粉尘螨浸液免疫治疗螨性哮喘患者的免疫功能观察

目的　探讨粉尘螨变应原浸液免疫治疗对螨性哮喘患者免疫功能的影响。　方法　用粉尘螨浸液和平喘药分别对实验组和对照组螨性哮喘患者进行免疫治疗和对症治疗 ,用ELISA法检测患者治疗前、后血清总IgE、螨特异性IgE、螨特异性IgG、IL 2和IL 4水平 ,用生物素 链霉亲和素法检测患者治疗前、后外周血CD3 + 、CD4+ 、CD8+ 和CD4+ /CD8+ 。　结果　患者血清总IgE、螨特异性IgE、螨特异性IgG治疗前分别为 (2 92 .3 5± 112 .46)IU/ml、(2 5 1.68±12 5 .15 )IU /ml和 (5 87.64± 3 5 4.68)IU /ml ,治疗后分别为 (2 65 .74± 12 4.67)IU /ml、(2 97.5 6± 172 .2 7)IU /ml和(82 4.5 1± 42 8.2 6)IU /ml,两者相比 ,螨特异性IgG显著上升 (P <0 .0 1)。外周血CD3 + 、CD4+ 、CD8+ 、CD4+ /CD8+ 治疗前分别为 (5 5 .87± 7.2 3 ) %、(3 8.43± 6.43 ) %、(3 0 .14± 5 .2 4) %和 1.2 6± 0 .5 6,治疗后分别为 (65 .83± 6.5 5 ) %、(4 2 .72± 6.2 6) %、(2 8.5 7± 4.67) %和 1.5 8± 0 .62 ,CD4+ /CD8+ 比值上升 ,差异显著 (P <0 .0 5～P <0 .0 1) ;治疗前、后IL 2和IL 4的水平分别为 (2 .16± 0 .3 8) pg/ml、(3 .49± 0 .5 7) pg/ml和 (1.64± 0 .82 )pg/ml、(1.0 3± 0 .78) pg/ml ,差异均具显著性 (P <0 .0     

运动诱发性支气管哮喘中免疫机制的初步探讨

目的　探讨嗜酸性粒细胞分泌的嗜酸细胞阳离子蛋白 (ECP)、T淋巴细胞的激活和运动诱发性支气管哮喘 (EIA)的关系。方法　选择支气管哮喘 (简称哮喘 )患者 3 2例 ,其中运动性哮喘患者 (A组 ) 13例 ,非运动性哮喘患者 (B组 ) 19例、正常对照组 (C组 ) 8名进行踏车运动试验 ,分别测定其运动前、运动后 10min、1h血清中的ECP浓度、白细胞介素 5 (IL 5 )mRNA、外周血CD+ 2 5T淋巴细胞占总淋巴细胞数的百分比 (CD+ 2 5% )。结果　 (1)运动前A组患者的一秒钟用力呼气容积 (FEV1)与ECP和CD+ 2 5%呈负相关 (r分别 =- 0 79和 - 0 61,P均 <0 0 1) ;(2 )运动后A组患者FEV1为 (2 5 2±14 4) % ,PEF为 (41 2± 3 3 0 ) % ;B组患者运动后FEV1为 (1 5± 5 5 ) % ,PEF为 (11 3± 7 9) % ,两组比较差异有显著性 (P <0 0 1) ;(3 )运动后 10min及 1hA、B两组患者ECP、CD+ 2 5%、IL 5mRNA组间比较差异无显著性 (P均 >0 0 5 )。结论　嗜酸性粒细胞分泌的ECP、T淋巴细胞的激活在运动诱发性哮喘的发病机制中未起主导作用     

病毒感染相关性哮喘患者外周血Tc1/Tc2的临床研究

目的　探讨CD+ 8T淋巴细胞亚群 (Tc1、Tc2 )、及Tc1/Tc2与病毒感染相关性哮喘发病的关系。方法　建立三色流式细胞分析法对病毒感染相关性哮喘、过敏性哮喘及正常对照者 (对照组 )外周血中CD+ 8T淋巴细胞内分泌细胞因子 (INF γ、IL 4)进行检测。结果　病毒感染相关性哮喘患者和过敏性哮喘患者中产生IL 4的Tc2的比例均高于对照组 (P <0 .0 1) ,且病毒相关性哮喘的比例也高于过敏组 (P <0 .0 5 )。结论　急性发作的病毒感染相关性哮喘患者的外周血CD8+ T细胞以Tc2亚群为主 ,这可能是引起病毒诱发哮喘急性发作的原因之一     

支气管肺泡灌洗液T淋巴细胞亚群和细胞DNA含量分析对肺癌的诊断价值

目的　探讨支气管肺泡灌洗液T淋巴细胞亚群和细胞DNA含量分析对肺癌的诊断价值。方法　用流式细胞仪对 3 0例肺癌和 12例肺良性病变患者的支气管肺泡灌洗液 (BALF)作T淋巴细胞亚群和细胞DNA含量分析 ,并与纤维支气管镜活检和刷检比较。结果　中央型肺癌组BALF中CD3 + (11.473± 3 .677) %、CD4+ (3 .660± 1.60 5 ) %、CD8+ (2 .3 49± 0 .880 ) %和CD4+ /CD8+ (1.411± 0 .3 0 9) ,周围型肺癌组BALF中CD3 + (12 .2 73± 4.42 5 ) %、CD4+ (2 .897±0 .695 ) %、CD8+ (2 .2 5 9± 0 .5 91) %和CD4+ /CD8+ (1.3 0 7± 0 .2 45 ) ;肺良性病变组BALFCD3 +(2 5 .0 78± 7.13 8) %、CD4+ (13 .2 44± 4.15 9) %、CD8+ (7.63 1± 3 .713 ) %和CD4+ /CD8+ (2 .2 78±0 .619) ,前两组显著低于后组 (肺良性病变组 ) (P <0 .0 0 1)。以异常二倍体为阳性标准 ,诊断肺癌的敏感性为 83 % ,特异性为 92 % ;中央型肺癌异常二倍体阳性率为 89% ,与活检 (95 % )和刷检(68% )比较 ,差异无显著性 (P >0 .5和P >0 .1) ;周围型肺癌异常二倍体阳性率为 82 % ,显著高于活检 (2 7% )和刷检 (2 7% )阳性率 (P均 <0 .0 5 )。结论　肺癌患者免疫功能低下 ,是肿瘤发生发展的原因之一 ,支气管肺泡灌洗液细胞DNA含量分析是诊断肺癌 (尤     

自体干细胞移植对晚期胃癌患者化疗后免疫重建作用的研究

目的　探讨自体外周造血干细胞移植对晚期胃癌化疗后患者免疫重建作用的影响。方法5 4例晚期胃癌患者进行数字化血管造影 (DSA)引导下的超选择高剂量动脉EAP方案 (VP16 10 0mg/m2+表阿霉素 6 0mg/m2 +卡铂 2 0 0mg/m2 )化疗后 ,其中 2 0例于 4 8h后接受自体外周血干细胞移植。结果　EAP动脉化疗后结合自体外周血干细胞移植方案对晚期胃癌患者的近期有效率为 85 .0 % ,显著高于单纯动脉化疗组的 2 9.3% (P <0 .0 1)。单纯动脉化疗组治疗前后患者的白细胞介素 2 (IL 2 )、γ 干扰素 (γ IFN)、可溶性白细胞介素 2受体 (sIL 2R)、白介素 2受体 (IL 2R)、自然杀伤细胞活性 (Nka)水平分别为 (2 0 .7± 2 .4 )U/ml,(6 4 5 .9± 4 8.2 )U/ml,(783.5± 77.1)U/ml,(13.2± 1.9) % ,(9.0± 1.1) %和(16 .3± 6 .4 )U/ml,(2 37.9± 17.4 )U/ml,(10 0 1.7± 112 .8)U/ml,(4.8± 0 .5 ) % ,(5 .93± 0 .2 ) %。γ IFN、IL 2R、NKa显著下降 (P <0 .0 1) ,sIL 2R则显著升高 (P <0 .0 1) ;而治疗组患者自体外周造血干细胞输注前及输注后 1周 ,IL 2、γ IFN、sIL 2R、IL 2R、Nka水平分别为 (2 1.7± 2 .3)U/ml,(6 32 .9± 4 7.8)U/ml,(76 8.3± 6 7.2 )U/ml,(12 .8± 1.7) % ,(9.8± 1.2 ) %和 (79.3± 7.4 )U/ml,(2 35     

小剂量茶碱调节哮喘患者T淋巴细胞的活性

目的 :观察茶碱对哮喘患者血清T淋巴细胞活性影响。方法 :检测哮喘患者每d给予茶碱控释片 4 0 0mg治疗 6周前后血清可溶性白细胞介素 2受体 (sIL 2R)浓度、T淋巴细胞亚群和IgE水平变化。结果 :哮喘患者经茶碱治疗 6周后其血清sIL 2R浓度显著下降 ,从治疗前 ( 0 31± 0 10 )U/L ,降低到治疗后 ( 0 2 5± 0 0 6 )U/L ,P <0 0 5。茶碱能显著提高哮喘患者外周血中的CD8T淋巴细胞数 (从治疗前的 18 9%± 4 4 %提高到治疗后的 2 5 8%± 5 9% ,P <0 0 5 ) ,同时CD4 /CD8%相应地显著降低 (P <0 0 5 )。茶碱并有降低哮喘患者外周血中IgE水平的趋势。结论 :小剂量茶碱能抑制哮喘患者血清T淋巴细胞活性 ,不仅具有抗炎作用 ,还有免疫调节作用 ,为评价茶碱在哮喘治疗中的作用提供了依据。     

骨髓增生异常综合征T细胞早期激活及可溶性肿瘤坏死因子受体的研究

目的　研究骨髓增生异常综合征 (MDS)外周血CD+ 4 、CD+ 8T细胞早期激活标志CD69的表达及血清、骨髓可溶性肿瘤坏死因子受体 1、2 (sTNF R1、2 )的水平及其意义。方法　在植物血凝素 (PHA) 2 0mg/L条件下进行全血细胞培养 ,于 0h和 4h分别用流式细胞仪对CD+ 4 、CD+ 8T细胞CD69的表达进行分析。用ELISA法检测血清和骨髓sTNF R1、2的水平。结果　PHA刺激前难治性贫血 (RA)与难治性贫血伴环形铁粒幼细胞增多 (RAS)CD+ 4 、CD+ 8细胞CD69的表达率分别为 8 32 %、9 88% ,难治性贫血伴原始细胞增多 (RAEB)与转变中的RAEB(RAEB T)CD+ 8细胞CD69的表达率为7 92 %。PHA刺激后MDS患者CD+ 4 、CD+ 8细胞表达CD69明显增强 ,RA +RAS为 5 3 4 6 %、5 1 6 3% ;RAEB +RAEB T为 4 2 93%、4 1 96 % ,CD+ 4 与CD+ 8细胞CD69的表达率相似。MDS两种sTNF R1水平均明显升高 ,RA +RAS组sTNF R1血清为 (1 5 8± 0 6 8) μg/L ,骨髓为 (2 10± 0 2 6 ) μg/L ;sTNF R2血清为 (1 4 1± 0 5 0 ) μg/L ,骨髓为 (1 95± 0 6 4 ) μg/L ;RAEB +RAEB T组sTNF R1血清为 (2 6 2± 2 5 5 ) μg/L ,骨髓为 (3 12± 0 6 7) μg/L ;sTNF R2血清为 (1 96± 0 5 6 ) μg/L ,骨髓为(3 0 9± 0 6 2 ) μg/L。血清sTNF R2水平与PHA刺激     

骨髓中表达白细胞介素5受体 mRNA的CD+34 细胞与支气管哮喘气道炎症的关系

目的　探讨支气管哮喘 (简称哮喘 )小鼠骨髓 (BM)中表达CD+ 34 与白细胞介素 5受体(IL 5RmRNA+ )的造血细胞 (CD+ 34 IL 5RmRNA+ 细胞 )在气道炎症中的作用。方法　以卵白蛋白(OVA)及生理盐水致敏并激发Balb/c小鼠 ,建立各哮喘及对照组 (A组 )模型。分别于OVA及生理盐水首次激发后 1、6、12、2 4、48h处死小鼠 ,取支气管肺泡灌洗液 (BALF)、外周血 (PB)及BM标本备用。测定BALF中嗜酸性粒细胞 (EOS)、PB中有核细胞及EOS计数及BM中有核细胞数 ;用流式细胞仪分别测定PB及BM中CD+ 34 细胞占相应有核细胞的比例并推算其相对计数 ;用免疫组化结合原位杂交法分别标记骨髓细胞CD+ 34 抗原及IL 5RmRNA ,定位BM中CD+ 34 IL 5RmRNA+ 细胞并计数其占CD+ 34 细胞的比例。结果　 (1)OVA激发后 6h组 ,BALF中EOS计数为 (2 67± 1 0 0 )× 10 5/L ,与A组 [(0 46±0 0 6)× 10 5/L]比较差异有显著性 (P <0 0 1) ;OVA激发后 12h组 ,BALF中EOS、PB中EOS计数分别为 (7 74± 1 98)× 10 5/L、(2 91± 0 64 )× 10 8/L ,与A组 [(0 46± 0 0 6)× 10 5/L、(1 43± 0 3 7)× 10 8/L]比较 ,差异有显著性 (P均 <0 0 1) ;OVA激发后 2 4h组 ,BALF中EOS、PB中EOS计数分别为 (19 43±3 69)× 10 5/L、(3 93± 0 5 1)× 10     

支气管哮喘患者外周血中的CD+4 CD+25 T淋巴细胞的测定

目的阐明支气管哮喘(简称哮喘)患者外周血中是否存訡D+4 CD+25 T调节性淋巴细胞,并探讨CD+4 CD+25细胞的免疫抑制活性.方法应用流式细胞仪检测29例过敏性哮喘患者[急性发作期患者(急性发作期)15例、缓解期患者(缓解期)14例和16名非过敏性健康志愿者(正常对照组)外周血中CD+4 CD+25 细胞数量变化.应用免疫磁珠法分离提纯CD+4 CD+25 细胞,将纯化的CD+4 CD+25细胞和(或)CD+4 CD-25细胞在体外培养,观察CD+4 CD-25细胞的增殖反应,将收集培养的上清液用酶联免疫吸附测定(ELISA)法检测Th1类细胞因子γ干扰素(IFN-γ)和Th2类细胞因子白细胞介素4(IL-4)和IL-13.结果急性发作期患者外周血中CD+4 CD+25细胞比值为(14.9±1.8)%,缓解期患者为(11.8±0.7)%,正常对照组为(11.2±0.8)%,发作期与缓解期患者比较差异有统计学意义(P<0.01);缓解期患者与正常对照组比较差异无统计学意义(P>0.05).哮喘组CD+4 CD-25细胞增殖反应为(74±9)%,正常对照组为(72±8)%,两组比较差异无统计学意义(P>0.05).此外,哮喘组和正常对照组的CD+4 CD+25 细胞均能抑制CD+4 CD-25细胞产生IFN-γ、IL-4和IL-13,而且两组的抑制能力也无明显区别.结论急性发作期哮喘患者外周血CD+4 CD+25 细胞数明显高于缓解期患者和正常对照组.哮喘患者的CD+4 CD+25 细胞的抑制活性和正常对照组比较差异无统计学意义.谮     

半相合供者淋巴细胞输注抗急性非淋巴细胞性白血病的实验研究

目的 :阐明半相合供者淋巴细胞 (HRDLs)体外抗急性非淋巴细胞白血病 (ANLL)的机制。方法 :通过预实验 ,确定白血病细胞培养过程中加入HRDLs产生移植物抗白血病效应 (GVL)的最佳时间及最佳浓度 ,并在此条件下检测白血病细胞培养过程加入去CD8+ 和去CD4 + HRDLs后白血病细胞凋亡率及培养液中白细胞介素 2(IL 2 )浓度。结果 :在白血病细胞培养 2 4h(最佳时间 )后 ,加入浓度为 2 .5× 10 8/L(最佳浓度 )的去CD8+ HRDLs混合培养 ,其白血病细胞凋亡率 (17.0± 2 .5 ) %与对照组 (4 .4± 1.1) % (未加入HRDLs)及加入去CD4 + HRDLs组的白血病细胞凋亡率 (4 .8± 1.6 ) %相比较差异有统计学意义 ,但与加入未去CD8+ 和CD4 + HRDLs组的白血病细胞凋亡率 (17.4± 0 .6 ) %比较则差异无统计学意义。同时 ,去CD8+ HRDLs组培养液中IL 2浓度显著高于对照组和去CD4 + HRDLs组。结论 :CD4 + HRDLs在抗白血病效应中可能起着比CD8+ HRDLs更重要的作用 ,临床使用中 ,选择性去除CD8+ HRDLs,可以减少或减轻移植物抗宿主病 (GVHD) ,而不影响GVL效应 ,同时IL 2在GVL效应过程中也可能起着重要作用     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.     

High prevalence of distal sensory polyneuropathy in antiretroviral-treated and untreated people with HIV in Tanzania

Objectives To describe the prevalence of distal sensory polyneuropathy (DSP), a complication of both advanced HIV disease and of antiretroviral therapy (ART), amongst Tanzanians with HIV, on and off ART (including stavudine) with CD4 counts above and below 200 cells/μl. Methods We recruited participants attending ART clinic into four groups: >6 months ART exposure and (i) CD4 < 200 cells/μl or (ii) CD4 > 200 cells/μl (ART/CD4 < 200 and ART/CD4 > 200, respectively); ART‐naïve and (iii) CD4 < 200 cells/μl or iv)CD4 > 200 cells/μl (noART/CD4 < 200 and noART/CD4 > 200, respectively). Primary outcome was DSP, as defined by presence of at least one symptom and one sign. Results Of 326 evaluable participants, 81 (32 men, median age 38 years, median CD4 142 cells/μl) were enrolled in the ART/CD4 < 200 group, 78 (17 men, median age 37 years, median CD4 345 cells/μl) in ART/CD4 > 200, 81 (30 men, median age 37 years, median CD4 128 cells/μl) in noART/CD4 < 200 and 86 (22 men, median age 33 years, median CD4 446 cells/μl) in noART/CD4 > 200. Numbness was the most commonly reported symptom. DSP prevalence ranged from 43.2% in ART/CD4 < 200 to 20.9% in noART/CD4 > 200. DSP was more common among men (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.2–3.3) and older participants (aOR 2.7, 95% CI 1.1–6.2 for age 40 + vs. <30 years). Conclusion Distal sensory polyneuropathy is common amongst those attending this clinic, even those with no ART exposure and a CD4 count above 200 cells/μl. Stavudine and didanosine expose HIV‐infected patients to an additional avoidable risk of DSP. Access to non‐neurotoxic ART regimes as well as earlier HIV diagnosis and initiation of ART is needed.     

Prise en charge d’un paragangliome rétropéritonéal

Paragangliomas are rare tumors arising from extraadrenal chromaffin cells. We report a 43-year-old man who presented with abdominal pain. An abdominal computed tomography scan revealed a large retroperitoneal mass. During an endoscopic biopsy of this tumor, the patient experienced marked hemodynamic fluctuations with tachycardia and high blood pressure, and an extraadrenal pheochromocytoma was suspected. Measurements of plasma and urinary catecholamines and urinary total metanephrines ruled in the diagnosis. Echocardiography disclosed acute myocardial dysfunction that returned to normal after surgical resection of the paraganglioma. This report also underlines the importance of the anesthetic preparation and monitoring around the surgical procedure and the need of a long-term follow-up to detect malignant paraganglioma in the absence of histological criteria of benign tumor.