Volume 133 · Issue 23 · 2020

为到2030年消除全球人类免疫缺陷病毒感染和获得性免疫缺陷综合征（HIV/AIDS）流行病对公共卫生的威胁，联合国艾滋病毒/艾滋病联合规划署于2014年启动了90-90-90控制目标，以帮助结束艾滋病毒的传播。中国积极应对，扩大和扩大艾滋病毒检测，实施早期抗逆转录病毒治疗。在实现90-90-90目标方面，中国在2018年实现了更高的百分比（83.4%vs79.5%）和第三（94.2%vs79.9%）高于全球平均水平，但低于第一个“90”目标的百分比（69.3%）vs79.9%），其目标是让90%的艾滋病毒感染者（PLWHIV）了解他们的艾滋病毒状况。同时，中国PLWHIV的估计数量由2013年的81万例增加至2018年的125万例。此外，虽然艾滋病在2019年全国法定法定传染病病例数中排名第三，但在此类疾病导致的死亡人数中排名第一。上述证据表明，过度依赖HIV检测和早期ART远远不足以完全控制HIV。有必要推进直接预防和控制战略，降低关键人群感染艾滋病毒的风险。艾滋病毒接触前预防（PrEP）和非职业接触后预防（nPEP）只是这项工作中需要充分利用的两项措施。

自1983年首次被隔离以来，人类免疫缺陷病毒（HIV）已导致近5000万人死亡，影响全球数百万人。联合抗逆转录病毒疗法（ART）因其对HIV复制和传播控制的有益作用而被普遍推荐用于HIV感染。^[1]世界卫生组织在2015年底取消了传统的基于CD4的ART资格要求。因此，现在建议所有HIV感染者（PLWH）接受ART，无论CD4水平或临床阶段如何。全球宣言呼吁在2010年至2020年期间将新的艾滋病毒感染和获得性免疫缺陷综合征（艾滋病）死亡人数减少75%，并通过实现联合国艾滋病毒/艾滋病联合规划署为2020年设定的90-90-90目标（90%的PLWH得到诊断，其中90%正在接受治疗，其中90%受到病毒抑制），到2030年结束艾滋病毒/艾滋病流行。^[2]尽管2019年在实现这些目标方面取得了积极进展，但仍存在巨大差距。据估计，全球79%（67%-92%）的PLWH知道他们的状态，78%（69%-82%）知道他们状态的人正在接受治疗，86%（72%-92%）正在接受治疗的人已经抑制了病毒载量。在全球范围内，估计有3790万（3270万-4400万）PLWH，2018年有170万（140万-230万）新感染和77万（57万至110万）艾滋病相关死亡。多年来进行了一系列政府资助的多中心研究，以指导优化HIV/AIDS患者的HIV/AIDS治疗方法，并出现了一些新的进展。^[2]

Human immunodeficiency virus (HIV) prevalence among student men who have sex with men (MSM) in college is more than 5.0% and keeps on increasing in China. This study aims to clarify the proportion of HIV recent infection, its propeller and the source among college student MSM.

We conducted a multicenter cross-sectional study in seven major Chinese cities during 2012-2013. HIV recent infections (≤168 days) and incidence was measured and estimated by BED HIV-1 capture enzyme immunoassay (BED-CEIA) testing strategy. HIV-related behaviors and transmitted drug resistance (TDR) were investigated and compared between the college student MSM, < 25-year-old non-student youth MSM (NSYM), and ≥25-year-old non-student non-youth MSM (NSNYM), using structured survey, and analyses of drug resistance.

Overall, 4496 (4496/4526, 99.3%) were eligible for enrollment, comprising 565 college student MSM, 1094 NSYM, and 2837 NSNYM. The proportion of HIV recent infection were 70.3% (26/37), 50.8% (65/128) and 35.1% (95/271), the HIV incidence rate were 10.0 (95% CI: 6.2-13.9)/100 person-year (PY), 12.9 (95% CI: 9.8-16.1 )/100PY, 6.8 (95% CI: 5.4-8.2)/100 PY, and TDR prevalences were 7.4% (2/27), 2.0%, (2/98) and 4.9% (11/226), among student MSM, NSYM, and NSNYM, respectively. Among HIV positive student MSM with age <21 years, the proportion of HIV recent infection is 90.9% (10/11). Factors independently associated with HIV recent infection in student MSM was usage of recreational drug in the past 6 months (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.0-5.8).

College student MSM had higher proportion of HIV recent infection and TDR than the youth and older MSM in China during 2012-2013. The HIV infections were more likely to happen during the early year of college life among student MSM.

Cryptococcal meningitis (CM) is one of the most common opportunistic infections caused by Cryptococcus neoformans in human immunodeficiency virus (HIV)-infected patients, and is complicated with significant morbidity and mortality. This study retrospectively analyzed the clinical features, characteristics, treatment, and outcomes of first-diagnosed HIV-associated CM after 2-years of follow-up.

Data from all patients (n = 101) of HIV-associated CM hospitalized in Shanghai Public Health Clinical Center from September 2013 to December 2016 were collected and analyzed using logistic regression to identify clinical and microbiological factors associated with mortality.

Of the 101 patients, 86/99 (86.9%) of patients had CD4 count <50 cells/mm³, 57/101 (56.4%) were diagnosed at ≥14 days from the onset to diagnosis, 42/99 (42.4%) had normal cerebrospinal fluid (CSF) cell counts and biochemical examination, 30/101 (29.7%) had concomitant Pneumocystis (carinii) jiroveci pneumonia (PCP) on admission and 37/92 (40.2%) were complicated with cryptococcal pneumonia, 50/74 (67.6%) had abnormalities shown on intracranial imaging, amongst whom 24/50 (48.0%) had more than one lesion. The median time to negative CSF Indian ink staining was 8.50 months (interquartile range, 3.25-12.00 months). Patients who initiated antiretroviral therapy (ART) before admission had a shorter time to negative CSF Indian ink compared with ART-naïve patients (7 vs. 12 months, χ² = 15.53, P < 0.001). All-cause mortality at 2 weeks, 8 weeks, and 2 years was 10.1% (10/99), 18.9% (18/95), and 20.7% (19/92), respectively. Coinfection with PCP on admission (adjusted odds ratio [AOR], 3.933; 95% confidence interval [CI], 1.166-13.269, P= 0.027) and altered mental status (AOR, 9.574; 95% CI, 2.548-35.974, P = 0.001) were associated with higher mortality at 8 weeks.

This study described the clinical features and outcomes of first diagnosed HIV-associated CM with 2-year follow-up data. Altered mental status and coinfection with PCP predicted mortality in HIV-associated CM.

Numerous studies have focused on lymphoma among patients infected with human immunodeficiency virus (HIV). However, little is known about the treatment options and survival rate of lymphoma in the Chinese people living with HIV (PLHIV). Our study aimed to investigate the prognosis and compare outcome of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) with standard cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab(R-CHOP) as front line therapy for PLHIV with diffuse large B-cell lymphoma (DLBCL) receiving modern combined antiretroviral therapy (cART).

A retrospective analysis evaluating PLHIV with DLBCL was performed in Shanghai Public Health Clinical Center from July 2012 to September 2019. The demographic and clinical data were collected, and overall survival (OS) and progression-free survival (PFS) analyses of patients receiving R-CHOP or DA-EPOCH-R therapy were performed by Kaplan-Meier analysis. Additionally, a Cox multiple regression model was constructed to identify related factors for OS.

A total of 54 eligible patients were included in the final analysis with a median follow-up of 14 months (interquartile range [IQR]: 8-29 months). The proportion of high international prognostic index (IPI) patients was much larger in the DA-EPOCH-R group (n = 29) than that in the R-CHOP group (n = 25). The CD4 cell counts and HIV RNA levels were not significantly different between the two groups. The 2-year OS for all patients was 73%. However, OS was not significantly different between the two groups, with a 2-year OS rate of 78% for the DA-EPOCH-R group and 66% for the R-CHOP group. Only an IPI greater than 3 was associated with a decrease in OS, with a hazard ratio of 5.0. The occurrence of grade 3 and 4 adverse events of chemotherapy was not significantly different between the two groups.

Outcomes of R-CHOP therapy do not differ from those of DA-EPOCH-R therapy. No HIV-related factors were found to be associated with the OS of PLHIV in the modern cART era.

Allogeneic natural killer (NK) cell immunotherapy is recognized as a promising anti-tumor strategy, but whether it plays a role in poor CD4 recovery among human immunodeficiency virus type 1 (HIV-1) infected patients is unknown. This study aimed to investigate the safety and effectiveness of allogeneic NK cells immunotherapy on HIV-1 immunological non-responders (INRs) receiving antiretroviral therapy (ART).

From February to April 2018, a prospective, randomized, controlled, open-label clinical trial, which enrolled 20 HIV-1 INRs following specific inclusion criteria, was conducted at Nankai University Second People’s Hospital. Participants were randomly allocated (simple randomization 1:1) to either the combined treatment (NK + ART) group (n = 10) or the control (ART) group (n = 10). The allogenic highly activated NK cells from killer cell immunoglobulin-like receptor (KIR)/human leukocyte antigen (HLA)-Cw mismatched healthy donor were prepared (10⁸ cells in each injection) and intravenously infused to each recruited patient of NK+ART group in three courses. Key immune parameters (CD4 count, CD8 count, CD4/CD8 ratio), laboratory tests (count of blood cells, biochemistry panel) and symptoms at baseline and at month 1, 3, 6, 9, 12, and 24 were measured/collected to analyze the safety and efficacy of the therapy. Comparisons were between the seven time-points of both groups using repeated measurement analysis of variance (ANOVA) test. Generalized estimating equations (GEE) model was performed to evaluate the overall effect of the NK+ART group vs. the ART group.

From baseline to 24 months, we noted a mean CD4 count augmentation (139 to 243 cells/μL) in the NK + ART group and (144 to 176 cells/μL) in the ART group (difference, 67; 95% CI, 10 to 124; P = 0.024). Our estimations revealed that NK+ART group could improve CD4 level (β = 54.59, P= 0.006) and CD8 level (β = 322.47, P= 0.010) on average among the six measurements compared with the ART group. Only two (2/10, 20%) participants in the NK+ART group developed a transient mild fever after the first course.

This preliminary study informs that HIV-1 INRs, allogenic NK cells immunotherapy is safe and could significantly improve CD4 recovery but not CD4/CD8 ratio. The practical effects, however, need long-term follow-up observations. Further study on the potential underlying mechanism is warranted.

www.chictr.org.cn/showproj.aspx?proj=34912 (No. ChiCTR1900020634).

Lipid abnormalities are prevalent among people living with human immunodeficiency virus (HIV) (PLWH) and contribute to increasing risk of cardiovascular events. This study aims to investigate the incidence of dyslipidemia and its risk factors in PLWH after receiving different first-line free antiretroviral regimens.

PLWH who sought care at the Third People’s Hospital of Shenzhen from January 2014 to December 2018 were included, and the baseline characteristics and clinical data during the follow-up were collected, including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). The risk factors of dyslipidemia after antiretroviral therapy were analyzed with the generalized estimating equation model.

Among the 7623 PLWH included, the mean levels of TC, HDL-C and LDL-C were 4.23 ± 0.85 mmol/L, 1.27 ± 0.29 mmol/L and 2.54 ± 0.65 mmol/L, respectively, and the median TG was 1.17 (IQR: 0.85-1.68) mmol/L. Compared with that in PLWH receiving tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) + ritonavir-boosted lopinavir (LPV/r), zidovudine (AZT) + 3TC + efavirenz (EFV), and AZT + 3TC + LPV/r, the incidence of dyslipidemia was lower in PLWH receiving TDF + 3TC + EFV. In multivariate analysis, we found that the risks of elevations of TG, TC, and LDL-C were higher with TDF + 3TC + LPV/r (TG: odds ratio [OR] = 2.82, 95% confidence interval [CI]: 2.55-3.11, P < 0.001; TC: OR = 1.24, 95% CI: 1.14-1.35, P < 0.001; LDL: OR = 1.06, 95% CI: 1.00-1.12, P = 0.041), AZT + 3TC + EFV (TG: OR = 1.41, 95% CI: 1.28-1.55, P < 0.001; TC: OR = 1.43, 95% CI: 1.31-1.56, P < 0.001; LDL: OR = 1.18, 95% CI: 1.12-1.25, P < 0.001), and AZT + 3TC + LPV/r (TG: OR = 3.08, 95% CI: 2.65-3.59, P < 0.001; TC: OR = 2.40, 95% CI: 1.96-2.94, P < 0.001; LDL: OR = 1.52, 95% CI: 1.37-1.69, P < 0.001) than with TDF + 3TC + EFV, while treatment with TDF + 3TC + LPV/r was less likely to restore HDL-C levels compared with TDF + 3TC + EFV (OR = 0.95, 95% CI: 0.92-0.97, P < 0.001). In addition to antiretroviral regimens, antiretroviral therapy duration, older age, overweight, obesity and other traditional factors were also important risk factors for dyslipidemia.

The incidence of dyslipidemia varies with different antiretroviral regimens, with TDF + 3TC + EFV having lower risk for dyslipidemia than the other first-line free antiretroviral regimens in China.

The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy.

A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study. Perioperative information, intraoperative blood loss, clinical and radiological outcomes, and complications were recorded. Japanese Orthopedic Association (JOA) score, 36-item short form survey (SF-36) score and cervical alignment were assessed.

There were no significant differences in JOA scores between the anterior and posterior group preoperatively (11.6 ± 1.6 vs. 12.1 ± 1.5), immediately postoperatively (14.4 ± 1.1 vs. 13.8 ± 1.3), or at the last follow-up (14.6 ± 1.0 vs. 14.2 ± 1.1) (P > 0.05). The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values. The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up. The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value (69.4 vs. 61.7). Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively (-2.0° ± 7.3° vs. -1.4° ± 7.5°). The Cobb angle significantly improved immediately postoperatively (12.3° ± 4.2° vs. 9.2° ± 3.6°) and at the last follow-up (12.4° ± 3.5° vs. 9.0° ± 2.6°) in both groups compared with their preoperative values (P = 0.00). Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group.

Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features. However, the JOA score recovery rate and SF-36 score in the anterior group were significantly higher. Persistent axial pain could be a major concern when undertaking the posterior approach.

There are an increasing number of patients with oral sensory complaints (OSCs) presenting to our dental clinic. For most dentists, it is difficult to distinguish burning mouth syndrome (BMS) from other oral mucosal diseases that may cause symptoms such as burning mouth. It is beneficial to effectively distinguish OSC patients to reduce misdiagnosis and eliminate burning symptoms as much as possible.

Patients with oral burning sensations in the oral mucosal disease clinic were collected from the Peking University Hospital of Stomatology between September 1, 2014 and December 31, 2018. After excluding oral candidiasis, anemic stomatitis, dental material allergy, and other diseases from patients with oral sensory complaints, basic conditions such as gender, age, education level, job status, hyperglycemia, hypertension, hyperlipidemia, history of brain abnormalities, history of cervical spondylitis, history of thyroid disease, history of thyroid disease and insomnia were obtained. The BMS patients were compared with the control group. The t test and Chi-square test were used for statistical analysis to compare the clinical symptoms of these diseases and explore the risk factors for BMS.

In this case-control study, 395 patients (321 females and 74 males, mean age 55.26 ± 10.51 years) with oral sensory complaints and 391 healthy controls (281 females and 110 males, mean age 47.11 ± 13.10 years) were enrolled, among which, 8.4% (33/395) had oral candidiasis, 1.3% (5/395) had dental material allergy, 0.8% (3/395) had anemic stomatitis and 0.5% (2/395) had lichen planus. A total of 352 patients were eventually diagnosed with BMS. Anxiety and depression were more severe in BMS patients, as were the incidences of sleep disorders and brain abnormalities. Logistic regression analysis showed that age (odds ratio [OR]= 2.79, 95% confidence interval [CI]: 1.61-4.83, P < 0.001), total cholesterol level (OR= 2.92, 95% CI: 1.32-6.50, P = 0.009) and anxiety score (OR = 1.75, 95% CI: 1.01-2.77, P = 0.017) significantly increased the incidence of BMS. Patients with hyperglycemia (OR = 0.46, 95% CI: 0.23-0.89, P = 0.022), low body mass index (BMI: OR = 0.57, 95% CI: 0.34-0.93, P = 0.026) and low education level (OR = 3.43, 95% CI: 1.91-6.15, P < 0.001) were more likely to suffer from BMS.

Oral candidiasis, anemic stomatitis, and dental material allergy with burning symptoms should be excluded from patients with BMS. It is recommended to conduct a questionnaire survey (including anxiety and depression), blood cell analysis, and salivary fungus culture for all patients with an oral burning sensation. It is necessary to conduct a patch test on patients with oral burning sensations and metal restorations.

Acute myeloid leukemia (AML) is a malignant hematological disease, originating from hematopoiesis stem cell differentiation obstruction and clonal proliferation. New reagents or biologicals for the treatment of AML are urgently needed, and exosomes have been identified as candidate biomarkers for disease diagnosis and prognosis. This study aimed to investigate the effects of exosomes from bone marrow mesenchymal stem cells (BMSCs) on AML cells as well as the underlying microRNA (miRNA)-mediated mechanisms.

Exosomes were isolated using a precipitation method, followed by validation using marker protein expression and nanoparticle tracking analysis. Differentially expressed miRNAs were identified by deep RNA sequencing and confirmed by quantitative real-time polymerase chain reaction (qPCR). Cell proliferation was assessed by the 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium inner salt method, and cell cycle progression and apoptosis were detected by flow cytometry. Functional gene expression was analyzed by qPCR and Western blotting (WB). Significant differences were determined using Student’s t test or analysis of variance.

BMSCs-derived exosomes effectively suppressed cell proliferation (both P < 0.0001 at 10 and 20 μg/mL) and cell cycle progression (P < 0.01 at G0-G1 stage), and also significantly enhanced cell apoptosis (P < 0.001) in KG-1a cells. There were 1167 differentially expressed miRNAs obtained from BMSCs-derived exosomes compared with KG-1a cell-derived exosomes (P < 0.05). Knockdown of hsa-miR-124-5p in BMSCs abrogated the effects of BMSCs-derived exosomes in regulating KG-1a such as the change in cell proliferation (both P < 0.0001 vs. normal KG-1a cell [NC] at 48 and 72 h). KG-1a cells treated with BMSCs-derived exosomes suppressed expression of structural maintenance of chromosomes 4 (P < 0.001 vs. NC by qPCR and P < 0.0001 vs. NC by WB), which is associated with the progression of various cancers. This BMSCs-derived exosomes effect was significantly reversed with knockdown of hsa-miR-124-5p (P < 0.0001 vs. NC by WB).

BMSCs-derived exosomes suppress cell proliferation and cycle progression and promote cell apoptosis in KG-1a cells, likely acting through hsa-miR-124-5p. Our study establishes a basis for a BMSCs-derived exosomes-based AML treatment.

尽管全球人类免疫缺陷病毒（HIV）疫情已得到有效遏制，但在高危人群中预防和管理HIV感染仍然具有挑战性。^[1]在中国，艾滋病毒主要通过性接触传播。^[1,2]暴露前预防（PrEP）是使用抗逆转录病毒药物预防HIV感染的一种新的有效方法^[3];全球多项临床试验数据显示，使用抗逆转录病毒药物进行PrEP可以限制HIV传播。^[4,5,6,7]世界卫生组织（世卫组织）于2015年发布指南，建议在HIV发病率超过3/100人年（PY）的人群和从事高危行为的个人中进行PrEP。^[3]根据现有研究，我国重点人群中男男性行为者(MSM)的HIV发病率为5.6/100 PY，^[8]静脉注射吸毒者为1.6/100 PY，^[9]女性性工作者为1.4/100 PY。^[10,11]截至2020年7月，已有54个国家和地区发布了成人预防HIV感染的PrEP指南，其中36个国家和地区还发布了儿童和青少年指南。但国内尚无PrEP指南或相关共识声明。因此，非常需要关于PrEP实施的标准化指导，涉及医疗选择标准、PrEP时机、药物安全性以及咨询和测试计划。在此，我们根据卫生政策制定者、科学家、临床专家、重点人群社区组织的意见和建议以及PrEP研究的最新报告，提出了在中国实施PrEP的共识声明。

研究发现，一些2019冠状病毒病（COVID-19）患者存在临床相关的心脏损伤，据报道，在中国武汉，COVID-19患者心肌炎的发病率在医院为12%，在重症监护室为32%。^[1]急性心肌损伤或心肌炎是一个非常重要的临床问题，因为疾病有快速进展为严重心律失常、心力衰竭、心源性休克等的风险。^[2,3]床旁超声心动图检查是评估心肌炎和其他并发症的一线首选影像学选择，如特别是由于肺动脉栓塞引起的急性右心衰竭、应激性心肌病、急性心肌梗死和并存的基础慢性心血管疾病。^[4,5,6,7]

梅毒是一种性传播感染(STI)，由梅毒螺旋体梅毒仍然是世界范围内的主要公共卫生问题。对梅毒治疗的阳性反应由治疗后非密螺旋体滴度降低四倍或血清逆转来指示。大约5%至41%的梅毒患者对治疗无反应，并保持血清反应迟钝^[1,2,3]并且在早期梅毒中6个月后和在晚期梅毒中12个月后仅显示非密螺旋体抗体滴度降低小于4倍（两次稀释），或者在治疗后显示持续的低滴度。^[4,5,6]这些状况被称为血清快状态。迄今为止，血清快状态的发病机制尚不清楚，并且很难预测血清快的发生。因此，我们评估了与血清快状态相关的因素。

梅毒是由螺旋体引起的性传播感染梅毒螺旋体(T.苍白球），具有全球和历史意义。由于病原体获取方式重叠，HIV（PLWH）感染者经常合并感染梅毒。神经梅毒可以发生在梅毒感染的任何阶段，PLWH在早期和晚期潜伏梅毒（包括无症状中枢神经系统（CNS）感染）中比没有HIV感染的人更有可能发生神经梅毒。部分神经梅毒患者表现为脑膜炎、脑卒中、脑神经功能障碍、听觉或眼科异常、精神状态急性改变等神经系统表现。然而，PLWH的一些神经梅毒病例缺乏中枢神经系统感染的体征或症状。无症状神经梅毒是在没有神经体征或症状的情况下诊断的，并且只能在存在指示CNS感染的脑脊液（CSF）异常的情况下检测到，包括单核红细胞增多症、蛋白质浓度增加和/或反应性CSF性病研究实验室（VDRL）测定。这引起了人们的担忧，即T.苍白球尽管在中枢神经系统中无症状，但可能导致PLWH的治疗失败和神经系统后遗症。神经梅毒甚至在感染数年后可能导致脑神经麻痹、梅毒性脑膜炎、全身轻瘫和背侧麻痹。因此，PLWH无症状神经梅毒可能需要早期干预。

致编辑：Rasmussen脑炎（RE）是一种原因不明的慢性炎症性疾病，通常累及大脑的一个半球。^[1]这是一种罕见的神经系统疾病，通常见于儿童。虽然RE的原因尚不清楚，但目前的证据表明，自身免疫过程是脑细胞损伤的原因。由于反复惊厥和进行性神经元损害，患者常出现智力下降和神经功能障碍。

在流行病学从传染性疾病向非传染性疾病转变的背景下，心房颤动（AF）是一个日益严重的公共卫生问题，在中国住院死亡患者中发现AF的高患病率。^[1]事实上，对房颤的大多数理解是基于在北美和西欧进行的临床试验和观察性研究的发现，^[2]并且一些研究描述了其他地区房颤患者的特征。这些数据突出了这些地区房颤患者的临床特征和治疗的重要差异。^[3,4]然而，很少有研究调查中国房颤患者的特征。因此，本研究的目的是使用最近在中国注册的一项针对房颤的全国性队列研究——中国房颤真实世界研究（RWS-CAF）注册中心的数据，调查因房颤住院的患者的临床人口统计学、管理和结局。RWS-CAF注册中心（注册号：ChiCTR1900021250）包括一个多中心、观察性、前瞻性队列，包括根据中国房颤指南诊断为房颤的需要住院的连续患者，时间跨度为2017年11月1日至2018年10月31日。所有入组医院均为三级甲等医院。招募了18岁或以上因房颤住院的个体患者。

自发性食管破裂，或Boerhaave综合征，是一种罕见但潜在致命的疾病，在文献中死亡率为20%至30%。^[1]在一些欧洲国家，发病率低于3至6/1,000，000人。^[2]如今，由于临床表现多变且缺乏共识或指南，这种疾病的治疗仍然是医生面临的挑战。^[3]

约翰·坎宁安（JC）多瘤病毒于1971年首次在一名患有进行性多灶性白质脑病（PML）的患者中发现。PML的诊断包括明确（病因）诊断和推定（临床）诊断。病因诊断包括脑脊液（CSF）确认的PML（CSF中JC多瘤病毒的证据）和组织确认的PML（脑组织中JC多瘤病毒的证据）。PML的临床诊断被定义为典型的临床和磁共振成像（MRI）发现的证据。^[1]

致编辑：慢性乙型肝炎病毒（HBV）感染在全球人类免疫缺陷病毒（PLWH）感染者中很常见（7.4%），据报道，撒哈拉以南非洲和亚洲的患病率最高。^[1]围产期和水平传播是这些地区HBV感染的主要途径。然而，在发达国家，人类免疫缺陷病毒（HIV）/HBV合并感染在男男性行为者或注射吸毒者中更为常见。另一方面，在6.2%的PLWH中发现了丙型肝炎病毒（HCV）抗体，这意味着全球3670万PLWH中估计有230万具有过去或现在HCV合并感染的血清学证据。^[1]

致编辑：中国有125万人类免疫缺陷病毒（HIV）（PLWH）感染者，2018年新增确诊病例超过13.5万例。^[1]HIV阳性骨折患者术后并发症发生率极高，医务人员在围手术期经常经历职业暴露。因此，外科医生经常担心对HIV阳性患者进行手术。为了确保外科医生的安全和减少患者的术后并发症，我们试图在术前最大限度地抑制病毒载量（VL）。先前的研究表明，PLWH表现出高活性抗逆转录病毒疗法（HAART）的高摄取和快速的VL抑制。^[2]近年来，新引入的抗逆转录病毒药物，例如整合酶链转移抑制剂(INSTI)的组合，在包含elvitegravir、cobicistat、恩曲他滨和替诺福韦艾拉酚胺(E/C/F/TAF)(150/150/200/10mg)的单片剂方案(STR)中观察到更快速的VL抑制。^[3]研究表明，STR比多片方案（MTR）具有更可靠的病毒抑制成功率。^[4]通常，患者更喜欢全国范围内可免费获得的HAART药物，包括富马酸替诺福韦二吡呋酯、拉米夫定和依法韦仑（TDF/3TC/EFV）（400/300/600 mg）。在这项研究中，我们比较了E/C/F/TAF和TDF/3TC/EFV方案在治疗HIV阳性患者7天和10天降低VL和改善免疫功能的术前效果。

致编辑：卡波西肉瘤（KS）是一种低度血管肿瘤，是获得性免疫缺陷综合征（AIDS）患者中最常见的肿瘤之一。根据流行病学和临床特征，已报道了四种类型的KS：经典KS、地方性KS（在赤道非洲）、艾滋病相关KS（AIDS-KS）和医源性KS。临床上，KS的表现可能是可变的，有可能在皮肤和粘膜上出血或溃疡的深色或棕色斑块、斑块或结节。此外，淋巴结和一些内脏器官也可能在疾病的更晚期受累。

致编辑：心房颤动（AF）是中风的主要危险因素之一，与中风发病率增加五倍相关。多年来，华法林一直被用于降低房颤患者的血栓形成风险。然而，由于华法林的挑剔性质（即，不可预测的药代动力学、频繁的国际标准化比值检测、复杂的食药相互作用等），已逐渐被多种直接口服抗凝剂（DOACs）所取代。达比加群是一种直接靶向凝血酶的强效、竞争性和可逆的DOAC，于2010年被美国食品药品监督管理局批准作为非瓣膜性房颤的替代抗血栓选择。虽然长期抗凝治疗随机评估（RE-LY）试验（一项比较华法林与达比加群在房颤患者中的非劣效性试验）显示达比加群在预防卒中或全身栓塞方面与华法林一样成功，但其不良反应也需要关注。^[1]不断累积的病例报告引起了人们对达比加群诱导的食管炎（DIE）问题的关注。^[2,3]最近的研究发现，老年患者更容易发生死亡。^[4]然而，在此，我们报告了一例服用达比加群后死亡的年轻男性病例。