用精制7—ADCA生产头孢拉定

为确保头抱拉定的色级在效期内符合药典标准,将主要原料7-ADCA进行精制,利用平行试验的方法,对比头孢拉定的色级及色级稳定性。用精制后的7-ADCA制成的头孢拉定色级由原来的5＃降至2＃,在效期内≤8＃,含量几乎不变,减少了头孢拉定的退货率。     

HPLC法测定加替沙星注射液的含量

采用HPLC法测定加替沙星注射液含量。方法精密，准确度高，重现性好。在4.4μg/ml-21.4μg/ml浓度范围内线性关系好。回收率为99.8%，RSD为0.7%。操作简便，结果准确。     

Prevalence of transfusion-transmitted Chagas disease among multitransfused patients in Brazil

Background

Prevalence and risk factors for Chlamydia trachomatis infection among young men in Switzerland is still unknown. The objective of the present study was to assess prevalence and risk factors for C. trachomatis infection in young Swiss men.

Methods

517 young Swiss men were enrolled in this cross-sectional study during their compulsory military recruitment. Participants completed a questionnaire and gave urine samples which were screened for C. trachomatis DNA by PCR. Genotyping of positive samples was done by amplification and sequencing the ompA gene.

Results

The prevalence of chlamydial infection among young Swiss male was 1.2% (95% confidence interval [95%CI], 0.4–2.5%). C. trachomatis infection was only identified among the 306 men having multiple sexual partner. Although frequent, neither unprotected sex (absence of condom use), nor alcohol and drug abuse were associated with chlamydial infection. Men living in cities were more frequently infected (2.9%, 95%CI 0.8–7.4%) than men living in rural areas (0.5%, 95%CI 0.1–1.9%, p = 0.046). Moreover, naturalised Swiss citizens were more often positive (4.9%, 95%CI 1.3–12.5%) than native-born Swiss men (0.5%, 95%CI 0.1–1.7%, p = 0.003).

Conclusion

In comparison with other countries, the prevalence of chlamydial infection in men is extremely low in Switzerland, despite a significant prevalence of risky sexual behaviour. C. trachomatis infection was especially prevalent in men with multiple sexual partners. Further research is required (i) to define which subgroup of the general population should be routinely screened, and (ii) to test whether such a targeted screening strategy will be effective to reduce the prevalence of chlamydial infection among this population.     

A Comparison of Open Surgery,Robotic-Assisted Surgery and Conventional Laparoscopic Surgery in the Treatment of Morbidly Obese Endometrial Cancer Patients

Methods:Morbidly obese (body mass index [BMI] > 40 kg/m²) patients with endometrial cancer who underwent OS, robotic-assisted laparoscopic surgery (RS), or conventional laparoscopic surgery (LS) were eligible. We sought to discern any outcome differences with regard to operative time, perioperative complications, and hospital stay.Results:Sixteen patients were treated with LS (BMI = 47.9 kg/m²), 13 were managed via RS (BMI = 51.2 kg/m²), and 24 underwent OS (BMI = 53.7 kg/m²). The OS (1.35 hours) patients had a significantly shorter operative duration than the LS (1.82 hours) and RS (2.78 hours) patients (P < .001); blood loss was greater in the OS (250 mL) group in comparison with the RS (100 mL) and LS (175 mL) patients (P = .002). Moreover, the OS (4 days) subjects had a significantly longer hospital stay than the LS (2 days) and RS (2 days) patients (P = .002).Conclusion:In the present study, we ascertained that minimally invasive surgery was associated with longer operative times but lower rates of blood loss and shorter hospital stay duration compared with treatment comprising an open procedure.     

Low Frequency of CXCR4-Using Viruses in Patients at the Time of Primary Non-Subtype-B HIV-1 Infection

We used genotypic and phenotypic assays to estimate the frequency of X4/DM viruses in 131 patients infected with non-subtype-B viruses at the time of primary HIV-1 infection (PHI). All patients were enrolled in the French PRIMO Cohort from 1996 to 2007. Most strains belonged to CRF02_AG (51.1%) and subtype A (14.5%). Sixteen viruses (12.2%) were classified as CXCR4 tropic (“X4 strains”) by the combined criteria of amino acids 11 and 25 of the V3 loop (11/25) and net charge rules and/or the SVMgeno2pheno_10% algorithm: 6 strains by the combined genotypic rule, 7 by the SVMgeno2pheno_10% algorithm, and 3, clustering in subtype D, by both algorithms. However, only one strain (0.8%), belonging to subtype A, was defined as a dual-tropic (DM) virus by the phenotypic assay. The 67 CRF02_AG strains included 2 classified as X4 strains by the combined genotypic rule (3%) and 2 others classified as X4 strains by SVMgeno2pheno_10% (3%), but none of these 4 strains was an X4 or DM strain according to the phenotypic assay. These results suggest that the cellular virus reservoir was established with X4 strains in very few non-subtype-B-infected patients at the time of PHI. Genotypic predictions can overestimate the proportion of non-subtype-B X4 viruses at PHI.Human immunodeficiency virus type 1 (HIV-1) can be characterized by the host chemokine coreceptor that it uses to enter CD4-expressing cells. HIV-1 variants usually bind to the CCR5 chemokine coreceptor early in the course of disease. These are “R5” viruses (3, 31, 48). Viruses that use another chemokine coreceptor, CXCR4, are “X4” viruses, and they emerge later in HIV infection. They can account for up to 40 to 50% of all viruses in heavily treated patients with advanced disease (1, 32). The presence of X4 viruses has been associated with accelerated disease progression and a precipitous loss of CD4 T cells (27, 29, 40). A recent Swiss study suggested that the presence of X4 strains and the X4-specific virus load strongly predict clinical disease progression during combined antiretroviral therapy (cART), in addition to the CD4 T-cell count or viral load (44). This potential correlation between virus tropism and disease progression has important clinical implications. The development of coreceptor CCR5 antagonists for treating retroviruses and the lack of a virological response by patients infected with X4 or dual/mixed (X4/DM) viruses have increased the need to determine HIV-1 tropism.Recent studies have found the frequency of X4/DM dual-tropic strains in plasma samples from recently infected patients in the United States and Spain to be from 3.2% to 17.5% (14, 15, 16). Similarly, we found 15.9% (95% confidence interval [CI], 12.3% to 19.5%) strains of X4/DM viruses in 390 HIV-1 subtype B-infected patients diagnosed at the time of primary HIV-1 infection (PHI) in France from 1996 to 2007 (18).One of the major challenges of determining tropism is to select the best method for identifying coreceptor usage. HIV coreceptor usage is most commonly determined with a recombinant phenotype assay in clinical studies (28, 45). Bioinformatic tools based on the virus genotype may also be able to predict coreceptor usage. They are faster, less expensive, and more suitable for studies of a large number of patients than are phenotypic recombinant assays. Each available genotypic test is adequately specific but not very sensitive for detecting X4/DM or X4 variants. An overall concordance of 71.2 to 92% between genotypic and phenotypic assays has been reported (8, 15, 37, 41). However, most of these studies included HIV-1 subtype B strains. Genotypic algorithms may not be suitable for predicting the tropism of non-subtype-B HIV-1 strains (20). Two recent studies demonstrated that genotypic tests performed well for predicting the coreceptor usage of CRF02_AG and subtype C strains (36, 38), but no study has examined the correlation between genotypic and phenotypic tests for predicting the tropism of non-subtype-B HIV-1 at the time of PHI. The French PRIMO Cohort contained a large proportion of patients infected with a non-subtype-B virus (25.5% in 2005 to 2006) (6).We have therefore estimated the frequency of X4/DM viruses in 131 patients infected with non-subtype-B viruses at the time of PHI. All of them were enrolled in the French PRIMO Cohort from 1996 to 2007. We also studied the concordance between genotypic and phenotypic assays for predicting the tropism of non-subtype-B viruses in these patients.     

Sequential chemotherapy and radiotherapy as sandwich therapy for the treatment of high risk endometrial cancer

Objective

The purpose of this retrospective study was to assess the tolerability and efficacy of sequential chemotherapy and radiotherapy for the treatment of high risk endometrial cancer.

Methods

We conducted a retrospective study of previously untreated high risk endometrial cancer patients who received sequential chemotherapy and radiotherapy in accordance with the sandwich approach from June 2008 until June 2011. High risk endometrial cancer patients underwent complete surgical staging followed by adjuvant therapy encompassing sequential chemotherapy, radiation therapy and consolidation chemotherapy.

Results

The study analysis comprised 32 endometrial cancer patients. All subjects were treated with carboplatin and paclitaxel chemotherapy; currently, 186 cycles have been administered and 94% of patients have completed the planned number of cycles. Grade 3 neutropenia developed in 1 (3.1%) patient; there was no incidence of grade 4 neutropenia. Moreover, we observed grade 3 anemia in four (12.5%) patients and grade 4 anemia in one (3.1%) patient. One (3.1%) patient developed grade 3 thrombocytopenia; grade 4 thrombocytopenia was not observed. Five patients exhibited progressive disease, three of whom have since expired; mean progression free survival and follow-up were 17.4 months and 18.9 months, respectively.

Conclusion

The preliminary results from our study suggest that the sandwich approach to treating high risk endometrial cancer patients is feasible. Hematologic toxicity was well tolerated and non-hematologic toxicity was mild and easily managed. Further study of this novel regimen in a larger patient population with extended follow-up is necessary.     

Virological characterization of an infection with a dual-tropic, multidrug-resistant HIV-1 and further evolution on antiretroviral therapy

We studied a case of recent infection with multidrug-resistant (MDR) HIV-1. Over 16 months off-therapy, the CD4 cell count decreased from 419 to 184 cells/mul. Antiretroviral therapy (ART) then led to an incomplete virological response but to an immunological benefit, concurrently with a shift to CCR5-only tropism and a reduction in replication capacity. ART, even if suboptimal, can be of interest in the case of MDR virus infection.     

CD4 cell recovery in treated HIV-2-infected adults is lower than expected: results from the French ANRS CO5 HIV-2 cohort

In 61 antiretroviral-naive HIV-2-infected patients starting triple therapy at a median CD4 cell count of 136 cells/microl, the median increase was 41 cells/microl at month 12, which was no different among those on protease inhibitors or triple nucleoside analogues. Despite virological response, as the median plasma load was under the detectable threshold from month 3, CD4 cell recovery remained poor in treated HIV-2 infection. Our results raise the question of the optimal regimen to recommend in HIV-2-infected patients.