Abstract： Objective To explore the optimal timing and treatment of acquired Lutembacher’s syndrome. Methods Sixteen acquired Lutembacher’s syndrome patients were studied retrospectively based on records collected between January 2000 and December 2009 in Beijing Anzhen Hospital. There were 9 males and 7 females at age of （39.45±10.23）years. All of them underwent endotracheal intubation, intravenous general anesthesia, and cardiopulmonary bypass. All patients were operated on through a median sternotomy incision into the chest, the right atrium, atrial septal defect to expand with mitral valve replacement and atrial septal defect repair. Postoperative mortality and perioperative complications were observed. During follow-up, periprosthetic leakage was observed using echocardiography, along with the level of residual atrial septal shunt, ventricular size, pulmonary artery pressure changes, and improvement in cardiac function. Results Two of the 16 patients（12.5%）died, one of renal failure, and one of respiratory failure. One patient required extracorporeal membrane oxygenation for 3 days, one required continuous renal replacement therapy for 11 days because of acute renal failure, and one experienced respiratory failure and used a respiratory machine for 23 days. All three of those patients recovered. Fourteen patients were followed up for between six months and five years, and the follow-up rate was 100%. The left ventricular end-diastolic diameter was （42.1±5.7） mm, as measured by echocardiography six months post-operation. There was no detectable periprosthetic leakage or residual shunt. The ejection fraction was （67.4%±6.7%）, and estimation of pulmonary artery pressure was （23.4±5.4） mm Hg. Twelve patients were class Ⅱ（ New York Heart Association） and two patients were class Ⅲ. Conclusion Acquired Lutembacher’s syndrome should be treated promptly if patients’ left ventricular end stage diastolic volume index is good enough to ensure they can tolerate surgery. Extracorporeal membrane oxygenation （ECMO）should be used early in patients who are anticipated to be difficult to withdraw from extracorporeal circulation perioperatively.
Objective To investigate the cl inical outcome of a surgical strategy by soft tissue expansion in treating acquired auricular defect. Methods Between January 2007 and December 2009, 136 patients with acquired auricular defect were treated with a surgical strategy by putting autoallergic costal framework after soft tissue expansion. There were 93 males and 43 females, aged 8-60 years (median, 20 years). Defects were caused by burn in 82 cases, by trauma in 47 cases, and by bite in 7 cases. Defect involved in almost the whole auricle and earlobe in 50 patients, 2/3 superior part of auricle in 35 patients, 1/3 superior part of auricle in 31 patients, 1/3 middle part of auricle in 9 patients, and 1/3 inferior part of auricle and earlobe in 11 patients. Results All the flaps had good blood supply, skin grafts all survived, and all the wounds healed by first intention after operation. All patients were followed up 6-24 months with an average of 14 months. All reconstructive auricle survived with good color, soft texture, and normal sensory function; the appearance had no enlargement and attrition, and the grafted costal cartilage framework had no malacosis, absorption, and deformation. The reconstructed ear had the same position, size, shape, and oto-cranium angle as normal ear. The curative effect was good according to ZHUANG Hongxing’s evaluation standard of auricular reconstruction. Conclusion To reconstruct auricle by soft tissue expansion is an effective method. The position of putting expander and the number of expanders are different in different patients.
Acquired Immunodeficiency Syndrome (AIDS) is a severe infectious disease induced by human immuno deficiency virus (HIV). Laboratory testing plays an important role in the diagnosis of HIV/AIDS. In general, laboratory testing includes detection of virus antibodies and antigens, virus RNA, immune cells (CD4+, CD8+) and anti-HIV drug resistance. During the past twenty years, great progress has been made in laboratory testing. As research on HIV/AIDS has advanced and biotechnology has developed rapidly, different methods of testing have been discovered. In recent years, the application of molecular biotechnology and immunology has led to important advances for epidemiological surveys, clinical diagnosis and treatment of HIV. The existence of a testing method with high sensitivity and specificity is not only helpful for early diagnosis and prediction, monitoring and evaluation of therapeutic efficacy, but can also reduce the risk of false-negative results. HIV laboratory testing is now developing towards a simple, rapid, sensitive, accurate and automatic way of diagnosing this condition.
【摘要】 目的 研究人類免疫缺陷病毒(HIV)感染者和獲得性免疫缺陷綜合癥(AIDS)患者CD4+T淋巴細胞數變化(ΔCD4+T)和外周血淋巴細胞總數變化(ΔTLC)的相關性。探討用ΔTLC預測ΔCD4+T在監測HIV/AIDS患者疾病進展以及高效抗逆轉錄病毒治療(HAART)療效的價值。 方法 回顧性分析2005〖CD3/5〗2008年確診的91例HIV/AIDS患者的臨床資料。 結果 ΔTLC與ΔCD4+T呈直線正相關(r=0809,Plt;001),好于TLC與CD4+T的相關性(r=0712,Plt;001)。分別用ΔTLC 170、330、630、910個/μL細胞預測ΔCD4+T 50、100、200、300個/μL細胞時具有較好的預測價值,各項評價指標符合率基本達到90%以上,顯著高于相同時間下用TLC預測CD4+T計數的價值。 結論 應用ΔTLC預測ΔCD4+T,可比TLC更加直觀、準確的反映HIV感染者疾病進展和評價AIDS患者HAART的療效。【Abstract 】Objective To assess the utility of total lymphocyte count (TLC) changes (ΔTLC) in place of TLC to predict the development of HIV/AIDS. To investigate the monitoring value of ΔCD4+T on progress of HIV/AIDS and HAART which predicted by ΔTLC. Methods Clinical data of 91 patiens with HIV/AIDS diagnosed from 2005 to 2009 were retrospectively analyzed. Results A linear correlation was found between the value of ΔTLC and the value of CD4+T changes(ΔCD4+T)(r=0809,Plt;001),which was better than the correlation between TLC and CD4+T (r=0712,Plt;001).Using ΔTLC as 170,330,630,910 cells/μL,respectively for forecasting ΔCD4+T as 50,100,200,300 cells/μL,respectively,had a better predictive value with the area under ROC curve near to 09,significantly higher than using TLC for predicting CD4+T counts. Conclusion ΔTLC is more accurate than TLC to reflect the development of HIV/AIDS.
Zhaojue is a deeply impoverished county located in Liangshan Autonomous Prefecture with high prevalence of human immunodeficiency virus infection. Based on local conditions, West China Hospital of Sichuan University has established a targeted supporting mode called “three-level organization and five-in-one”. This mode integrates administrative support teams, multiple disciplinary technical support teams and on-site expert teams to achieve five goals, including building effective teams, promoting clinical practice, enhancing skill training, focusing on academics and building a systematic platform. This model has improved the ability of treatment on human immunodeficiency virus infection and overall health services in Zhaojue County. It also reflects the responsibility of West China Hospital of Sichuan University in poverty alleviation and public welfare.
Objective To review the surgical treatment progress in repair and reconstruction of acquired auricle defects. Methods The related literature concerning the surgical methods and techniques for acquired auricle defects was reviewed and summarized. Results In order to attain an aesthetic ear with a clear structure, the location, size, and condition of surrounding skin must be taken into account when planning excision and repair. The application of tissue engineering and digital technology for acquired auricle defects can achieve a satisfactory effectiveness. Conclusion The surgical programs for acquired auricular defects have been constantly improved in recent years, and the emerging medical technologies also play a promoting role in the process, which providing a great deal of reference for obtaining structurally clear and stereoscopic auricle.
Objective To observe ocular manifestations of acquired immunodeficiency syndrome（AIDS）.Methods Fourtytwo AIDS patients（66 eyes）with ocular complaints received examinations of visual acuity, slit-lamp microscope, ophthalmoscope and fundus fluorescence angiography (FFA). The results were retrospectively analyzed. Results There are five types of ocular findings, including cytomegalovirus (CMV) retinitis (37 eyes, 56.0%), retinal microvasculopathy of human immunodeficiency virus (21 eyes, 32.0%), optic nerve diseases (three eyes, 4.5%), retinal neuroepithelial layer detachment (two eyes, 3.0%) and uveitis (three eyes, 4.5%).Conclusions The common ocular manifestations showed progressive necrotic retinitis, retinal hemorrhage and retinal vasculitis and attenuated，cotton-wool spots in AIDS patients.
ObjectiveTo evaluate the efficacy and safety of reduced-dose intravitreal ganciclovir for the treatment of acquired immunodeficiency syndrome (AIDS) patients with cytomegalovirus retinitis (CMVR).MethodsA prospective observational cohort study observed 15 AIDS patients (28 eyes) who suffered from CMVR onset between January 2016 and December 2018 at Nanning Aier Eye Hospital. Among this 28 eyes, BCVA of 6 eyes (21.4%) were between moving hand to counting finger, 15 eyes (53.6%) were between 0.02 to 0.1 and 7 eyes were better than 0.1 (25.0%). All eyes received intravitreal injection 0.1 ml of ganciclovir at 4 mg/ml (contain ganciclovir 0.4 mg). The induction regimen was twice weekly for 2 weeks and a maintenance period of the same dose weekly. The mean number of injections was 7.1±1.7 times. For hospitalized patients who had no contraindicated received a 14-day twice daily intravenous ganciclovir (IVG) 5.0 mg/kg·d until complete resolution of CMVR. All patients were divided into intravitreal ganciclovir (IVTG) group and IVTG+IVG group according to different treatment plans, which were 5 cases with 8 eyes and 10 cases with 20 eyes, respectively. The follow-up was more than 6 months. BCVA, complete resolution or stable of the lesion and complications were observed.ResultsSix months later, 20 eyes (71.4%) had a obvious reduced or disappeared of the anterior chamber and vitreous inflammation, and the retinal lesions became stable or complete resolution. 24 eyes showed improvements of BCVA and 4 eyes showed stable. 2 eyes (7.1%) presented with BCVA ≤ counting finger, 7 eyes (25.0%) were 0.02 - 0.1 and 19 eyes were ≥ 0.1 (67.9%). Compared with before treatment, the ratio of BCVA that less than or equal to counting finger and between 0.02 to 0.1 decreased (21.4% vs 7.1% and 53.6% vs 25.0%, respectively), but the ratio of BCVA better than 0.1 increased (25.0% vs 67.9%). When IVTG+IVG group was compared with IVTG group, the average time-to-resolution of CMVR were 83.2±25.2 and 85.3±24.4 days respectively. There was no significant difference in resolution times (Z=0.17, P=0.87). The ratio of retinal lesions became stable or complete resolution were 75.0% (15 eyes) and 62.5% (5 eyes), there was no evident difference in time-to-resolution between the two groups (F=0.42, P=0.51). No recurrence was seen during the follow-up period. In cases of unilateral CMVR, there were no patients with a second eye involvement during the follow-up period. No endophthalmitis, vitreous hemorrhage, retinal detachment were found in our study.ConclusionReduced-dose intravitreal ganciclovir is a safe and effective treatment option for CMVR.
ObjectiveTo systematically evaluate the effects of cognitive behavioural therapy (CBT) on improving depression, medication adherence and quality of life in people living with HIV/AIDS (PLHIV). MethodsWe searched The Cochrane Library (Issue 4, 2013), Ovid-JBI, PubMed, EMbase, PsycARTICLES, CBM and CNKI to collect randomized controlled trials (RCTs) on improving depression, medication adherence and quality of life in PLHIV from the establishment dates to April 30th 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Meta-analysis was conducted using RevMan 5.2. ResultsA total of 17 RCTs were included, involving 2 163 patients. The results of meta-analysis showed that CBT significantly improved PLHIV's depression (SMD=-0.26, 95%CI-0.41 to-0.10, P=0.001), and quality of life (SMD=-0.57, 95%CI-1.04 to-0.11, P=0.02) in 6 months. Meanwhile, CBT significantly improved PLHIV's medication adherence (WMD=3.98, 95%CI 1.67 to 6.30, P=0.000 8) in the long term. ConclusionCBT is efficacious in improving PLHIV's depression and quality of life in the short term, and improving medication adherence in the long term, compared to standard care.
ObjectiveTo analyze the sensitivity and specificity of polymerase chain reaction (PCR) tests in the detection of cytomegalovirus (CMV) in the diagnosis of patients with acquired immune deficiency syndrome (AIDS), using aqueous humor samples. Methods25 AIDS patients (including 21 men and 4 women) were studied. The age of the patients varied from 24 to 59 years, with an average of (39.2±9.3) years. The CD4+ T cell count was from 1 to 523 cells/μl, with a medium of 40 cells/μl. They were infected with human immunodeficiency virus(HIV)for a period from 15 days to 9 years with a median of 10 months. They were divided into three groups according to the fundus and treatment, including untreated cytomegalovirus retinitis (CMVR), treated CMVR and control group. There were 10 patients without anti-CMV treatment and 7 patients treated previously with foscarnet or ganciclovir whose eyes were diagnosed CMVR. Control group has 8 patients who had normal fundus or minor retinopathy excluded from CMVR. Approximately 100 μl of aqueous humor was obtained by anterior-chamber paracentesis and PCR was performed in all cases. ResultsThere were CMV DNA in 9 of 10 eyes with untreated CMVR (90.0% sensitivity). Of 7 specimens from eyes with treated CMVR, 3 were CMV PCR positive (42.9% sensitivity). All 8 samples of the control group were negative for CMV DNA, indicating the clinical specificity of our PCR was greater than 99.9% for CMVR. The anterior chamber paracentesis did not cause any complications in our patients except for a patient with subconjunctival hemorrhage. ConclusionsThe assay had an estimated sensitivity of 90.0% in detecting untreated CMVR and a sensitivity of 42.9% in detecting CMVR that had been treated. The specificity of this assay was greater than 99.9%.