湖北省十堰市艾滋病流行特征及变化趋势分析

目的 通过分析十堰市1998—2020年艾滋病疫情流行特征和变化趋势,为制定艾滋病精准防控措施提供科学依据。方法 对十堰市1998—2020年累计报告的HIV感染/AIDS疫情资料进行回顾性流行病学分析。结果 按现住址和终审日期统计,1998—2020年十堰市累计报告HIV感染/AIDS共1496例,其中男性1093例,女性403例,性别比为2.71:1。2020年底全市存活HIV感染/AIDS患者1094例,以2020年十堰市人口普查数据321万计算,十堰市艾滋病患病率为33.25/10万。1998—2020年报告病例呈现增长趋势,同时病死率也呈现上升趋势;艾滋病感染者年龄以20～49岁为主,占63.37%;职业以农民为主,占46.39%;传播途径以性传播为主,占86.83%,其次为经血液途径传播占10.63%。结论 十堰市艾滋病感染者以男性青壮年为主,性接触为主要传播途径;近年来老年人群、青年学生感染率增长较快,提示该市应根据流行特点,采取相应综合性防治措施。     

北京市东城区HIV/AIDS病例特征分析

目的分析北京市东城区艾滋病的流行病学特征,为东城区制定艾滋病综合防控措施提供依据。方法运用SAS 9.3软件,对全国艾滋病综合防治管理信息系统中,截止到2017年8月31日现住址为北京市东城区且存活可随访的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)进行统计分析。结果可随访HIV/AIDS病例为844例,其中HIV感染者为628例,AIDS病人为216例。男性感染者占96.80%(817例);20~50岁性活跃人群占83.29%(703例);非本区户籍病例占75.24%(635例);经性传播占97.63%(824例),其中同性性传播占79.03%(667例),异性性传播占18.60%(157例);病例来源于检测咨询占38.27%(323例),性病门诊占18.72%(158例)。结论东城区HIV/AIDS病人传播途径以男男性行为传播为主,病例主要来源于检测咨询和性病门诊。今后应重点加强男男性行为者及其配偶和医疗机构重点科室宣传干预和动员检测力度。     

2011年山东省报告的HIV/AIDS病例的报告来源分析

目的分析山东省2011年报告的艾滋病病毒感染者(HIV)和艾滋病(AIDS)病人的报告来源,为进一步发现HIV/AIDS病例、及时提供随访和医疗服务,从而为有效防控艾滋病提供科学依据。方法对2011年山东省报告的HIV/AIDS病例的流行病学调查资料进行统计学描述分析。结果 2011年山东省共报告HIV/AIDS病人885例,平均年龄(31.32±10.45)岁;男性占84.64%;高中及以上学历占39.78%;59.55%为本省户籍。传播途径以性传播为主,占72.55%,其中同性性传播36.95%,异性性传播35.60%。检测报告来源为检测咨询的占25.99%,医疗机构的占30.85%。女性病例、文化程度为初中的病例、异性性传播病例主要由医疗机构检测报告,男性病例、文化程度在高中及以上的病例、同性性传播病例主要由检测咨询点报告。结论同性性传播首次成为山东省艾滋病流行的主要传播方式,其主要报告来源为检测咨询点。可进一步探索检测咨询点对男男性行为人群开展溯源调查、随访干预工作模式。     

瑞丽市28年跨境缅甸籍HIV/AIDS病人流行特征分析

目的分析瑞丽市1989—2016年跨境缅甸籍艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的流行病学特征,为瑞丽市针对跨境缅甸籍人群制定艾滋病防治策略提供参考依据。方法利用全国艾滋病综合防治信息系统获得瑞丽市1989—2016年报告的缅甸籍HIV/AIDS病例信息,并对其进行流行病学特征分析。结果 1989—2016年,瑞丽市报告的缅甸籍HIV/AIDS病例其年均增长率为6.64%,累计报告病例4 577例,男女比例为2.71∶1, 20～39岁年龄段占77.54%,小学文化程度占40.77%,农民占39.46%,异性性传播占56.52%。其中,中老年病例、初中及以上文化程度病例、职业为长途司机病例、以及感染途径为异性性传播病例所占比例均总体呈上升趋势(P0.001)。2010年及以后每年报告的缅籍病例数高于同年报告的中国籍病例数,且总体缅籍病例数比例呈上升趋势(P0.001)。结论瑞丽市跨境缅甸籍人群艾滋病疫情发展迅速,急需采取针对性措施,控制其疫情发展。     

深圳市南山区1998-2012年HIV/AIDS流行情况分析

目的 了解15年来深圳市南山区HIV/AIDS监测和流行情况的变化趋势,分析流行因素,为今后防控措施的制定提供理论依据.方法 采用描述性流行病学研究方法分析深圳市南山区1998-2012年HIV/AIDS监测资料和调查资料.结果 病例报告数呈快速增长趋势,累计报告750例HIV/AIDS患者,其中20～40岁占多数,以外地流动人口为主;性传播是区内目前最主要的感染途径,占全部病例的74.80％,男男同性传播感染比例为38.27％.HIV/AIDS患者能够得到综合管理及免费抗病毒治疗.免费抗病毒治疗后,患者病死率从18.78％下降到3.35％.结论 近年来性传播途径感染者逐渐增加,疫情已向一般人群发展,新发现即进入发病期的感染者逐渐增多,老年男性感染者和男男同性性行为感染者增加较快.因此,应进一步加大宣传教育和防控力度,增强人群的自我保护意识.     

东莞市2009-2014年15~24岁HIV/AIDS病人的流行病学特征北大核心

目的了解东莞市15~24岁艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）疫情及变化趋势,为针对该人群开展艾滋病防控工作提供科学依据。方法收集东莞市2009-2014年15~24岁HIV/AIDS病人的疫情报告资料,对病例三间分布特点和传播途径构成进行分析。结果 2009-2014年,共报告15~24岁HIV/AIDS病人251例,报告例数呈现逐年增长的趋势,2009-2014年平均增长率为58.49%。HIV/AIDS病人平均年龄（21.76±1.659）岁,男性占74.10%（186/251）;家政/家务/待业占26.69%（67/251）,工人占17.93%（45/251）;性传播占97.61%（245/251）;15~24岁HIV/AIDS病人中,同性性传播所占比例显著高于同期其他年龄段,在学生群体的HIV/AIDS病人中所占比例显著高于其他职业的人群。结论 15~24岁人群的HIV/AIDS病人不断增加,性传播为主要传播途径,且同性性传播比例很高,应采取有针对性的措施降低HIV对该人群的危害。     

2002-2012年广州市学生HIV/AIDS流行情况

目的了解广州市学生的艾滋病病毒(HIV)流行特征,为开展对该人群的艾滋病(AIDS)防控工作提供科学依据。方法回顾性分析广州市2002-2012年学生的HIV流行特征。结果 2002-2012年,共报告117例学生HIV感染者/AIDS病例,占广州市总病例的比例从2008年的0.5%上升至2012年的2.5%。平均年龄(22.1±2.9)岁,最小14岁;男性占96.6%;大专及以上占79.5%;病例至少来自47所大中专院校。性传播感染占95.7%(112/117),同性性传播占72.6%(85/117);2009-2012年,学生病例中的同性性传播的比例逐年增加(χ2=6.70,P=0.035),2008-2012年,总体疫情中同性性传播的比例逐年增加(χ2=209.07,P=0.000);2008-2012年,学生中HIV感染者/AIDS病例同性性传播的比例高于广州市同期总体疫情中同性性传播的比例,差异有统计学意义(χ2=136.05,P=0.000)。病例通过自愿咨询检测发现的占32.5%,专题调查占25.6%。2008-2012年,学生人群中AIDS病例发现的时间较总体人群早(χ2=9.07,P=0.003),CD+4T淋巴细胞数200个/μL占92.3%。结论HIV对学生的影响已逐渐显现,应及早采取针对性的措施降低AIDS对该人群的危害。     

成都市新都区431例≥50岁HIV/AIDS病人生存时间及其影响因素分析

目的了解成都市新都区≥50岁艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的生存时间,并探讨相关影响因素。方法通过中国艾滋病综合防治信息系统下载2008-2017年报告现住址为新都区且年龄≥50岁的HIV/AIDS病例资料,计算病死率和累计生存概率,采用COX比例风险回归模型分析死亡的相关影响因素。结果新都区2008-2017年累计报告HIV/AIDS病人431例,死亡115例,占26.68%。病死率从2008年0升至2011年57.14%,后降至2017年14.75%。死亡者均为汉族,以60～69岁为主,占38.26%,男性占83.48%,未婚/离异/丧偶者占63.48%,61.74%为农民/工人,小学及以下占65.22%,94.78%为异性性传播,8.70%有性病史。≥50岁HIV阳性人群的平均生存时间为5.08年[95%可信区间(CI):4.55～5.61年],1、3、5年累计生存概率分别为78.18%、66.00%、53.09%。COX回归分析显示,年龄和首次CD4+T淋巴细胞计数是≥50岁HIV/AIDS病人死亡的影响因素。结论成都市新都区≥50岁HIV/AIDS死亡病例以男性为主,未婚/离异/丧偶比例高且文化程度偏低,≥50岁HIV/AIDS病例死亡风险高,与其年龄和首次CD4+T淋巴细胞计数有关。     

2017年贵州省新报告HIV/AIDS病例晚发现比例及其影响因素

目的了解2017年贵州省新报告艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)晚发现比例及其影响因素。方法通过"艾滋病综合防治信息系统",按照报告地下载2017年1月1日至12月31日期间,贵州省新报告的全部HIV/AIDS病例进行分析。结果 2017年贵州省新报告HIV/AIDS病人共7 843例,平均年龄(48.27±16.85)岁,其中男性占70.3%;本省户籍占95.2%;初中及以下文化程度占84.0%;汉族占70.0%;农民与农民工占64.7%;异性性传播占90.6%;医疗机构检测发现占71.5%。病例的晚发现比例为39.7%(3 117/7 843),多因素Logistic回归分析发现,女性、25岁年龄组、外省户籍、已婚有配偶、服务业人员、检测咨询及羁押人员检测来源病例晚发现比例较低。结论 2017年贵州省晚发现比例较高。继续加强全人群艾滋病的宣传教育,提高人群的HIV主动检测意识;积极推动医疗与疾病预防控制机构艾滋病主动检测咨询工作,提升病例的尽早发现水平对贵州省降低艾滋病的晚发现比例具有重要的意义。     

阿克苏地区50岁及以上人群HIV/AIDS流行病学分析

目的分析2013—2017年新疆阿克苏地区50岁及以上艾滋病人群流行病学特征和趋势,为制定有针对性的艾滋病防控措施提供参考依据。方法应用描述流行病学方法,分析2013—2017年阿克苏地区报告的50岁及以上人群HIV感染者/艾滋病病例(HIV/AIDS)数据。结果阿克苏地区共报告50岁及以上1 286例HIV/AIDS,占全地区总报告病例的23.71%,发病率由2013年的50.66/10万上升至2017年的106.70/10万;地区报告发病率居前三位的是沙雅县(113.93/10万)、新和县(107.42/10万)和库车县(75.28/10万),其中男性占25.47%,男女性别比为1.56∶1,以50～59岁为主、占67.96%,农民为主、占60.33%,小学文化程度为主、占48.06%,异性传播为主、占96.20%。结论阿克苏地区50岁及以上HIV/AIDS艾滋病疫情增长迅速,防控形势仍然十分严峻;应采取有针对性的防控措施,降低老年人群艾滋病感染风险。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.