathway of mitochondrial metabolism, results in a variety of clinical manifestations, and the term mitochondrial disorders is currently ascribed to (mostly) genetic diseases of the respiratory chain associated with mitochondrial DNA mutation or nuclear DNA mutations. Genetic disorders with impaired oxidative phosphorylation are extremely heterogeneous, as their clinical presentation ranges from lesions of single tissues or specialized structures, such as the optic nerve in the mitochondrial DNA-associated Leber’s hereditary optic neuropathy and in the nuclear DNA-associated dominant optic atrophy, to more widespread pathologies, including myopathies, peripheral neuropathies, encephalomyopathies, cardiopathies, or complex multisystem disorders. The age at onset ranges from neonatal to adult life. This review focuses on mitochondrial diseases that find significant expression outside the central nervous system and the peripheral neuromuscular system, and manifest with substantial clinical signs and symptoms in tissues and organs such as the heart, endocrine system, liver, kidney, blood, and gastrointestinal tract. The available information on putative genotype–phenotype correlations and the related pathogenic mechanisms are summarized when appropriate. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

河南省1996～2000年食物中毒分析

目的 研究河南省食物中毒发生的规律及趋势,探讨预防措施,以减少食物中毒的发生。方法 对河南省1996～2000年全省各地市食品卫生监督机构食物中毒个案报表汇总统计,根据其发生中毒的种类、场所、致病因素等进行归类,食物中毒的诊断按国家标准进行。结果 食物中毒的发生在河南省种类多是植物性食品、场所以农村乡镇家庭聚餐为最多。致病因素多是农药和化学物。结论 针对食物中毒发生的种类、场所及致病因素,加强预防性卫生监督,减少食物中毒的发生。     

纤维肌痛综合征疼痛机制的研究进展

纤维肌痛综合征（FMS）是风湿病门诊中的常见病，其疼痛的病因、发病机制尚未完全阐明。最新的研究热点集中于中枢神经系统疼痛传导通路的异常，如中枢致敏和疼痛抑制不充分等。外周组织伤害性传入刺激也作为相关因素引发和／或维持中枢致敏状态，同时神经内分泌和应激反应异常在FMS发病中也起重要作用。