Jun-fei Zhang, Jian Fang, Hai-yan Song, Wei-li Wu, Bo Liu and Cong-xin Chen
Background Military recruits are at a higher risk of acute respiratory disease (ARD) and the causative agents might change over time, which needs to be investigated.
Methods The nasopharyngeal swabs and blood samples were consecutively collected from conscripts for three years in a military training center. The real-time fluorescent quantitative PCR assays were conducted for 15 species of common respiratory pathogens; the serum anti-Legionella pneumophila antibodies were detected by indirect immunofluorescence (IIF) assay, and serum anti-Microplasma pneumoniae antibodies, serum anti-influenza B virus and anti-influenza A virus-IgM and IgG were detected by ELISA.
Results The prevalences of ARD were 59.3% (108/182) in 2008, 23.3% (50/215) in 2009, and 19.6% (40/204) in 2010. Among the patients with ARD from 2008 to 2010, the influenza B virus infection accounted for 45.4%, 30.0% and 55.0%, and seasonal influenza A virus infection for 8.3%, 8.0% and 5.0%, respectively; the positive rates of serum anti-Legionella pneumophila and anti-Microplasma pneumoniae antibodies in recruits was lower than 10% each year respectively in the three years without diagnostic significance.
Conclusion The early appropriate diagnosis and treatment of ARD in military personnel will ensure the power strength of armed forces.
Hui Li, Xiao-Dong Yang, Yong-Rui Yang, Si-Yuan Gao, De-Ying Tian and Quan Yuan
Background and Aims Recently, epidemiology studies of hepatitis E in different areas are attracted more attention. Extensive studies of prevalent status and clinical manifestations could help us to broaden our knowledge, so as to excellently prevent and treat hepatitis E. The study analyzed the epidemiological characteristics and clinical features of 394 cases of sporadic acute hepatitis E (AHE) in Southwest of China from 2008 to 2010.
Methods The clinical data of 394 cases with sporadic AHE in Southwest of China from 2008 to 2010 were reviewed.
Results In the 394 cases with sporadic AHE, the ratio of male/female was 1.432 : 1, and the mean age was (31.53 ± 18.12) years. Totally, 94 (23.86%) patients aged under 18, 271 (68.78%) patients aged between 18 and 60, and 29 (7.36%) patients aged above 60. The incidence rate was significantly increased in summer (P = 0.000), especially in May (14.72%) and July (13.71%). In addition, the characteristics of occupation and ethnic group distribution were migrant laborers (106/394, 26.90%) and Han people (365/394, 92.64%). The length of stay, incidence of jaundice, the peak value of total bilirubin and alanine aminotransferase in male patients were all higher than those in female patients significantly (P < 0.05). The prolonged length of stay, decreased levels of ALT/ALB/CHE, increased levels of TBil, and increased incidence of jaundice and fatigue were associated with older age significantly (P < 0.05). The differences in peak values of total bilirubin (TBil), total bile acid (TBA), glutamyltransferase (GGT), cholinesterase (CHE) between AHE group and the groups of AHE accompanied respectively by chronic hepatitis B (CHB), acute alcoholic fatty liver (AFL), nonalcoholic fatty liver disease (NAFLD) were significant (P < 0.05). In addition, no significant difference was found in length of stay and biochemical indexes among anti-HEV-IgG positive group, anti-HEV-IgM positive group and anti- HEV-IgM/IgG both positive group (P > 0.05).
Conclusions Four epidemiological characteristics, including aged between 18 and 60, male, summer and migrant laborers, are found to be associated with acute hepatitis E. The prognosis of AHE in the majority of patients was favorable, but aged above 60 years and coexistence with CHB, AFL and NAFLD could be considerede as the factors inducing the infaust prognosis.
Yang Zhou, Hui Wang, Sha-xi Li, Gui-lin Yang and Ying-xia Liu
Objectives To investigate the clinical features of tuberculosis (TB)-associated immune reconstitution inflammatory syndrome (TB-IRIS) in patients co-infected with HIV/TB or latent infection during highly active antiretroviral therapy (HAART).
Methods HIV-infected patients treated in the Third People’s Hospital of Shenzhen, China between March 2012 and March 2013 were recruited, and divided into 3 groups: 1) HIV/TB co-infection group (n = 50), 2) HIV/ MTB latent infection group (n = 50), and 3) HIV infection group (n = 50), with 12-month follow-up. Patients in the HIV/TB co-infection group were treated with HAART 2 weeks after TB therapy. Patients were assessed at different time-points.
Results The incidence and mortality rates of TB-IRIS were 40% and 10% in the HIV/TB co-infected patients, and 2% (and no mortality) in the HIV/MTB group. The HIV infected group did not display TB-IRIS or death. About 95% HIV/TB co-infected patients were 20-39 years old when TB-IRIS occurred, and 65% of the patients developed TB-IRIS 2 weeks after HAART. For the co-infection group, those with TB-IRIS (20/20, 100%) had fever, with a significantly higher incidence than those who did not develop TB-IRIS (6.7%, 2/30, P < 0.05). The patients with TB-IRIS in co-infection group displayed markedly higher clinical biochemical markers, acute phase reactants, increased CD4+ cell counts, and 2 log10-decreases of HIV RNA loads, compared with the patients not presenting with TB-IRIS (P < 0.05).
Conclusion HIV/TB co-infected patients presented with a high-risk of developing TB-IRIS during HAART treatment. Early diagnosis and treatment could decrease mortality rates in TB-IRIS.
Ha-lida Xiaerfuhazi, Hai-lin Ma, Xiu-jiang Shi, Xiao-tang Fan, Xi-ernayi Abuduheilili and Fang-ping He
Objective To investigate the differences of clinical and biochemical characteristics between patients with liver cirrhosis induced by HBV infection combined with and without mild alcohol intake.
Methods Data of patients with liver cirrhosis who were hospitalized in the First Hospital Affiliated to Xinjiang Medical University were retrospectively analyzed. Patients were divided into three groups: patients with liver cirrhosis induced by HBV infection and combined with mild alcohol intake, patients with HBV-related cirrhosis, and patients with alcohol-related cirrhosis. Biochemical detections including liver function, fasting lipid profiles, lipoprotein, kidney function, glucose, uric acid and regular blood tests were carried out and results were compared among three groups. Data were analyzed through STATA software and co-variant analysis.
Results Total of 2 350 patients with liver cirrhosis were included, 732 patients had cirrhosis induced by HBV infection combined with mild alcohol intake, 1 316 patients had HBV-related liver cirrhosis, 302 patients had alcohol-related cirrhosis. The highest mean level of white cell count, mean corpuscular volume, γ-glutamyltranspeptidase and uric acid were observed in HBV infection combined with mild alcohol intake group. Multivariate regression analysis revealed that HBV infection, excessive alcohol intake, male and age were risk factors for hepatocellular carcinoma (HCC) in patients with liver cirrhosis.
Conclusions HBV infection combined with mild alcoholic-related liver cirrhosis group showed the highest oxidative stress compared with alcoholic liver cirrhosis group, which suggested that mild alcohol intake may increase the incidence of liver cirrhosis in HBV infected patients and may not increase the incidence of HCC.
Zhu Chen, Yi-lan Zeng, Li Wang, Rong Hu, Yan Wang, Yu-zhen Tang, Li Zhu and Bei Wu
Objective To compare the efficacy of peginterferon alfa-2a (PEGASYS) plus ribavirin (RBV) with interferon alfa-2a plus RBV, and evaluate the safety.
Methods Total of 117 patients with chronic hepatitis C were enrolled to receive either PEGASYS (135 μg or 180 μg) subcutaneously once per week, plus RBV (800 mg-1 200 mg) per day for 48 weeks (79 patients, PEGASYS group), or 5 million units of interferon alfa-2a subcutaneously every other day, plus RBV as above dosage for 48 weeks (38 patients, IFNα group).
Results Sixty-three of 79 (79.7%) patients reached sustained virological response (SVR) in PEGASYS group, while 14 of 38 (36.8%) patients reached SVR in IFNα group. PEGASYS group was associated with a higher rate of virologic response than IFNα group at week 4, 12, 36, 48 and week 72. Sustained normalization of serum ALT concentrations at week 36, 48 and week 72 was also more common in PEGASYS group than in IFNα group. Baseline levels of ALT and HCV RNA had no effect on SVR in either PEGASYS group or IFNα group. Both groups were similar in the frequency and severity of adverse events.
Conclusions PEGASYS plus RBV produced similar adverse events but higher rate of SVR. Meanwhile, complications should be prevented and treated promptly in order to increase compliances and effects.
This paper reviews the recent Helicobacter infection associated with chronic liver disease. The bacteriology, prevalence, pathogenesis and diagnosis were reviewed. Future work should be conducted on the pathogenesis and treatment of this disease.
Tao Lan, Bao-chun Chen, Li-ping Fu, Zhi-juan Li, Xiang-jun Wu and Nai-qiang Cui
Intestinal barrier dysfunction, facilitating translocation of bacteria and bacterial products, plays an important role in the pathophysiology of liver cirrhosis and its complications. Intestinal defense system including microbial barrier, immunologic barrier, mechanical barrier, chemical barrier, plays an important role in the maintenance of intestinal function. Under normal circumstances, the intestinal barrier can prevent intestinal bacteria through the intestinal wall from spreading to the body. Severe infection, trauma, shock, cirrhosis, malnutrition, immune suppression conditions, intestinal bacteria and endotoxin translocation, can lead to multiple organ dysfunction. The intestinal microflora is not only involved in the digestion of nutrients, but also in local immunity, forming a barrier against pathogenic microorganisms. The derangement of the gut microflora may lead to microbial translocation, defined as the passage of viable microorganisms or bacterial products from the intestinal lumen to the mesenteric lymph nodes and other extraintestinal sites. In patients with cirrhosis, primary and intestinal flora imbalance, intestinal bacterial overgrowth, intestinal mucosal barrier dysfunction, endotoxemia is associated with weakened immunity.
Hong Zang, Dong Ji, Qing Shao, Guang-de Zhou, Deng Pan, Shao-jie Xin, Jing-min Zhao and Guo-feng Chen
Objective The cellular apoptosis susceptibility (CAS) protein plays a regulatory role in the induction of cell death in tumor cells. The objective of this study was to investigate the association of the expression of CAS protein with HBV infection in the development of HCC.
Methods The expression level of CAS was measured with immunohistochemistry. The occurrence of HBsAg, HBeAg and HBV DNA in HCC were concurrently examined with immunohistochemistry and in situ hybridization, respectively.
Results The results showed that the CAS protein was detected in 86% (43/50), 70% (7/10), 15% (3/20) and none (0/20) of livers from patients with HCC, cholangiocarcinoma, cirrhosis and hepatitis, respectively. Furthermore, the level of CAS protein was higher in poorly differentiated tumors than moderately or well differentiated HCC. Interestingly, the CAS was stained significantly stronger in HBV-infected HCC than in non-HBV infected tissues (P < 0.01).
Conclusions The expression of CAS is facilitated by HBV infection in HCC, suggesting that CAS might be a prognostic marker and a putative therapeutic target for HCC.
Qing Zhou, Xu-wen Xu, De-ming Tan, Yu-tao Xie, Yun-zhu Long and Meng-hou Lu
Objective A diagnostic model was established to discriminate infectious diseases from non-infectious diseases.
Methods The clinical data of patients with fever of unknown origin (FUO) hospitalized in Xiangya Hospital Central South University, from January, 2006 to April, 2011 were retrospectively analyzed. Patients enrolled were divided into two groups. The first group was used to develop a diagnostic model: independent variables were recorded and considered in a logistic regression analysis to identify infectious and non-infectious diseases (αin = 0.05, αout = 0.10). The second group was used to evaluate the diagnostic model and make ROC analysis.
Results The diagnostic rate of 143 patients in the first group was 87.4%, the diagnosis included infectious disease (52.4%), connective tissue diseases (16.8%), neoplastic disease (16.1%) and miscellaneous (2.1%). The diagnostic rate of 168 patients in the second group was 88.4%, and the diagnosis was similar to the first group. Logistic regression analysis showed that decreased white blood cell count (WBC < 4.0×109/L), higher lactate dehydrogenase level (LDH > 320 U/L) and lymphadenectasis were independent risk factors associated with non-infectious diseases. The odds ratios were 14.74, 5.84 and 5.11 (P ≤ 0.01) , respectively. In ROC analysis, the sensitivity and specificity of the positive predictive values was 62.1% and 89.1%, respectively, while that of negative predicting values were 75% and 81.7%, respectively (AUC = 0.76, P = 0.00).
Conclusions The combination of WBC < 4.0×109/L, LDH > 320 U/L and lymphadenectasis may be useful in discriminating infectious diseases from non-infectious diseases in patients hospitalized as FUO.