Prevalence of Thrombocytopenia among Chinese Adult Antiretroviral-na?ve HIV-positive Patients

Background:

The prevalence of thrombocytopenia among Chinese antiretroviral therapy (ART)-naïve HIV-infected adults has not been well-described. The aim of this study was to investigate the prevalence and associated risk factors of thrombocytopenia among Chinese ART-naïve HIV-infected adults.

Methods:

We performed a cross-sectional study of Chinese adult ART-naïve HIV-infected patients from September 2005 through August 2014. Socio-demographic variables and laboratory results including platelets, CD4+ cell count, and viral load were obtained from medical records. Factors and outcomes associated with thrombocytopenia were assessed using logistic regression.

Results:

A total of 1730 adult ART-naïve HIV-infected patients was included. The mean age was 38 years. The prevalence of thrombocytopenia was 4.5%. There were significant differences in the prevalence of thrombocytopenia between patients <30 years of age (2.8%) and 30–39 years (4.0%) compared with patients greater than 50 years (7.0%) (P = 0.006 and P = 0.044, respectively). The prevalence of thrombocytopenia was also significantly different between patients with CD4+ counts of 200–349 cells/mm³ (3.3%) and >350 cells/mm³ (2.8%) compared with patients with CD4+ counts of 50–199 cells/mm³ (7.1%) (P = 0.002 and P = 0.005, respectively). The prevalence of thrombocytopenia was significantly different by hepatitis C virus antibody (HCV-Ab) seropositivity (10.2% for HCV-Ab positive vs. 3.9% for HCV-Ab negative, P = 0.001). We observed differences in prevalence of thrombocytopenia by mode of transmission of HIV infection: Blood transmission (10.7%) versus men who have sex with men (3.9%) (P = 0.002) and versus heterosexual transmission (3.9%) (P = 0.001). In binary logistic regression analyses, age ≥50 years, HCV-Ab positivity and having a CD4+ cell count of 50–199 cells/mm³ were significantly associated with thrombocytopenia with adjusted odds ratio of 2.482 (95% confidence interval [CI]: 1.167, 5.281, P = 0.018), 2.091 (95% CI: 1.078, 4.055, P = 0.029) and 2.259 (95% CI: 1.028, 4.962, P = 0.042), respectively.

Conclusions:

Thrombocytopenia is not common among adult ART-naïve HIV-infected patients in China. Older age (age over 50 years), HCV-Ab positivity and lower CD4+ cell count are associated with an increased risk of thrombocytopenia. Therefore, early diagnosis and treatment of thrombocytopenia in these patients are necessary.     

Pedestrian Injuries and the Relevant Burden in Shanghai,China:Implications for Control

Objective To study the associations of pedestrian injuries with age, income and educational level in Shanghai and to analyze the relative disease burden. Methods Information on pedestrian-related cases and deaths were collected from 494 hospitals and mortality registry systems from 1992 to 2010, and a multistage cluster sampling survey conducted in 2006. Logistic regression model was used in the analyses. Results The age group of 5-9 had the highest mortality and morbidity among children. Mortality increased obviously among those aged 60 or above. Individuals with an educational level under the primary school and with the lower family average income were more likely to suffer pedestrian-related injuries. Multivariate Logistic analysis demonstrated that lower income and lower educational level increased the risk of pedestrian injuries with the odds ratio of 1.40 (95%CI:1.15-1.71) and 1.70 (95%CI:1.20-2-40), respectively. About 13.54% of the share of GDP for the healthcare, social security and welfare industries in Shanghai was occupied by the burden of pedestrian-related injuries in 2006. Conclusion Pedestrian-related injury has inverse association with victims’ income and educational level. Children of 5-9 years old and adults over 60 with lower educational level and lower monthly income are the target persons to be intervened.     

烧伤感染后血清补体 C3 IL-10的变化

目的：探究机体烧伤感染后免疫因子的水平变化。方法选取2013年4月至2014年2月我院收治的200例烧伤患者,分别于烧伤后第3、7、14天检测观察外周血补体C3、IL‐10水平并进行比较。结果随着时间的推移,患者创面感染率升高;烧伤后患者补体C3和IL‐10的水平均呈现先上升后下降的变化;感染患者体内的补体C3水平均高于未感染患者;烧伤后脓毒血症患者机体补体C3和IL‐10水平均高于单独创面感染患者。结论烧伤后感染可影响患者血清补体C3和 IL‐10水平的改变,可通过对相应免疫因子水平的调节进行治疗以维持患者体内免疫反应平衡,防止感染加重。     

基于医生视角下网络环境对医患关系的影响研究

通过对医生群体的问卷调查,了解医生上网习惯情况、医生与患者的网络交流沟通情况、网络环境对医生实际诊疗的影响、网络环境下新闻媒体对医生的影响以及医生群体关于网络发展对医患关系影响的综合看法。指出了目前网络环境给医患关系带来的影响：互联网成为一些医生知识信息更新与积累的源地,网络成为一些医生与患者交流互动的重要平台,医生需要应对日益增多的“网络型”患者,医生对媒体负面报道的反应性出现转变。     

桑黄多糖缓解日本血吸虫感染小鼠氧化应激及 肝纤维化的实验研究

目的　探讨桑黄醇提多糖（PPI）对日本血吸虫感染小鼠氧化应激、肝肉芽肿和肝纤维化的改善作用。方法　采用日本血吸虫尾蚴玻片贴腹感染法建立日本血吸虫肝病小鼠模型。设健康对照组（A组）、感染对照组（B组）、PPI单独治疗组（C组）、吡喹酮单独治疗组（D组）和PPI加吡喹酮混合治疗组（E组），每组各10只小鼠；除A组外，其他各组每只小鼠感染（30 ± 2）条尾蚴。自感染后42 d开始，D、E组小鼠灌胃给予500 mg/kg吡喹酮，连续2 d；C、E组给予400 mg/kg PPI灌胃，连续给药30 d。HE染色观察小鼠肝组织病理学改变，测定小鼠血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、透明质酸（HA）、层黏连蛋白（LN）及小鼠肝组织匀浆中丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH?PX）、谷胱甘肽还原酶（GSH?R）、谷胱甘肽（GSH）含量，采用免疫组化技术检测小鼠肝组织中转化生长因子?β（TGF?β）、α?平滑肌肌动蛋白（α?SMA）表达水平，采用实时荧光定量PCR检测Nrf2、Gsta4基因表达水平。结果　日本血吸虫感染但未予治疗小鼠出现典型血吸虫病肝病病理改变，PPI干预后能有效减轻小鼠肝虫卵肉芽肿及胶原沉积。血吸虫病肝病小鼠肝脏脂质过氧化加剧，诱导了氧化应激，小鼠血清中MDA含量增加，GSH和各种抗氧化酶含量下降。与B组相比，PPI治疗抑制了脂质过氧化，提高了GSH含量，恢复了抗氧化酶活性。此外，PPI治疗可抑制TGF?β信号通路，提升Nrf2、Gsta4基因表达水平。结论　PPI在治疗血吸虫病肝纤维化方面发挥重要作用，其内在机制可能是通过上调Nrf2和Gsta4基因表达、改善氧化应激损伤，从而抑制肝脏虫卵肉芽肿形成和肝纤维化。     

Novel NOD2 haplotype strengthens the association between TLR4 Asp299gly and Crohn's disease in an Australian population

BACKGROUND: The first major Crohn's disease (CD) susceptibility gene, NOD2, implicates the innate intestinal immune system and other pattern recognition receptors in the pathogenesis of this chronic, debilitating disorder. These include the Toll-like receptors, specifically TLR4 and TLR5. A variant in the TLR4 gene (A299G) has demonstrated variable association with CD. We aimed to investigate the relationship between TLR4 A299G and TLR5 N392ST, and an Australian inflammatory bowel disease cohort, and to explore the strength of association between TLR4 A299G and CD using global meta-analysis. METHODS: Cases (CD = 619, ulcerative colitis = 300) and controls (n = 360) were genotyped for TLR4 A299G, TLR5 N392ST, and the 4 major NOD2 mutations. Data were interrogated for case-control analysis prior to and after stratification by NOD2 genotype. Genotype-phenotype relationships were also sought. Meta-analysis was conducted via RevMan. RESULTS: The TLR4 A299G variant allele showed a significant association with CD compared to controls (P = 0.04) and a novel NOD2 haplotype was identified which strengthened this (P = 0.003). Furthermore, we identified that TLR4 A299G was associated with CD limited to the colon (P = 0.02). In the presence of the novel NOD2 haplotype, TLR4 A299G was more strongly associated with colonic disease (P < 0.001) and nonstricturing disease (P = 0.009). A meta-analysis of 11 CD cohorts identified a 1.5-fold increase in risk for the variant TLR4 A299G allele (P < 0.00001). CONCLUSIONS: TLR 4 A299G appears to be a significant risk factor for CD, in particular colonic, nonstricturing disease. Furthermore, we identified a novel NOD2 haplotype that strengthens the relationship between TLR4 A299G and these phenotypes.     

并殖吸虫病86例临床分析

1 一般资料 1．1年龄与性别 86例并殖吸虫病患者中男性63例，女性23例。3～5岁23例，6～10岁38例，11～15岁21例，16～20岁3例，20岁以上1例。 1．2 籍贯 四川省81例，云南省1例，广东省3例，贵州省1例。     

不同免疫原免疫小鼠后抗细粒棘球绦虫感染的免疫功能观察

目的 观察经猪囊尾蚴和细粒棘球绦虫抗原免疫的昆明小鼠后,感染细粒棘球绦虫后的免疫功能。方法将4种细粒棘球蚴和猪囊尾蚴体抗原及分泌抗原分别免疫4组小鼠,观察其诱发的抗体水平、对囊肿抑制率及其免疫细胞功能。结果 E.gPS组抑制率(77.1％)显著高于其它3组(P<0.05),其湿重(374±12.3mg)与对照组(163.0±53.7mg)相比差异具有非常显著性(q=5.9671,P<0.01);与另外3组比较差异也均有显著性(q=4.2061、4.3796、4.8670,P<0.05)。巨噬细胞吞噬指数(IM):E.gPS组显著高于对照组、C.cSW组及E.gCF组(q=9.9592、8.3332、8.6719,P均<0.01)。胸腺指数(IT):E.gPS组、E.gCF组显著低于对照组(q=5.2242、5.6189,P均<0.01)和C.cSW组(q=4.0466、4.4391,P均<0.05)。脾脏指数(IS):E.gPS组显著高于C.cSW组(q=4.8251,P<0.01)、E.gCF组和对照组(q=4.4078、3.3374,P均<0.05)。结论 经E.gPS抗原免疫的昆明小鼠明显增强了抗细粒棘球绦虫感染的免疫功能。     

脊髓损伤后早期小鼠肠道功能的变化

目的探讨脊髓损伤后短期内小鼠肠道功能的变化。方法将105只昆明种小鼠随机分为正常组(A组,n=30)、假手术组(B组,n=30)和模型组(C组,n=45)。A组不作处理,B组仅暴露脊髓,不夹持。C组采用动脉瘤夹夹持T10处脊髓,复制脊髓损伤模型。分别于术后12 h、24 h、48 h测定小鼠回肠肌电慢波及平滑肌收缩力,并做回肠HE染色。结果脊髓损伤后12 h、24h、48 h,C组小鼠肌电频率和振幅低于A组和B组(P0.05),收缩力振幅低于A组和B组(P0.05),但24 h、48 h后收缩力频率高于A组和B组(P0.05)。C组各时间点肠黏膜评分均较A组和B组高(P0.05)。结论小鼠脊髓损伤后早期,肠道平滑肌肌电活动减弱,收缩力减小,肠黏膜轻度损伤。     

运动发育推拿法与神经发育疗法对小儿脑性瘫痪的疗效比较

目的比较运动发育推拿法与神经发育疗法在小儿脑瘫治疗中的疗效。方法依据纳入和排除标准和分层配对原则,回顾性研究接受运动发育推拿治疗与传统神经发育疗法两组患儿粗大运动功能测量(GMFM-66)评分。结果两组各24例脑瘫患儿纳入研究。治疗后,两组患儿GMFM-66评分均高于治疗前,两组间无显著性差异(P=0.596)。结论运动发育推拿法和神经发育疗法都能改善脑瘫患儿的粗大运动功能,两种方法的疗效没有显著性差异。