2021年 · 第134卷第23期

Human immunodeficiency virus (HIV) testing is the only way to find people living with HIV (PLWH). Early diagnosis and early treatment of HIV can extend the life of PLWH and reduce the subsequent transmission of HIV. Therefore, HIV testing plays a crucial role in public health. The global scale of HIV testing has expanded significantly over the past 10 years. Of the estimated 37 million people with HIV worldwide, approximately 79% knew their HIV status in 2018, compared with 12% in 2005. By 2018, 68.9% of PLWH in China had received a diagnosis.^[1]This number is far from the target of 90% of PLWH knowing their HIV status, which is advocated in the implementation plan for containing the spread of HIV/acquired immunodeficiency syndrome (AIDS) (2019-2022).^[2]Expanding HIV testing has become an essential and challenging issue for China’s current HIV/AIDS prevention and control.

Previous surveys have found that children with iron deficiency (ID) were likely to suffer from early childhood caries (ECC). We aimed to assess the scientific evidence about whether ID is intrinsically related to ECC.

The medical subject headings (MeSH) terms and free words were searched on PubMed, Web of Science, Cochrane, China National Knowledge Infrastructure, Wanfang, and the Database for Chinese Technical Periodicals from March 2020 to September 2020. Two researchers independently screened the articles. Data extraction and cross-checking were performed for the studies that met the inclusion criteria. Meta-analysis was performed using the Cochrane Collaboration’s Review Manager 5.3 software.

After excluding duplication and irrelevant literature, 12 case-control studies were included in the study. The meta-analysis demonstrated that children with ECC were more likely to have ID (odds ratio [OR] = 2.63, 95% confidence interval [CI]: [1.85, 3.73], P < 0.001). There was no statistically significant association found between the level of serum ferritin and ECC (weighted mean difference (WMD) = -5.80, 95% CI: [-11.97, 0.37], P= 0.07). Children with ECC were more likely to have iron-deficiency anemia (OR = 2.74, 95% CI: [2.41,3.11], P < 0.001). The hemoglobin (HGB) levels in the ECC group were significantly lower compared with that in the ECC-free group (WMD = -9.96, 95% CI: [-15.45, -4.46], P = 0.0004). The mean corpuscular volume (MCV) levels in the ECC group were significantly lower compared with that in the ECC-free group (WMD = -3.72, 95% CI: [-6.65, -0.79], P= 0.01).

ID was more prevalent in children with ECC, and the markers of iron status in the ECC group, such as serum ferritin, HGB, and MCV, were relatively lower than the ECC-free group.

Nontuberculous mycobacteria (NTM) infection can occur in both immunocompetent and immunocompromised patients, but disseminated NTM infection is mostly occurred in immunocompromised patients such as people using long-term immunosuppressants or patients with human immunodeficiency virus (HIV) infection, particularly in those with CD4+ T lymphocyte count <50 cells/mm³. Disseminated infection by NTM is considered a fatal acquired immunodeficiency syndrome (AIDS)-defining opportunistic infection with high mortality in this population.

Akkermansia muciniphila (A. muciniphila), a type of Gram-negative anaerobe, was first isolated and identified from the feces of a healthy Caucasian woman at Wageningen University in 2004.^[1]It can stably colonize the human gut 1 year after birth and accounts for 1%-4% of the total gut microbiota.A. muciniphilaspecializes in the degradation of mucin (the glycoprotein in mucus) and uses the mucin as the sole source of carbon and nitrogen.A. muciniphilais abundant in the host intestinal mucosal layer, with the greatest abundance in the cecum, where most mucin is produced.^[2]Although degradation of mucin is a pathogen-like behavior;A. muciniphiladoes not show any pathogenicity, it resides only in the outer mucosal layer and does not reach the inner mucosal layer. Recently, several studies have revealed thatA. muciniphilahas important regulatory effects on gut homeostasis.

Caroli disease (CD) is a rare congenital disorder characterized by segmental dilatation of the intrahepatic bile ducts.^[1]The simple CD is rare, with the majority of patients complicated by congenital liver fibrosis. Current treatments for CD mostly target complications but do not prevent disease progression. Surgical resection and liver transplantation are effective treatment options, but both have limitations.^[2]Therefore, fully elucidating the pathogenesis of CD to identify therapeutic targets to delay disease progression is a priority.

Rotator cuff tendons respond to continuous loading in both states of rest and motion; therefore, it is not surprising that rotator cuff tear (RCT) is the most common musculoskeletal injury of the shoulder. According to the classification of RCTs, massive RCT is defined as a tear of >5 cm or a tear involving two or more rotator cuff tendons.^[1]When a massive RCT cannot be repaired surgically, i.e., a tear in which direct tendon-to-bone repair in the remaining rotator cuff is not possible, it was termed as irreparable massive RCT.^[2]Unsurprisingly, patients with irreparable massive RCT have extremely poor functional outcomes.

Central nervous system (CNS) symptoms after efavirenz (EFV) treatment in people living with human immunodeficiency virus (HIV) could persist and impact their quality of life. We assessed the impact of EFV-based regimen replacement with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF), which is considered an alternative option for subjects who do not tolerate EFV. Most specifically, we assessed the safety and the efficacy of E/C/F/TAF and its effects on the participants’ neuropsychiatric toxicity symptoms in a real-life setting.

A prospective cohort study was conducted among virologic suppressed HIV-positive participants receiving EFV-based regimens with ongoing CNS toxicity ≥ grade 2. The participants were switched to single-pill combination regimens E/C/F/TAF and followed up for 48 weeks. The neuropsychiatric toxicity symptoms were measured using a CNS side effects questionnaire, as well as the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. The primary outcome measure was the proportion of participants experiencing grade 2 or higher CNS toxicity after EFV switch off at weeks 12, 24, and 48. Secondary endpoints included virologic and immunological responses and the effect on fasting lipids at week 48 after switch.

One hundred ninety-six participants (96.9% men, median age: 37.5 years, median: 3.7 years on prior EFV-containing regimens) were included in the study. Significant improvements in anxiety and sleep disturbance symptoms were observed at 12, 24, and 48 weeks after switching to E/C/F/TAF (P < 0.05). No significant change in depression symptom scores was observed. At 48 weeks after switch, HIV viral load <50 copies/mL was maintained in all of the participants, median fasting lipid levels were moderately increased (total cholesterol [TC]: 8.2 mg/dL, low-density lipoprotein cholesterol [LDL-C]: 8.5 mg/dL, high-density lipoprotein cholesterol [HDL-C]: 2.9 mg/dL, and triglyceride (TG): 1.6 mg/dL, and the TC:HDL-C ratio remained stable.

The single-pill combination regimens E/C/F/TAF is safe and well tolerated. This study reveals that switching from EFV to E/C/F/TAF significantly reduces neuropsychiatric toxicity symptoms in people living with HIV with grade 2 or higher CNS complaints.

Physical activity (PA) and sedentary behavior (SB) have been associated with mortality, while the joint association with mortality is rarely reported among Chinese population. We aimed to examine the independent and joint association of PA and SB with all-cause mortality in southern China.

A cohort of 12,608 China Hypertension Survey participants aged ≥35 years were enrolled in 2013 to 2014, with a followup period of 5.4 years. Baseline self-reported PA and SB were collected via the questionnaire. Kaplan-Meier curves (log-rank test) and Cox proportional hazards regression were performed to evaluate the associations of PA and SB on all-cause mortality.

A total of 11,744 eligible participants were included in the analysis. Over an average of 5.4 years of follow-up, 796 deaths occurred. The risk of all-cause mortality was lower among participants with high PA than those with low to moderate level (5.2% vs. 8.9%; hazards ratio [HR]: 0.75, 95% confidence interval [CI]: 0.61-0.87). Participants with SB ≥ 6 h had a higher risk of all-cause mortality than those with SB <6 h (7.8% vs. 6.0%; HR: 1.37, 95% CI: 1.17-1.61). Participants with prolonged SB (≥6 h) and inadequate PA (low to moderate) had a higher risk of all-cause mortality compared to those with SB < 6 h and high PA (11.2% vs. 4.9%; HR: 1.67, 95% CI: 1.35-2.06). Even in the participants with high PA, prolonged SB (≥6 h) was still associated with the higher risk of all-cause mortality compared with SB < 6 h (7.0% vs. 4.9%; HR: 1.33, 95% CI: 1.12-1.56).

Among Chinese population, PA and SB have a joint association with the risk of all-cause mortality. Participants with inadequate PA and prolonged SB had the highest risk of all-cause mortality compared with others.

Patients’ recovery after surgery is the major concern for all perioperative clinicians. This study aims to minimize the side effects of peri-operative surgical stress and accelerate patients’ recovery of gastrointestinal (GI) function and quality of life after colorectal surgeries, an enhanced recovery protocol based on pre-operative rehabilitation was implemented and its effect was explored.

A prospective randomized controlled clinical trial was conducted, patients were recruited from January 2018 to September 2019 in this study. Patients scheduled for elective colorectal surgeries were randomly allocated to receive either standardized enhanced recovery after surgery (S-ERAS) group or enhanced recovery after surgery based on pre-operative rehabilitation (group PR-ERAS). In the group PR-ERAS, on top of recommended peri-operative strategies for enhanced recovery, formatted rehabilitation exercises pre-operatively were carried out. The primary outcome was the quality of GI recovery measured with I-FEED scoring. Secondary outcomes were quality of life scores and strength of handgrip; the incidence of adverse events till 30 days post-operatively was also analyzed.

A total of 240 patients were scrutinized and 213 eligible patients were enrolled, who were randomly allocated to the group S-ERAS (n = 104) and group PR-ERAS (n = 109). The percentage of normal recovery graded by I-FEED scoring was higher in group PR-ERAS (79.0% vs. 64.3%, P < 0.050). The subscores of life ability and physical well-being at post-operative 72 h were significantly improved in the group PR-ERAS using quality of recovery score (QOR-40) questionnaire (P < 0.050). The strength of hand grip post-operatively was also improved in the group PR-ERAS (P < 0.050). The incidence of bowel-related and other adverse events was similar in both groups till 30 days post-operatively (P > 0.050).

Peri-operative rehabilitation exercise might be another benevolent factor for early recovery of GI function and life of quality after colorectal surgery. Newer, more surgery-specific rehabilitation recovery protocol merits further exploration for these patients.

ChiCTR.org.cn, ChiCTR-ONRC-14005096

The complement system plays an important role in the immune response to transplantation, and the diagnostic significance of peritubular capillary (PTC) C4d deposition (C4d+) in grafts is controversial. The study aimed to fully investigate the risk factors for PTC C4d+ and analyze its significance in biopsy pathology of kidney transplantation.

This retrospective study included 124 cases of kidney transplant with graft biopsy and donor-specific antibody (DSA) testing from January 2017 to December 2019 in a single center. The effects of recipient pathological indicators, eplet mismatch (MM), and DSAs on PTC C4d+ were examined using univariate and multivariate logistic regression analyses.

In total, 35/124 (28%) were PTC C4d+, including 21 with antibody-mediated rejection (AMR), eight with renal tubular injury, three with T cell-mediated rejection, one with glomerular disease, and two others. Univariate analysis revealed that DSAs (P < 0.001), glomerulitis (P < 0.001), peritubular capillaritis (P < 0.001), and human leukocyte antigen (HLA) B eplet MM (P = 0.010) were the influencing factors of PTC C4d+. According to multivariate analysis, DSAs (odds ratio [OR]: 9.608, 95% confidence interval [CI]: 2.742-33.668, P < 0.001), glomerulitis (OR: 3.581, 95%CI: 1.246-10.289, P = 0.018), and HLA B eplet MM (OR: 1.166, 95%CI: 1.005-1.353, P= 0.042) were the independent risk factors for PTC C4d+. In receiver operating characteristic curve analysis, the area under the curve was increased to 0.831 for predicting PTC C4d+ when considering glomerulitis, DSAs, and HLA B eplet MM. The proportions of HLA I DSAs and PTC C4d+ in active antibody-mediated rejection were 12/17 and 15/17, respectively; the proportions of HLA class II DSAs and PTC C4d+ in chronic AMR were 8/12 and 7/12, respectively. Furthermore, the higher the PTC C4d+ score was, the more serious the urinary occult blood and proteinuria of recipients at the time of biopsy.

PTC C4d+ was mainly observed in AMR cases. DSAs, glomerulitis, and HLA B eplet MM are the independent risk factors for PTC C4d+.

Obesity and insulin resistance (IR) are common features of polycystic ovary syndrome (PCOS). Metformin (MET) increases insulin sensitivity, but it is associated with unsatisfactory weight loss. The glucagon-like peptide-1 receptor agonist exenatide has been shown to reduce weight and IR in patients with diabetes. This study aimed to explore the therapeutic effects of exenatide once-weekly (QW) combined with MET on body weight, as well as metabolic and endocrinological parameters in overweight/obese women with PCOS.

Fifty overweight/obese women with PCOS diagnosed via the Rotterdam criteria were randomized to one of two treatment groups: MET (500 mg three times a day [TID]) or combination treatment (COM) (MET 500 mg TID, exenatide 2 mg QW) for 12 weeks. The primary outcomes were anthropometric changes associated with obesity, and the secondary outcomes included changes in reproductive hormone levels, glucose and lipid metabolism, and C-reactive protein.

Forty (80%) patients completed the study. COM therapy was superior to MET monotherapy in reducing weight (P = 0.045), body mass index (BMI) (P = 0.041), and waist circumference (P = 0.023). Patients in the COM group on an average lost 3.8 ± 2.4 kg compared with 2.1 ± 3.0 kg in the MET group. In the COM group, BMI and waist circumference decreased by 1.4 ± 0.87 kg/m² and 4.63 ± 4.42 cm compared with 0.77 ± 1.17 kg/m² and 1.72 ± 3.07 cm in the MET group, respectively. Moreover, levels of fasting glucose, oral glucose tolerance test (OGTT) 2-h glucose, and OGTT 2-h insulin were significantly lower with COM therapy than with MET (P < 0.050). Mild and moderate gastrointestinal reactions were the most common adverse events in both groups.

COM therapy was more effective than MET alone in reducing body weight, BMI, and waist circumference, and improving insulin sensitivity in overweight/obese women with PCOS, with acceptable short-term side effects.

ClinicalTrials.gov, NCT04029272. https://clinicaltrials.gov/ct2/show/NCT04029272

As one of the most aggressive and lethal malignant tumors, the 5-year survival rate of oesophageal cancer is less than 20%.^[1]There are two main pathological subtypes of esophageal cancer: esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma.^[1]In China, more than 95% of esophageal cancer is ESCC. Encouragingly, cancer immunotherapy has entered a new era recently with the discovery of drugs that interfere with specific immune checkpoints. Moreover, due to the good effect of immunotherapy in squamous cell carcinoma, it may be a new strategy for ESCC treatment in the future.

To the Editor:The prevalence of type 2 diabetes mellitus (T2DM) in older Chinese adults (≥60 years) is over 20%.^[1]In comparison to younger patients, older diabetes patients tend to have lower rate of adequate glycemic control (<7.0% hemoglobin A1c [HbA1c]) and a higher risk of hypoglycemia.^[2]Currently, there are limited data on the clinical characteristics and treatment patterns of older T2DM patients in China. We conducted a nationwide cross-sectional study to examine the clinical characteristics, anti-diabetic treatment patterns, and glycemic control in older (≥60 years) Chinese patients. Factors associated with poor glycemic control were identified with multivariate regression analysis.

To the Editor:IgA nephropathy (IgAN) is of a great concern in China, where apprehensions regarding this condition are related to the fact that approximately 30% of IgAN patients experience a poor outcome and the tendency for IgAN to develop within younger patients. Moreover, 40% of IgAN patients developed end-stage renal disease (ESRD) within 20 years after diagnosis of this condition.^[1]The pathogenesis associated with IgAN has not been clearly characterized, nor is there an effective treatment for this condition. Now, clinical treatment typically involves use of glucocorticoids and immune inhibitors, such as cyclophosphamide with mycophenolate mofetil. Therefore, a better understanding of the pathogenesis of IgAN along with more effective treatments represents critical issues requiring immediate attention.