艾滋病合并结核的临床特点及分析

目的对艾滋病合并结核病患者的临床资料进行分析,总结其临床特点,提高对艾滋病合并结核感染的认识。方法对近年来本院收治的艾滋病合并结核病的患者60例进行临床分析。结果60例患者中肺外结核21例,占35％;肺结核39例,占65％;蛋白纯化衍生物（PPD）试验弱阳性5例（8．3％）;痰涂片、痰培养查抗酸杆菌仅6例阳性（10％）。60例患者治疗前CD4＋T淋巴细胞计数明显低于其他未合并结核病的艾滋病患者（P〈0．01）。结论艾滋病合并结核病患者PPD试验阳性率低,治疗前CD4＋T淋巴细胞计数明显降低,发生血行播散型肺结核和肺外结核多见;结核是引起艾滋病机会性感染和死亡的主要疾病,而CD4＋T淋巴细胞计数和功能低下是最主要的原因。     

艾滋病临床与IL—2免疫重建治疗的研究

目的:了解深圳地区艾滋病患者的临床流行病学及并发症发生情况,HIV抗病毒及IL-2免疫重建治疗的效果。方法:25例AIDS患者的临床流行病学及并发症,高效抗逆转录病毒治疗(HAART)及IL-2免疫重建治疗进行回顾性分析。结果:艾滋病患者并发症发生部位多系统受累者达88%,机会性感染占所有并发症的68.5%。并发症依次为细菌性肺炎、消化道真菌感染、性病、结核杆菌感染、疱疹病毒感染、肺孢子虫肺炎、皮肤粘膜损害及全血细胞减少等。HIV主要感染途径为性接触占80%,而吸毒途径的为20%。艾滋病患者血红蛋白(Hb)含量的高低对其预后及存活率的判断有重要意义。Hb>8g/dl的艾滋病患者其存活率远高于Hb<8g/dl者。用HAART治疗的艾滋病患者其存活率为81.3%,经HAART治疗一月后,CD4+细胞数目及CD4+/CD8+比值均明显升高。对少数患者使用小剂量IL-2进行免疫重建治疗,可明显减少艾滋病患者的并发症,并提高CD4+水平。结论:艾滋病患者临床表现多样,但并发症仍以机会性感染为主,故临床治疗应以HAART及控制机会性感染治疗为主,建议同时辅以免疫重建治疗,可明显提高生存率及生活质量。     

46例艾滋病合并重度贫血的临床特征及病因分析

目的 分析艾滋病合并重度贫血患者的临床特征和病因。方法 回顾性分析46例艾滋病合并重度贫血患者的临床资料,了解重度贫血发生的临床特征及病因,分析其与年龄、高效抗逆转录病毒疗法(HAART)治疗、CD4 T淋巴细胞计数、艾滋病病毒核糖核酸(HIV-RNA)、药物、感染、肿瘤之间的关系。结果 46例艾滋病合并重度贫血患者中已HAART治疗患者14例, 10例使用含有齐多夫定片的HAART方案, 3例发生恶性肿瘤,未行HAART治疗或治疗后自行停药的32例患者中88%患者CD4 T淋巴细胞计数<50个/μl, HIV-RNA>10⁶ IU/ml患者占53%,与多重机会性感染有关,且为严重感染。13例患者死亡、占28%。结论 艾滋病合并重度贫血主要与CD4 T淋巴细胞计数、HIV-RNA、HAART药物、恶性肿瘤、机会性感染等主要因素相关。     

长兴县2012—2020年中老年艾滋病患者抗病毒治疗情况分析

目的 分析长兴县年老年艾滋病患者抗病毒治疗情况。方法 长兴县2012—2020年接受抗病毒治疗的老年艾滋病患者80例,回顾性分析其人口学特征和治疗情况。结果 80例中男性占65.0%,50～65岁占71.3%,高中及以下占78.8%,已婚/同居占72.5%,同性性传播占58.8%,CD4细胞计数<200个/μL占42.5%,WHO分期Ⅰ期占85.0%,拉米夫定+替诺福韦+依非韦仑治疗方案占51.3%。抗病毒治疗6、12、24个月后患者CD4细胞计数均高于治疗前,且随着治疗时间的延长呈现逐渐升高的趋势。治疗24个月后,病毒完全抑制71例（88.8%）,出现药物不良反应18例（22.5%）,免疫重建不良14例（17.5%）,死亡5例（6.2%）。结论 长兴县2012—2020年接受抗病毒治疗的老年艾滋病患者人口学特征表现为以已婚中老年男性、文化程度低下、性传播为主,抗病毒治疗效果较为理想,能够有效抑制艾滋病病毒,促进CD4细胞计数上升,有利于免疫功能改善,但存在一定药物不良反应和免疫重建不良,临床应密切关注老年艾滋病患者病情进展,按照患者具体情况实施抗病毒治疗,以提高生存率。     

艾滋病合并马尔尼菲青霉菌病63例患者的护理

艾滋病合并马尔尼菲青霉菌病（PSM）的患者抵抗力低,CD4^＋水平低,病死率高,该中心对2007年1月至2013年12月收治的63例艾滋病合并PSM患者采取药物治疗护理、健康宣教、消毒隔离等一系列规范的护理措施,其中60例好转出院（3例发生轻度静脉炎）,3例中途拒绝治疗,未愈出院。因此,提高对艾滋病合并PSM的认识,通过早治疗及有效的护理,可促进疾病康复,改善患者预后,提高其生活质量。     

28例艾滋病合并隐形脑膜炎患者的护理

目的:探讨艾滋病合并隐形脑膜炎患者的临床特点及护理方法。方法:对2008年8月～2010年10月本科收治的28例艾滋病合并隐形脑膜炎患者进行临床分析,并对其实施心理护理、饮食指导、药物观察及护理、腰穿后的护理、口腔及皮肤护理等。结果:隐球菌脑膜炎症状好转,颅内压降低,血CD4上升,28例多为青壮年,20例好转,3例自动出院放弃治疗,5例AIDS后期多脏器功能衰竭死亡。结论:艾滋病合并隐形脑膜炎的患者抵抗力低,CD4低,病死率高,只要提高认识,通过早治疗及有效的护理,即可改善预后,提高患者生活质量。     

哈尔滨市社会组织开展男男同性传播艾滋病病毒感染者/艾滋病患者病例随访效果分析

目的 了解并评估哈尔滨市社会组织开展男男同性传播艾滋病病毒感染者/艾滋病患者病例的随访及CD4+T检测、免费抗病毒治疗工作的效果,为制订下一步艾滋病防治策略提供数据支持。方法 选取2020年1月至12月“中国疾病预防控制信息系统”中“艾滋病综合防治数据信息系统”的5 413例艾滋病病毒感染者及艾滋病患者为研究对象进行回顾性分析。根据随访情况,将其分为常规随访组（4 566例）和社会组织随访组（847例）。常规随访组为疾控中心与定点治疗医院对病例进行每年一次的常规随访,社会组织随访组在常规随访的基础上,采用由社会组织配合疾控中心及定点治疗医院为病例提供随访及治疗服务的模式进行随访。比较两组艾滋病病毒感染者/艾滋病患者的随访及CD4+T检测率、坚持治疗率、病毒学抑制率。结果 社会组织随访组的随访及CD4+T检测率、坚持治疗率、病毒学抑制率均高于常规随访组,差异均有统计学意义（P<0.01）。结论 社会组织参与艾滋病随访关怀工作效果显著,对哈尔滨市艾滋病防治工作起到积极的促进作用,可供艾滋病流行特征相似的城市推广借鉴。     

罗定市2014年新发现HIV感染者首次CD4+T淋巴细胞检测情况分析

目的 了解人类免疫缺陷病毒(HIV)新感染者的首次CD4+T淋巴细胞检测情况,尽早发现机体免疫功能情况,为艾滋病防治工作提供有力的科学依据。方法 对罗定市2014年新发现的HIV感染者采取全血样本,用流式细胞仪进行CD4+T淋巴细胞检测并统计分析检测数据。结果 共检测83例HIV/艾滋病(AIDS)的外周血样本,HIV/AIDS首次检测的CD4+T淋巴细胞均值为(158.04±180.45)个/μl,其中≤200个/μl有54例,占65.06%;201~350个/μl有22例,占26.51%;351~500个/μl有2例,占2.41%;CD4>500个/μl有5例,占6.02%。不同性别CD4+T淋巴细胞计数比较,差异无统计学意义(t=-1.569,P>0.05)、不同年龄CD4+T淋巴细胞计数比较,差异有统计学意义(F=6.480,P<0.05)。结论 HIV感染者首次CD4+T淋巴细胞免疫水平较低,HIV感染者发现较晚。早发现、早治疗是防治AIDS的重要措施。对新发现的HIV感染者进行首次CD4+T淋巴细胞检测,以便及时发现是否感染或是否需要及时进行抗病毒治疗,以提高机体免疫力,从而降低机会性感染和病死率,提高患者生存质量。     

艾滋病合并非结核分枝杆菌病28例临床分析

目的探讨艾滋病（AIDS）合并非结核分枝杆菌病（NTM）的临床特点、诊断和治疗方法。方法对28例AIDS/NTM患者的临床资料进行分析。结果AIDS/NTM以发热和咳嗽为主要表现,NTM占同期艾滋病合并分枝杆菌肺病（AIDS/PTB）的25.93%。CD4＋T淋巴细胞平均值为（47.79±32.17）×106/L,X线胸片异常17例,抗酸杆菌培养阳性28例,涂片阳性1例,治疗后死亡3例（10.71%）。结论AIDS/NTM感染率高,诊断困难。患者免疫功能差,并发症多,经过抗分枝杆菌、抗病毒等治疗后大部分患者有明显好转。     

艾滋病患者抗病毒治疗的疗效及对免疫功能的影响

目的：探讨艾滋病患者抗病毒治疗的疗效及对免疫功能的影响,进一步提高艾滋病患者抗病毒的治疗效果。方法选取收治的80例艾滋病患者为研究对象,对其进行高效联合抗病毒（HAART）治疗,观察病毒载量及免疫功能。结果治疗后,73患者CD4＋淋巴细胞计数上升,较治疗前差异具有统计学意义（P〈0.05）;65例患者的全血病毒载量（HIVRNA）〈50拷贝/ml,3例〈100拷贝/ml,病毒抑制有效率为85%。结论抗病毒治疗艾滋病患者能提高患者的CD4＋T淋巴细胞水平,并能有效抑制艾滋病病毒的复制率,对艾滋病患者有确切的疗效,值得临床进一步推广使用。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

---

Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.