Baculovirus per os Infectivity Factors Are Involved in HearNPV ODVs Infection of HzAM1 Cells in vitro

Baculoviruses produce two viral phenotypes, the budded virus (BV) and the occlusion-derived virus (ODV). ODVs are released from occlusion bodies in the midgut where they initiate a primary infection. Due to the lack of an in vitro system, the molecular mechanism of ODV infection is still unclear. Here we present data demonstrating that Helicoverpa armigera nucleopolyhedrovirus (HearNPV) ODV infected cultured Hz-AM1 cells in a pH dependent manner. The optimal pH for ODV infection was 8.5, which is same to that in the microvilli of midgut epithelial cells, the ODV native infection sites. Antibodies neutralization analysis indicated that four HearNPV oral infection essential genes p74, pif-1, pif-2 and pif-3 are also essential for HearNPV ODV infection in vitro. Thus, HearNPV-HzAM1 system can be used to analyze the mechanism of ODV entry.

The implementation and evaluation of HIV symptom management guidelines: A preliminary study in China

Objective:The overarching objective of this study was to examine the effectiveness of HIV symptom management guidelines in China in reducing the incidence and severity of symptoms and improving patients'quality of life.Methods:We conducted a controlled,pre-and post-implementation design in the HIV/AIDS inpatient unit in Shanghai.Patients recruited from November 2014 to February 2015 were in the intervention group and those from October 2013 to February 2014 were in the control group.There were 74 patients in each group.Participants in the intervention group received interventions based on the HIV symptom management guidelines.Overall symptom severity,depression,and quality of life were measured in two groups at baseline,week 4,and week 8.Results:Totally 126 patients completed the research,65 in the intervention group and 61 in the control group.The total symptom severity scores showed a statistically significant difference between groups across time(P<0.05).It showed that frequencies of fatigue(36.9%vs.44.3%),fever(6.2%vs.11.5%),loss in weight(9.2%vs.16.4%),mouth ulcers(12.3%vs.16.4%),headaches(9.2%vs.19.7%)and depression(F=1.09,P>0.05)in the intervention group were lower than those in the control group in week 8 without statistical significance.The multilevel growth mixture model indicated a greater increase in the total score of quality of life for the group treated according to the symptom management guidelines(P=0.04).Conclusion:The evidence-based HIV symptom management guidelines can improve a patient's quality of life and relieve negative symptoms.The guidelines can be applied in a similar context to other HIV/AIDS units or clinics.

Treatment of postoperative infectious complications in patients with human immunodef iciency virus infection

BACKGROUND: Antibiotics are widely given for surgical patients to prevent infection. Because of the lack of study on the rational use of antibiotics in patients with human immunodef iciency virus(HIV)-infected during surgical procedures, we analyzed the risk factors affecting postoperative infectious complications in HIV-infected patients and explore the rational use of perioperative antibiotics.METHODS: This retrospective study consisted of 308 HIV-infected patients, 272 males and 36 females, who had undergone operation at the Shanghai Public Health Clinical Center from November 2008 to April 2012. The patients were divided into postoperative infection and non-infection groups. Their age and clinical variables were compared. The correlation between surgical incision, surgical site infection(SSI) and postoperative sepsis was analyzed. Prophylactic antibiotics were used for patients with type I and II incisions for less than 2 days. Patients with type III incisions were given antibiotics until the infection was controlled. Antiretroviral therapy(ART) was prescribed preoperatively for patients whose preoperative CD4 count was <350 cells/μL. For those patients whose preoperative CD4 count was <200 cells/μL, sulfamethoxazole and fluconazole were given preoperatively as prophylactic agents controlling Pneumocystis carinii pneumonia and fungal infection.RESULTS: A total of 196 patients developed postoperative infectious complications, and 7 patients died. Preoperative CD4 counts, ratio of CD4/CD8 cells, hemoglobin level, and postoperative CD4 counts, hemoglobin and albumin levels were risk factors of perioperative infection in HIV-infected patients. Patients with a preoperative CD4 count <200 cell/μL, anemia, a postoperative CD4 count <200 cell/μL or albumin levels <35 g/L were correlated with a higher rate of perioperative infection. There was a signif icant correlation between SSI and the type of surgical incision. The rate of SSI in patients with type I surgical incision was 2% and in those with type II surgical incision was 38%. All the patients who received type III surgical incision developed SSI, and they were more likely to develop postoperative sepsis.CONCLUSIONS: HIV-infected patients are more likely to develop postoperative infectious complications. The rational use of antibiotics in HIV-infected patients could help to reduce the rate of postoperative infectious complications in these patients.

Noninvasive assessment of liver fibrosis with combined serum aminotransferase/platelet ratio index and hyaluronic acid in patients with chronic hepatitis B

AIM:To construct a noninvasive assessment model consisting of routine laboratory data to predict significant fibrosis and cirrhosis in patients with chronic hepatitis B (CHB). METHODS: A total of 137 consecutive patients with CHB who underwent percutaneous liver biopsy were retrospectively analyzed. These patients were divided into two groups according to their aminotransferase (ALT) level. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), the likelihood ratio (LR) of aminotransferase/platelet ratio index (APRI)≥1.5 or <1.5 in combination with different hyaluronic acid (HA) cut-off points were calculated for the presence of moderate to severe fibrosis/cirrhosis (fibrosis stages 2 and 4) and no to mild fibrosis/cirrhosis (fibrosis stages 0 and 1). RESULTS: The APRI correlated with fibrosis stage in CHB patients. The APRI≥1.5 in combination with a cut-off HA cut-off point >300 ng/mL could detect moderate to severe fibrosis (stages 2-4) in CHB patients. The PPV was 93.7%, the specificity was 98.9%. The APRI <1.5 in combination with different HA cut-off points could not detect no to mild fibrosis in CHB patients. CONCLUSION: The APRI≥ 1.5 in combination with a HA cut-off point >300ng/mL can detect moderate to severe fibrosis (stages 2-4) in CHB patients.

Metformin inhibits food intake and neuropeptide Y gene expression in the hypothalamus

Metformin may reduce food intake and body weight, but the anorexigenic effects of metformin are still poorly understood. In this study, Sprague-Dawley rats were administered a single intracere- broventricular dose of metformin and compound C, in a broader attempt to investigate the regula- tory effects of metformin on food intake and to explore the possible mechanism. Results showed that central administration of metformin significantly reduced food intake and body weight gain, par- ticularly after 4 hours. A reduction of neuropeptide Y expression and induction of AMP-activated protein kinase phosphorylation in the hypothalamus were also observed 4 hours after metformin administration, which could be reversed by compound C, a commonly-used antagonist of AMP-activated protein kinase. Furthermore, metformin also improved lipid metabolism by reducing plasma low-density lipoprotein. Our findings suggest that under normal physiological conditions, central regulation of appetite by metformin is related to a decrease in neuropeptide Y gene expres- sion, and that the activation of AMP-activated protein kinase may simply be a response to the anorexigenic effect of metformin.

Correlation analysis of compromised immune function with perioperative sepsis in HIV-positive patient

Objective: To investigate the relationship between immune function and perioperative sepsis in HIV-positive patients. Methods: Retrospective analysis of 144 HIV-positive patients surgically treated from Oct 2008 to Dec 2010 in Shanghai Public Health Clinical Center. The patients were divided into four groups based on their CD4+ T cells counts in preoperative period: group A (0 – 99 cell/ul), group B (100 – 199 cell/ul),group C (200 – 349 cell/ul),group D (≥350 cell/ul). All patients had received standardized surgical procedures, careful surgical routines were applied. To reduce operational damage, conventional antibi-otics, anti-TB, anti-fugal, antiretroviral therapies were used to prevent infection and promptly treatment of complications. Results among 144 HIV-positive patients (male 133 and female 11, aged 42.6 ± 12.5), 80 patients got perioperative sepsis (14 cases in preoperative period and 66 cases in postoperative period). 64 cases did not get sepsis. The average CD4+ T cell count was 276.97 ± 137.91 in preoperative period of patients without sepsis, which was significant higher than the patients with preoperative sepsis (151.29 ± 110.64) and patients with postope- rative sepsis(161.14 ± 128.45) (F = 13.91, P χ2 = 23.680, P +T cells (r = –0.987, P = 0.013). Conclusions With the decrease of preoperative CD4+T cells, the risk of perioperative sepsis had notable increase. Complete evaluation of surgical risk and suitable perioperative treatments may obtain better effect for the patients infected HIV.

A case report of brucellosis with fever and abdominal pain at onset

Brucellosis is a zoonosis caused by Brucella,with an acute or chronic clinical infection.Clinical manifestations of brucellosis are various or atypical,and it is easily misdiagnosed and miss-diagnosed.The case we have reported had an onset of fever and abdominal pain,associated with arthralgia,headache and rashes during the course,and was initially misdiagnosed as "acute cholangitis,associated with biliary pancreatitis".According to epidemiologic survey,radiological evidence,as well as blood culture and agglutination test showing Brucella positive,the diagnosis of brucellosis associated with splenic infarction and multi-systemic involvement including lungs,skin and brain was made.After regular anti-brucellosis treatment,the patient's symptoms were significantly improved.Brucellosis associated with splenic infarction is rare,which is possibly due to vasculitis resulting from Brucella infection.

艾滋病合并结核病55例临床资料分析（文摘）

目的探讨上海市公共卫生临床中心对艾滋病合并结核病患者的诊疗现状，评价诊疗水平及疗效。方法回顾性分析上海市公共卫生临床中心自2005年至今收治的艾滋病合并结核病患者55例，分析其人口学信息、艾滋病合并结核病患者实验室诊断数据、HAART及抗结核治疗方案、预后等资料。

Expert consensus on prevention and cardiopulmonary resuscitation for cardiac arrest in COVID-19

Background:Cardiopulmonary resuscitation(CPR)strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest.During CPR,both healthcare and non-healthcare workers who provide resuscitation are at risk of infection.The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients.Main recommendations:1)A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs.2)Psychological counseling and treatment are highly recommended,since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest.3)Healthcare workers should wear personal protective equipment(PPE).4)Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19.5)Hands-only chest compression and mechanical chest compression are recommended.6)Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early.7)CPR should be provided for 20-30 min.8)Various factors should be taken into consideration such as the interests of patients and family members,ethics,transmission risks,and laws and regulations governing infectious disease control.Changes in management:The following changes or modifications to CPR strategy in COVID-19 patients are proposed:1)Healthcare workers should wear PPE.2)Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols.3)Both the benefits to patients and the risk of infection should be considered.4)Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Computed tomography in predicting smear-negative pulmonary tuberculosis in AIDS patients

Background The correct diagnosis of sputum smear-negative pulmonary tuberculosis in AIDS patients is very important to their therapy. We aimed to assess the value of the computed tomography （CT） and clinical findings in predicting smear- negative pulmonary tuberculosis in AIDS patients. Methods A total of 121 AIDS patients suspected of smear-negative pulmonary tuberculosis by clinical and radiographic findings were recruited. Pulmonary tuberculosis was diagnosed in 57 （47.1%） patients. The CT and clinical predictors were selected to diagnose AIDS-related pulmonary tuberculosis through univariate and multivariate Logistic analysis. Results Multivariate analysis showed that five variables, including weight loss, presence of miliary nodules, necrotic lymph node, Iobular consolidation, tree-in-bud sign, were independent predictors of pulmonary tuberculosis in AIDS patients. Predicted scores based on the five variables were used to identify pulmonary tuberculosis. If the predicted score of 3 was taken as the ideal cut-off point in the diagnosis of AIDS-related smear-negative pulmonary tuberculosis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.2%, 81.2%, 80.0%, 85.2%, and 82.6%, respectively. Conclusion The prediction method based on five key factors of clinical and CT findings are useful in guiding the diagnosis of smear-negative pulmonary tuberculosis in AIDS patients.

Hospitalized patients with novel influenza A （H1N1） virus infection： Shanghai, June-July 2009

Background From late May 2009, sporadic imported cases of novel influenza A （HIN1） were continuously confirmed in Shanghai, but there were few reports on its clinical presentation in China. The aim of the study was to investigate the demographic and clinical features of the laboratory-confirmed cases and the treatment with oseltamivir. Method We performed a retrospective study in the Shanghai Public Health Clinical Center （SHAPHC）, reviewing the medical records of the laboratory-confirmed patients derived from June 10 to July 20, 2009. Results A total of 156 cases were enrolled, of whom 152 had a history of recent travel. The mean age was 22.6 years and 89 cases （57.1%） were males. The most common symptoms were fever, cough, and sore throat, with children more likely to run a temperature above 38.5℃ than adults. The mean leucocyte count was 5.4×10^9/L, the mean neutrophil count 3.2×10^9/L and the mean lymphocyte count 1.4×10^9/L. Other findings included a normal range or elevated level of C-reactive protein （CRP） and glutamic-pyruvic transaminase and a normal or decreased level of prealbumin; the levels of prealbumin and CRP were significantly lower in the children than in the adults. Fifty-two patients had abnormal chest CT results, with small unilateral or bilateral pulmonary infiltrates, axillary and mediastinal lymphadenopathy and local pleural thickening, while no cases showed symptoms of hypoxia. All the patients received oseltamivir and recovered without complications, but the duration of fever and virus shedding were significantly longer in the children than in the adults. Conclusions Travel-related circulation may be an important reason for the H1N1 epidemic in the non-epidemic areas, and the virus caused mild respiratory symptoms. The infection in children was more severe in terms of prealbumin levels, temperature, the duration of fever and virus shedding. Oseltamivir was effective for H1N1, but more effective in the adults than in the children.

SARS-CoV-2-triggered mast cell rapid degranulation induces alveolar epithelial inflammation and lung injury

SARS-CoV-2 infection-induced hyper-inflammation links to the acute lung injury and COVID-19 severity.Identifying the primary mediators that initiate the uncontrolled hypercytokinemia is essential for treatments.Mast cells(MCs)are strategically located at the mucosa and beneficially or detrimentally regulate immune inflammations.In this study,we showed that SARS-CoV-2-triggered MC degranulation initiated alveolar epithelial inflammation and lung injury.SARS-CoV-2 challenge induced MC degranulation in ACE-2 humanized mice and rhesus macaques,and a rapid MC degranulation could be recapitulated with Spike-RBD binding to ACE2 in cells;MC degranulation altered various signaling pathways in alveolar epithelial cells,particularly,the induction of pro-inflammatory factors and consequential disruption of tight junctions.Importantly,the administration of clinical MC stabilizers for blocking degranulation dampened SARS-CoV-2-induced production of pro-inflammatory factors and prevented lung injury.These findings uncover a novel mechanism for SARS-CoV-2 initiating lung inflammation,and suggest an off-label use of MC stabilizer as immunomodulators for COVID-19 treatments.

Fungal granuloma of mediastinal lymph nodes in an immunocompetent host

This is a case report of mediastinal fungal granuloma in an immunocompetent host. The definite diagnosis was made by pathological biopsy via video-assisted thoracoscopy and silver methenamine staining showed aspergillus hyphae and spores in the epithelioid granuloma. In conclusion, opportunistic pathogenic fungi can cause granulomatous inflammation in mediastinal lymph nodes in an immunocompetent host, as it can do in an immunocompromised host. More attention should be paid on tissue biopsy and pathological examination to ensure a correct diagnosis for these kinds of cases.

HCV核心抗原动态监测抗HCV疗效的临床研究(英文)

Objective To evaluate the performance of Hepatitis C virus (HCV) core antigen and HCV RNA PCR in the determining of the efficacy of HCV antiviral therapy in patients infected with HCV.Methods HCV core antigen and HCV RNA were measured in sera of 35 chronic HCV infected Chinese patients.Concentrations of HCV core antigen and HCV RNA were analyzed at 5 time points before,during and at the end of antiviral therapy.Results This study showed that the HCV core antigen and HCV RNA concentrations in 35 HCV patients were significantly correlated.Decrease of HCV core antigen and HCV RNA concentrations at the 4th,12th,24th and 48th week were observed during the antiviral therapy.However,HCV core antigen levels at week 12 and 24 of therapy were significantly lower than those at week 4 (P<0.05).In contrast,no further decrease was observed in HCV RNA concentrations at weeks 12 and 24 (P>0.05).HCV core antigen testing may be advantageous in some cases,in particular,the low levels of HCV core antigen at week 4 may be predictive of satisfactory outcome of treatment.Conclusions HCV core antigen represents a stable and sensitive marker of viral replication and could be used to monitor the clinical efficacy of HCV antiviral therapy.