MedNexus
2022年 · 第135卷第22期
出版日期 2022-11-20电子版 ￥0.00元
MedNexus
- 全部
- Editorial
- Consensus Statement
- Review Article
- Meta Analysis
- Medical Progress
- Original Article
- Clinical Observation
- Rapid Report
- Correspondence
Editorial
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脂肪组织中的血管和脉管系统来源的信号在控制脂质代谢和代谢性疾病中的作用Yihai Cao
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002406
摘要
代谢紊乱，包括内分泌紊乱、肥胖症、糖尿病、脑心血管疾病，甚至癌症，是最常见和最致命的疾病，在全球范围内全因死亡率领先。[
Consensus Statement
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成人下呼吸道感染局部应用抗菌药物中国专家共识执行摘要Jing Zhang, Qijian Cheng, Yi Huang, Hong Fan, Guoxiang Lai, Xiangdong Mu, Wei Sha, Danyang She, Ning Shen, Xin Su 等
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002472
摘要
近年来，随着耐多药（MDR）细菌感染和慢性肺部感染患病率的增加，以吸入性抗生素为主的抗菌药物的局部应用又回到了临床实践中。用于雾化和干粉吸入器（DPI）的几种制剂已被批准用于吸入性抗感染治疗。同时，已经积累了使用经气道递送的抗微生物剂的证据和经验。然而，该领域的可用研究在研究人群、药物递送途径和剂量方面是异质性的。需要评估吸入性抗感染治疗在各种类型下呼吸道感染（LRTIs）中的疗效和安全性。而且，由于国内缺乏开发用于吸入的制剂，存在包括静脉制剂局部使用等问题。为规范成人LRTIs局部抗感染治疗的临床实践，中国胸科学会肺部感染大会发起并组织专家制定了共识文件，根据现有证据总结了呼吸道局部使用的抗菌药物及其适应症。由于高质量的证据很少，因此没有说明推荐的级别。本文为共识的执行摘要，全文发表于中国结核病与呼吸道疾病杂志.[
Review Article
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免疫功能低下患者接种新冠肺炎疫苗的安全性和免疫原性Jin-Wen Song, Wei Hu, Lili Shen, Fu-Sheng Wang
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002505
摘要
The coronavirus disease 2019 (COVID-19) pandemic poses a great threat to public health. Individuals who are immunocompromised because of the progression of the primary disease or receiving immunosuppressive medications are prone to severe COVID-19 complications and poor outcomes. Abundant data have shown that many COVID-19 vaccines are safe and effective in large-scale populations; however, these clinical trials have excluded immunocompromised populations. Available evidence indicates that immunocompromised populations have a blunted immune response to other vaccines, raising concerns regarding the efficacy of COVID-19 vaccination in these populations. Thus, there is an urgent need to delineate the efficacy of COVID-19 vaccines in these vulnerable populations. Here, we review the characteristics of specific humoral and cellular responses to COVID-19 vaccination in immunocompromised populations, including HIV-infected patients and those receiving immunosuppressive treatment, especially solid organ transplant recipients and those undergoing anti-CD20 treatment. We also addressed the challenges that immunocompromised populations will face in the future pandemic and the need for basic and clinical translational studies to highlight the best vaccination strategies for these populations.
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HIV储库：治疗HIV感染的抗病毒免疫反应和免疫干预Shuang Li, Christiane Moog, Tong Zhang, Bin Su
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002479
摘要
Antiretroviral therapy against human immunodeficiency virus (HIV) is effective in controlling viral replication but cannot completely eliminate HIV due to the persistence of the HIV reservoir. Innate and adaptive immune responses have been proposed to contribute to preventing HIV acquisition, controlling HIV replication and eliminating HIV-infected cells. However, the immune responses naturally induced in HIV-infected individuals rarely eradicate HIV infection, which may be caused by immune escape, an inadequate magnitude and breadth of immune responses, and immune exhaustion. Optimizing these immune responses may solve the problems of epitope escape and insufficient sustained memory responses. Moreover, immune interventions aimed at improving host immune response can reduce HIV reservoirs, which have become one focus in the development of innovative strategies to eliminate HIV reservoirs. In this review, we focus on the immune response against HIV and how antiviral immune responses affect HIV reservoirs. We also discuss the development of innovative strategies aiming to eliminate HIV reservoirs and promoting functional cure of HIV infection.
Meta Analysis
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载脂蛋白E ε 4与成人人类免疫缺陷病毒患者认知障碍的关系：一项荟萃分析Tingting Mu, Jiaqi Wei, Jun Sun, Junyan Jin, Tong Zhang, Hao Wu, Bin Su
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002480
摘要
Background:
It is controversial whether the apolipoprotein E epsilon 4 allele (APOE ε4) is a risk gene for human immunodeficiency virus (HIV)-related neurocognitive impairment. This meta-analysis aimed to summarize evidence of the associations between APOE ε4 and cognitive impairment in people living with HIV (PLWH).
Methods:
Our study conducted a systematic literature search of PubMed, Web of Science, Embase, Google Scholar, and ProQuest for studies published before April 11, 2022 that evaluated associations between APOE ε4 and cognitive impairment in adult PLWH (aged ≥18 years). We calculated pooled odds ratios (ORs) of global cognitive impairment and 95% confidence intervals (CIs) and standardized mean differences (SMDs) for specific cognitive domains between APOE ε4 carriers and non-carriers. Subgroup meta-analyses were used to evaluate the result profiles across different categorical variables.
Results:
Twenty studies met the inclusion criteria, including 19 that evaluated global cognitive impairment. APOE ε4 was significantly associated with global cognitive impairment in PLWH (OR = 1.36, 95% CI = [1.05, 1.78], number of estimates [k] = 19, P = 0.02, random effects). Subgroup meta-analysis based percentage of females showed evident intergroup differences in global cognitive performance between ε4 carriers and non-carriers (P = 0.015). APOE ε4 carriers had lower cognitive test scores than non-carriers in all seven cognitive domains, including fluency (SMD = -0.51, 95% CI = [-0.76, -0.25], P < 0.001, k = 4, I2= 0%), learning (SMD = -0.52, 95% CI = [-0.75, -0.28], P < 0.001, k = 5, I2 = 0%), executive function (SMD = -0.41, 95% CI= [-0.59, -0.23], P < 0.001, k= 8, I2= 0%), memory (SMD=-0.41, 95% CI= [-0.61, -0.20], P < 0.001, k= 10, I2= 36%), attention/working memory (SMD=-0.34, 95% CI= [-0.54, -0.14], P= 0.001, k= 6, I2= 0%), speed of information processing (SMD = -0.34, 95% CI = [-0.53, -0.16], P < 0.001, k = 8, I2 = 0%), and motor function (SMD = -0.19, 95% CI = [-0.38, -0.01], P = 0.04, k = 7, I2 = 0%).
Conclusions:
Our meta-analysis provides significant evidence that APOE ε4 is a risk genotype for HIV-associated cognitive impairment, especially in cognitive domains of fluency, learning, executive function, and memory. Moreover, the impairment is sex specific.
Meta analysis registration:
PROSPERO, CRD 42021257775.
Medical Progress
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艾滋病患者距骨真菌病的诊治进展Pengle Guo, Linghua Li, Xiaoping Tang
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002506
摘要
Talaromycosis（原名青霉病）是一种重要的侵袭性真菌病，由马尔尼菲塔拉菌（以前马尔尼菲青霉菌,T·马尔尼菲).[
Original Article
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三十年来全球和中国人类免疫缺陷病毒（HIV）负担的变化：全球HIV统计数据的二次分析Yanqiu Lu, Shengquan Tang, Yuanyuan Qin, Vijay Harypursat, Hao Wu, Yaokai Chen
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002500
摘要
Background:
A more comprehensive understanding of the trends of incidence, prevalence, and mortality in human immunodeficiency virus (HIV), and their complex interrelationships, may provide important evidence for decision-making related to HIV prevention and control. The variances in these indices between different population groups, genders, and ages are critical to decipher evolving patterns of the HIV epidemic in specific populations.
Methods:
A secondary analysis of relevant data was conducted using data extracted from the Global Burden of Disease study of 2019. HIV/acquired immune deficiency syndrome (AIDS) incidence, prevalence, AIDS-related mortality, and mortality-to-prevalence ratio (MPR) for annual percentage change, average annual percentage change (AAPC), and corresponding 95% confidence intervals (CIs) were calculated using joinpoint regression statistical analysis.
Results:
The AAPC of HIV/AIDS incidence, prevalence, AIDS-related mortality rate, and MPR were -1.4 (95% CI: -1.6, -1.2), 4.1 (95% CI: 4.0, 4.3), 2.0 (95% CI: 1.7, 2.3), and -2.1 (95% CI: -2.3, -1.8) between 1990 and 2019 globally, and were 3.5 (95% CI: 2.2, 4.8), 6.9 (95% CI: 6.8, 7.0), 8.1 (95% CI: 7.1, 9.1), and 1.2 (95% CI: 0.1, 2.3) in China during the same period. In terms of differences in the preceding indicators by gender, we observed a similar pattern of trends for male and female genders both globally and in China during the entire study period. Each specific age group exhibits a distinct pattern in terms of incidence, prevalence, mortality rate, and MPR both globally and in China.
Conclusions:
Prevalence and mortality rates of HIV/AIDS have increased between 1990 and 2019 globally and in China. While the incidence rate and MPR have declined globally over the past three decades, these two indicators are observed to present an increasing trend in China. There is a high HIV burden among young and middle-aged adults globally; however, the elderly have a high HIV burden in China. HIV screening at older age should be scaled up, and patients with advanced HIV disease should be provided early with additional care and health resources.
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持续低CD4细胞计数与HCV/HIV合并感染患者的肝脏事件相关：来自中国国家免费抗逆转录病毒治疗计划的数据Weiyin Lin, Huolin Zhong, Chunyan Wen, Yaozu He, Xiaowen Zheng, Hong Li, Xiejie Chen, Haolan He, Jinfeng Chen, Lijuan Chen 等
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002502
摘要
Background:
Chronic liver disease has emerged as a leading cause of non-acquired immune deficiency syndrome (AIDS)-related mortality in hepatitis C virus (HCV)/human immunodeficiency virus (HIV)-coinfected patients. The relationship between CD4 cell count and HIV-related opportunistic infections and tumors has been well characterized; however, it is unclear whether CD4 cell count is associated with HCV-related hepatic events.
Methods:
This observational cohort study enrolled HCV/HIV-coinfected patients from the National Free Antiretroviral Treatment Program of China from 2004 to 2019 in Guangzhou. The primary outcome was a composite of hepatic events, including cirrhosis complications, hepatocellular carcinoma (HCC), and liver-related mortality. Kaplan-Meier survival and multivariate logistic regression analyses were performed.
Results:
Among the 793 patients, 43 developed hepatic events during a median follow-up of 6.7 years, including 35 cirrhosis complications, 13 HCC cases, and 14 cases of liver-related mortality. The 5-year and 10-year cumulative incidences of hepatic events were 4.2% and 9.3%, respectively. Patients who developed hepatic events had a less satisfactory increase in CD4 cell count, lower peak CD4 (354.5 cells/μL vs. 560.0 cells/μL, P < 0.001), and lower percentage of peak CD4 > 500 cells/μL (30.2% vs. 60.7%, P < 0.001) after the initiation of antiretroviral therapy (ART) than those who did not. The cumulative incidences of hepatic events were higher in patients with lower peak CD4 levels with adjusted odds ratios of 3.96 (95% confidence interval [CI]: 1.51-10.40), 2.25 (95% CI: 0.87-5.86), and 0.98 (95% CI: 0.35-2.74) for patients with peak CD4 at <200 cells/μL, 200-350 cells/μL, and 351 to 500 cells/μL, respectively, relative to those with peak CD4 > 500 cells/μL. Peak CD4 was negatively associated with the risk of hepatic events in a dose-response manner (P-value for trend = 0.004).
Conclusion:
Persistently low CD4 cell counts after ART are independently associated with a high risk of hepatic events in HCV/HIV-coinfected patients, highlighting the important role of immune reconstitution in improving liver outcomes.
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去泛素酶泛素特异性蛋白酶3（USP3）通过促进APOBEC3G（A3G）的表达以酶活性依赖性和非依赖性方式抑制HIV-1复制Simin Zhao, Baisong Zheng, Liuli Wang, Wenzhe Cui, Chunlai Jiang, Zhuo Li, Wenying Gao, Wenyan Zhang
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002478
摘要
Background:
Ubiquitination plays an essential role in many biological processes, including viral infection, and can be reversed by deubiquitinating enzymes (DUBs). Although some studies discovered that DUBs inhibit or enhance viral infection by various mechanisms, there is lack of information on the role of DUBs in virus regulation, which needs to be further investigated.
Methods:
Immunoblotting, real-time polymerase chain reaction, in vivo/in vitro deubiquitination, protein immunoprecipitation, immunofluorescence, and co-localization biological techniques were employed to examine the effect of ubiquitin-specific protease 3 (USP3) on APOBEC3G (A3G) stability and human immunodeficiency virus (HIV) replication. To analyse the relationship between USP3 and HIV disease progression, we recruited 20 HIV-infected patients to detect the levels of USP3 and A3G in peripheral blood and analysed their correlation with CD4+ T-cell counts. Correlation was estimated by Pearson correlation coefficients (for parametric data).
Results:
The results demonstrated that USP3 specifically inhibits HIV-1 replication in an A3G-dependent manner. Further investigation found that USP3 stabilized 90% to 95% of A3G expression by deubiquitinating Vif-mediated polyubiquitination and blocking its degradation in an enzyme-dependent manner. It also enhances the A3G messenger RNA (mRNA) level by binding to A3G mRNA and stabilizing it in an enzyme-independent manner. Moreover, USP3 expression was positively correlated with A3G expression (r= 0.5110) and CD4+ T-cell counts (r= 0.5083) in HIV-1-infected patients.
Conclusions:
USP3 restricts HIV-1 viral infections by increasing the expression of the antiviral factor A3G. Therefore, USP3 may be an important target for drug development and serve as a novel therapeutic strategy against viral infections.
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协同磺胺类药物加克林霉素作为HIV相关弓形虫脑炎的替代治疗方案：一项随机对照试验Yao Li, Yanming Zeng, Yanqiu Lu, Xuejiao He, Yushan Wu, Wei Zhang, Yanqun Huang, Hui Chen, Yaokai Chen
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002498
摘要
Background:
The preferred therapeutic regimen for Toxoplasma encephalitis (TE) is a combination of pyrimethamine and sulfadiazine, and trimethoprim-sulfamethoxazole (TMP-SMX) plus azithromycin is the widespread alternative therapeutic regimen. The synergistic sulfonamides tablet contains TMP, sulfadiazine, and SMX and hypothetically could be used for TE treatment. This study aimed to compare the efficacy and safety of synergistic sulfonamides plus clindamycin (regimen B) with TMP-SMX plus azithromycin (regimen A) for the treatment of human immunodeficiency virus (HIV) associated TE.
Methods:
This was an open-labeled, multi-center randomized controlled trial recruited from 11 centers. Each recruited patient was randomly assigned to receive regimen A or regimen B for at least 6 weeks. The overall response was evaluated by assessment of the clinical response of TE-associated clinical features and the radiological response of TE-associated radiological findings. The overall response rate, clinical response rate, radiological response rate, and adverse events were assessed at 2, 6, and 12 weeks. Death events were compared between the two regimens at 6, 12, and 24 weeks.
Results:
A total of 91 acquired immunodeficiency syndrome (AIDS)/TE patients were included in the final analysis (44 in regimen A vs. 47 in regimen B). The overall response rate, which refers to the combined clinical and radiological response, was 18.2% (8/44) for regimen A and 21.3 % (10/47) for regimen B at week 6. The results of clinical response showed that, in comparison with regimen A, regimen B may perform better with regards to its effect on the relief of clinical manifestations (50.0% [22/44] vs. 70.2% [33/47], P = 0.049). However, no significant differences in radiological response, mortality events, and adverse events were found between the two regimens at week 6.
Conclusions:
Synergistic sulfonamides plus clindamycin, as a novel treatment regimen, showed no significantly different efficacy and comparable safety in comparison with the TMP-SMX plus azithromycin regimen. In addition, the regimen containing synergistic sulfonamides may exhibit advantages in terms of clinical symptom alleviation.
Trial Registration:
ChiCTR.org.cn, ChiCTR1900021195.
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联合配制的比替格拉韦/恩曲他滨/替诺福韦艾拉酚胺用于人类免疫缺陷病毒-1潜在暴露后暴露后预防的安全性和耐受性的开放标签评价An Liu, Ruolei Xin, Hongwei Zhang, Lili Dai, Ruojun (Esther) Wu, Xi Wang, Aixin Li, Wei Hua, Jianwei Li, Ying Shao 等
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002494
摘要
Background:
Single-tablet regimen (STR) provides a convenient once-daily regimen for the prevention of human immunodeficiency virus (HIV) infection. Here, we investigated the safety and tolerability of coformulated bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) as a three-drug, STR for post-exposure prophylaxis (PEP) in Chinese individuals.
Methods:
This was a prospective, open-label, single-arm trial conducted in a sexually transmitted diseases and acquired immunodeficiency syndrome clinic of a tertiary hospital in Beijing, China. Adults requiring PEP were prescribed BIC/FTC/TAF one pill once a day for 28 days. Clinical and laboratory data were collected and analyzed at baseline, weeks 2, 4, 8, 12, and 24.
Results:
Of 112 participants enrolled in the study, 109 (97.3%) were male and the mean age was 30 ± 8 years. PEP completion was 96.4% (95% confidence interval: 91.1-99.0%). Two participants stopped PEP after 2 days because the source partner was identified as HIV uninfected. One participant was excluded due to hepatitis B virus infection according to the exclusion criteria. One discontinued due to the participant’s decision. No participant acquired HIV through week 24. Adherence was 98.9% (standard deviation [SD]: 3.3%) by self-reporting and 98.5% (SD: 3.5%) by pill count. Only five participants experienced mild clinical adverse events attributed to the study drug (including headache, diarrhea, and nausea) and four participants had elevated serum creatinine (grade 1).
Conclusions:
A once daily, STR of BIC/FTC/TAF used as PEP was safe and well-tolerated with a high rate of completion and adherence in Chinese. BIC/FTC/TAF may be a good option for PEP.
Trial Registration:
ChiCTR.org.cn, ChiCTR2100048080
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中国深圳新诊断的原发性HIV感染中暴露前预防和暴露后预防摄取率低，传播耐药性患病率高：一项真实世界回顾性研究Qiaoli Peng, Xiaoning Liu, Xian Tang, Qiuyue Zhang, Jin Zhao, Chenli Zheng, Fang Zhao, Yang Zhou, Lukun Zhang, Liqin Sun 等
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002510
摘要
Background:
Understanding the characteristics of newly diagnosed primary human deficiency virus-1 (HIV-1) infection in the context of the post-antiretroviral therapy era and HIV drug prophylaxis is essential for achieving the new target of 95-95-95-95 by 2025. This study reported the characteristics of newly diagnosed primary HIV-1 infection in Shenzhen.
Methods:
This is a real-world retrospective study. Eighty-seven newly diagnosed primary HIV-1-infected patients were recruited from January 2021 to March 2022 at the Third People’s Hospital of Shenzhen. Demographic, epidemiological, diagnostic, drug resistance, and medical data were described and analyzed.
Results:
Overall, 96.6% (84/87) of the newly identified primary HIV-1-infected patients were male, including 88.5% (77/87) men have sex with men (MSM), with a median age of 29.0 years (Q1-Q3: 24.0-34.0 years); of these, 85.1% (74/87) reported high-risk sexual behaviors with casual partners. The rate of condom usage was only 28.7% (25/87). The overall rate of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) was 8.0% (7/87, including 4 PrEP and 3 PEP cases) around the potential exposure, although 41.4% of the patients had prior awareness of such interventions. Moreover, only 19.5% (17/87) had previously used PrEP or PEP. Of those, 58.8% (10/17) of the patients obtained drugs from the internet, and only 35.3% (6/17) reported good compliance. A total of 54.0% (47/87) of subjects were diagnosed by the HIV nucleic acid test. Acute retroviral syndrome appeared in 54.0% (47/87) of patients. The prevalence of transmitted drug resistance (TDR) mutation was 33.9% (19/56), including 6 (10.7%) against nucleoside reverse transcriptase inhibitor (NRTI) plus non-nucleoside reverse transcriptase inhibitor (NNRTI), 8 (14.3%) against NNRTI, and 5 (8.9%) against protease inhibitor (PI) only.
Conclusions:
Owing to the low utilization rate and incorrect usage of PrEP and PEP, massive efforts are needed to promote HIV-preventive strategies in the MSM population. The extremely high prevalence of TDR mutation in this population implies the need for future pretreatment drug resistance surveillance.
Clinical Observation
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中国人牛奶过敏及致敏特点Sainan Bian, Ruiqi Wang, Tao Xu, Kai Guan, Liping Wen, Lianglu Wang, Jianqing Gu, Jinlyu Sun, Rui Tang, Yuxiang Zhi 等
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002152
摘要
在全球范围内，儿童食物过敏的患病率估计约为4%至10%。[
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应用血清高尔基体蛋白73筛查社区需要抗病毒治疗的慢性乙型肝炎病毒感染者Jinwei Duan, Xiajie Wen, Huai Wang, Weixin Chen, Pei Gao, Qianli Yuan, Han Zheng, Yanna Liu, Jiang Wu, Jie Wang 等
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002051
摘要
慢性乙型肝炎病毒（HBV）感染是一个重大的全球公共卫生问题。每年约有887,000人死于HBV感染相关疾病，其中肝硬化和肝细胞癌（HCC）是主要的死亡原因。[
Rapid Report
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在接受抗逆转录病毒治疗的HIV/HBV合并感染的中国成年人中，乙型肝炎病毒（HBV）功能性治愈率很高Huan Xia, Liying Gao, Yue Hu, Xiaojie Huang, Hao Wu, Ping Ma
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002501
摘要
报告表明，全球约有3770万人感染了人类免疫缺陷病毒（HIV），[
Correspondence
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在病毒学抑制的人类免疫缺陷病毒/获得性免疫缺陷综合征患者中改用elvitegravir/cobicistat/恩曲他滨/替诺福韦治疗的优势Lina Fan, Lei Li, Liying Gao, Yue Hu, Aiping Yu, Defa Zhang, Chunting Qiu, Rong Huang, Yue Wu, Ping Ma
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002503
摘要
致编辑：随着抗逆转录病毒治疗（ART）方案的最新进展，许多患者可能会从转换药物中受益。新型组合药物elvitegravir/cobicistat/恩曲他滨/替诺福韦（E/C/F/TAF）已在中国获批用于人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AID[PLWHA]）感染者，也已纳入医保范围。这种单片方案为许多PLWHA提供了方便的、每日一次的治疗选择。E/C/F/TAF显示可增加ART依从性，降低耐药性和病毒学失败的风险。[
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河南省人类免疫缺陷病毒1型（HIV-1）感染患者传播耐药突变的患病率Jinjin Liu, Xiaohua Zhang, Mingjie Hou, Shuguang Wei, Jie Ma, Lixia Xu, Xuan Yang, Yan Sun, Chunli Liu, Qingxia Zhao 等
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002523
摘要
致编辑：即使出现了高效抗逆转录病毒疗法，人类免疫缺陷病毒1型（HIV-1）仍然是世界范围内严重的公共卫生问题。抗逆转录病毒疗法（ART）的广泛使用，一方面显著提高了HIV-1感染者的预期寿命；另一方面，也不可避免地带来了一个难题——病毒抗药性。病毒耐药性是进化上的常见现象，特别是在依从性差和药物水平次优的患者中。通过采用病毒敏感的ART方案，可以避免在经历过治疗的患者中出现病毒耐药性而导致的病毒抑制失败。然而，在传播过程中获得的病毒耐药性，称为“传播的耐药性”，可能是消除HIV-1感染的主要障碍。因为在未经治疗或新诊断的HIV-1患者中进行的基因型耐药性测试不如在经历过治疗的患者中广泛实施。HIV-1中的传播耐药突变（TDRMs）对当前ART方案和暴露前预防（PrEP）的疗效构成严重威胁。更好地了解当地TDRM的患病率可以为临床和政府层面的决策提供有价值的数据。
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机器人辅助支气管镜系统在外周肺结节取样中的学习曲线Fangfang Xie, Qin Zhang, Shuaiyang Liu, Lijun Yan, Yongzheng Zhou, Jiayuan Sun
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002304
摘要
致编辑：计算机断层扫描（CT）已被用于高危人群的肺癌筛查，随后肺癌相关死亡率降低。[
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宏基因组下一代测序诊断吉罗维氏肺孢子虫实体器官移植受者的肺炎Erdan Lu, Hanshui Jiang, Li Yang, Ning Wu, Ming Lu
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002120
摘要
致编者：吉罗维氏肺孢子虫（P.jirovecii）肺炎（PJP）是一种机会性感染，通常发生在免疫抑制患者中。由于使用免疫抑制治疗，实体器官移植（SOT）接受者PJP的发病率很高。近年来，宏基因组下一代测序（mNGS）越来越多地用于传染病的诊断。在此，我们报告了10例由mNGS诊断的PJP病例，并比较了mNGS与常规实验室方法的诊断价值。
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肠镜医生的“第三只眼”：人工智能辅助息肉检测的临床前对比研究Xinjue He, Lei Xu, Chengfu Xu, Jie Zhang, Meng Li, Weihong Wang, Xiaoyun Ding, Youming Li, Xuequn Zhang
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002364
摘要
致编辑：在中国，结直肠癌（CRC）在癌症发病率中排名第三，在癌症相关死亡中排名第五。[
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滑车内侧上表面——全膝关节置换术中辅助股骨旋转排列的新骨标志Yuan Liu, Jun Ma, Limin Wu, Xianchao Bao, Jing Yang, Bin Shen
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002401
摘要
致编辑：股骨旋转对齐不仅会影响髌骨跟踪并改变峰值接触力，还会决定部件的屈曲间隙。[
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微创钢板接骨术与切开复位内固定治疗肱骨干中远端骨折的中期结果比较Bo Yin, Lianhua Li, Zheng Lu, Jie Gao, Huayong Zeng, Yanhong Cai, Yuanming He, Zhi Liu
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002424
摘要
致编辑：关于肱骨干中远端骨折切开复位内固定（ORIF）和微创钢板接骨术（MIPO）的益处，文献中存在争议。[
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硬性输尿管镜，支架取出术中被忽视的选择：一项比较硬性输尿管镜、柔性膀胱镜和硬性膀胱镜的随机对照试验Boya Li, Xiongfeng Zeng, Deyi Luo, Yucheng Ma, Hong Li, Kunjie Wang
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002242
摘要
致编辑：作为泌尿科医生最有力的工具之一，输尿管支架常用于结石、梗阻、输尿管损伤和肾移植等疾病，并在3天至4周后用可视化仪器取出。最初，硬性膀胱镜检查（RC）最常用于支架取出，但由于其不灵活和直径大，RC经常导致疼痛和对患者的潜在损害，如血尿、疼痛和下尿路症状，尤其是对男性。
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人类精子库精子冷冻保存：中国大陆精子库网络11年结果Xiao Liu, Qiling Wang, Wenbing Zhu, Zhou Zhang, Wenhao Tang, Huiqiang Sheng, Jigao Yang, Yushan Li, Xiaowei Liang, Tianqing Meng 等
中华医学杂志英文版2022年 135卷 22期
DOI: 10.1097/CM9.0000000000002384
摘要
致编辑1866年，蒙特加扎第一个提出了冷冻人类精液库的建议。[
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