BACKGROUND & AIMS: :Finding work and/or re-entering the workforce can be extremely challenging for persons living with HIV/AIDS. Also difficult is assisting them in the process, mostly because there is little documentation or resources about programs that provide vocational services specifically for this population. In response to this dilemma and because it was perceived as a win/win situation, three urban residential community organizations serving the HIV/AIDS population, decided independently to create in-house work opportunities for their clients. All of these organizations are a variation of the same theme: transitional/supportive housing for persons with HIV/AIDS that were formerly homeless and are now interested in becoming increasingly self-sufficient. This article will present a program description that addresses unique manner in which these three sites created in-house job programs in the areas of receptionist, kitchen, and maintenance work. More specifically, this paper will address the strengths, limitations, and ethical considerations that guided program development.

背景与目标： ：寻找工作和/或重新加入劳动力对于艾滋病毒/艾滋病患者可能是极具挑战性的。在此过程中协助他们也很困难，主要是因为很少有文件或资源有关专门为该人群提供职业服务的计划。为解决这一难题，并认为这是一种双赢的局面，为艾滋病毒/艾滋病人口服务的三个城市居民社区组织独立决定为其客户创造内部工作机会。所有这些组织都是同一主题的变体：为以前无家可归，现在有兴趣变得越来越自给自足的艾滋病毒/艾滋病患者提供过渡/支助性住房。本文将提供一个程序说明，​​以解决这三个站点在接待员，厨房和维护工作领域中创建内部工作程序的独特方式。更具体地说，本文将探讨指导程序开发的优势，局限性和道德考量。

BACKGROUND & AIMS: Malnutrition is a common complication of HIV infection and plays a significant and independent role in morbidity and mortality. Many studies have been conducted to assess the appropriate role of nutrition in the clinical management of HIV infection. The complex nature of AIDS wasting, however, requires individualized strategies when providing nutritional support. Algorithms to assist in the diagnosis and treatment of malnutrition in HIV infection serve as general guidelines.

背景与目标： 营养不良是艾滋病毒感染的常见并发症，在发病率和死亡率中起着重要而独立的作用。已经进行了许多研究，以评估营养在HIV感染的临床管理中的适当作用。然而，浪费艾滋病的复杂性，在提供营养支持时需要个性化的策略。辅助诊断和治疗HIV感染中营养不良的算法为一般准则。

BACKGROUND & AIMS: :Few details are known about how the human immunodeficiency virus type 1 (HIV-1) genomic RNA is trafficked in the cytoplasm. Part of this process is controlled by the activity of heterogeneous nuclear ribonucleoprotein A2 (hnRNP A2). The role of hnRNP A2 during the expression of a bona fide provirus in HeLa cells is investigated in this study. Using immunofluorescence and fluorescence in situ hybridization techniques, we show that knockdown of hnRNP A2 expression in HIV-1-expressing cells results in the rapid accumulation of HIV-1 genomic RNA in a distinct, cytoplasmic space that corresponds to the microtubule-organizing center (MTOC). The RNA exits in the nucleus and accumulates at the MTOC region as a result of hnRNP A2 knockdown even during the expression of a provirus harboring mutations in the hnRNP A2-response element (A2RE), the expression of which results in nuclear retention of genomic RNA. We also demonstrate that hnRNP A2 expression is required for downstream trafficking of genomic RNA from the MTOC in the cytoplasm. Genomic RNA localization at the MTOC that was both the result of hnRNP A2 knockdown and the overexpression of Rab7-interacting lysosomal protein had little effect on pr55Gag synthesis but negatively influenced virus production and infectivity. These data indicate that altered HIV-1 genomic RNA localization modulates viral assembly and that the MTOC serves as a central site to which HIV-1 genomic RNA converges following its exit from the nucleus, with the host protein, hnRNP A2, playing a central role in taking it to and from this site in the cell.

背景与目标： 关于人类免疫缺陷病毒1型（HIV-1）基因组RNA如何在细胞质中运输的信息鲜为人知。该过程的一部分由异质核糖核蛋白A2（hnRNP A2）的活性控制。这项研究调查了hnRNP A2在HeLa细胞中表达真正的原病毒的过程中的作用。使用免疫荧光和荧光原位杂交技术，我们显示敲低表达HIV-1的细胞中hnRNP A2表达的表达导致HIV-1基因组RNA在与微管组织中心相对应的独特细胞质空间中的快速积累（ MTOC）。即使hnRNP A2反应元件（A2RE）中携带有突变的原病毒表达，RNA仍会通过hnRNP A2敲除而留在细胞核中并在MTOC区域积聚，其表达会导致基因组RNA的核保留。我们还证明hnRNP A2表达是从细胞质MTOC下游运输基因组RNA所必需的。基因组RNA在MTOC处的定位既是hnRNP A2敲除的结果，又是与Rab7相互作用的溶酶体蛋白的过表达，对pr55Gag的合成影响很小，但对病毒的产生和感染性产生负面影响。这些数据表明，改变的HIV-1基因组RNA定位可调节病毒装配，MTOC充当HIV-1基因组RNA从细胞核退出后向其汇聚的中心位点，宿主蛋白hnRNP A2发挥着核心作用。将其带入和移出该单元格中的此站点。

BACKGROUND & AIMS: :Between February and April 2003, a total of 80 single-dwelling households close (< 70 m) to high-tension (161 or 345 kV) power lines in a northern community of Taiwan received measurements of indoor extremely low-frequency (ELF) magnetic field for 72 h. Measurements were performed with EMDEX II meter at a sampling rate of every 300 s, yielding some 860 readings of ELF magnetic field for each household. In addition to the 72-h mean ELF magnetic field, we also calculated arithmetic means of the first 2, 6, 12, and 288 readings taken in each household to represent the information on spot, 30-min, 60-min, and 24-h exposures, respectively. The mean 72-h exposure to ELF magnetic field for the 80 study households was estimated at 0.80 micro-Tesla (microT) with a standard deviation (SD) of 1.13 microT. The mean for pot, 30-min, 60-min, and 24-h exposure was 0.88 (SD 1.38), 0.90 (SD 1.40), 0.9 (SD 1.17), and 0.83 (SD 1.17) microT, respectively. There were high agreements, indicated by a nearly perfect intra-class correlation coefficient, between 72-h mean exposure and those short-term exposure measures. Additionally, the sensitivity and specificity of various short-term exposures in the prediction of 72-h exposure greater than 0.4 microT were similar at values of 0.82-0.87 and 0.93-0.95, respectively. This study indicates that short-term measurements of indoor ELF magnetic field seem adequate to represent the mean 72-h exposure, but tended to overpredict 72-h exposure greater than 0.4 microT. Further investigation is needed to assess whether these findings can be replicated in households far away from high-tension power lines.

背景与目标： ：在2003年2月至2003年4月之间，台湾北部一个社区中共有80个单户家庭靠近（<70 m）高压（161或345 kV）电力线，他们接受了室内极低频（ELF）的测量磁场72小时。使用EMDEX II仪表以每300 s的采样速率进行测量，每个家庭可获得约860个ELF磁场读数。除了平均72小时的ELF磁场外，我们还计算了每个家庭获取的前2个，6个，12个和288个读数的算术平均值，以表示当场，30分钟，60分钟和24点的信息。 -h曝光。 80个研究家庭平均暴露在ELF磁场下72小时的时间为0.80微特斯拉（microT），标准偏差（SD）为1.13 microT。锅暴露30分钟，60分钟和24小时的平均值分别为microT的0.88（SD 1.38），0.90（SD 1.40），0.9（SD 1.17）和0.83（SD 1.17）。在72小时平均暴露量与那些短期暴露量之间，存在接近一致的类内相关系数，表明存在高度一致性。此外，预测72 h暴露大于0.4 microT时，各种短期暴露的敏感性和特异性分别为0.82-0.87和0.93-0.95。这项研究表明，室内ELF磁场的短期测量似乎足以代表72小时的平均暴露量，但往往会高估大于0.4 microT的72小时暴露量。需要进一步调查以评估这些发现是否可以在远离高压电线的家庭中复制。

BACKGROUND & AIMS: :In 1969, the United States established its national rubella vaccination program. With the success of the program, 32 years later, reports of rubella reached record low numbers. To assess the achievement of elimination of rubella and congenital rubella syndrome (CRS) in the United States, 7 epidemiological criteria were used. Rubella cases reported to the National Notifiable Diseases Surveillance System from 1998 through 2004 and CRS cases reported to the National Congenital Rubella Syndrome Registry from 1998 through 2004 were analyzed. During 1998-2000, the median number of reported rubella cases was 272, whereas, during 2001-2004, the median number reported was 13. The incidence of rubella decreased significantly, from 0.1/100,000 population in 1998 to 0.005/100,000 population in 2004. Since 2001, 5 infants with CRS have been reported--3 were born in 2001, 1 was born in 2003, and 1 was born in 2004. The epidemiological evidence strongly supports the claim that rubella is no longer endemic in the United States. To prevent future rubella outbreaks and CRS cases, current strategies must be maintained.

背景与目标： ：1969年，美国制定了国家风疹疫苗接种计划。随着该计划的成功，在32年后，风疹的报告数量达到了创纪录的低水平。为了评估在美国消除风疹和先天性风疹综合症（CRS）的成就，使用了7种流行病学标准。分析了1998年至2004年向国家法定传染病监测系统报告的风疹病例和1998年至2004年向国家先天性风疹综合症登记处报告的CRS病例。在1998-2000年期间，报告的风疹病例中位数为272，而在2001-2004年期间，报告的风疹病例中位数为13。风疹的发病率显着下降，从1998年的0.1 / 100,000人口下降到2004年的0.005 / 100,000人口自2001年以来，已有5例CRS婴儿被报告为-3出生于2001年，1出生于2003年，1出生于2004年。流行病学证据强烈支持风疹在美国不再流行的说法。为了防止未来的风疹暴发和CRS病例，必须保持当前的策略。

BACKGROUND & AIMS: OBJECTIVES:Cases of hypophosphataemia (often coincident with renal dysfunction) have been reported in HIV-infected patients taking tenofovir disoproxil fumarate (TDF), but randomized placebo-controlled trials of HIV-infected persons with normal baseline renal function have found a comparable incidence of hypophosphataemia in the TDF and placebo groups. We assessed the incidence of grade 2 and higher hypophosphataemia in the HIV Outpatient Study (HOPS). METHODS:We analysed a prospective cohort of patients who initiated either a TDF-containing highly active antiretroviral therapy (HAART) regimen [TDF-exposed (TDF+) group; n = 165] or a TDF-sparing HAART regimen [TDF-unexposed (TDF-) group; n = 90], and who had normal baseline phosphate and creatinine values. RESULTS:The TDF+ and TDF- groups had comparable median follow-up times (10.9 vs 8.8 months, respectively; P = 0.18) and number of phosphate measurements (median = 3 for both) and were similar on most clinical and demographic factors. During follow up, 12.7% of TDF+vs 6.7% of TDF-patients developed grade 2 hypophosphataemia (2.0-2.4 mg/dL), and 2.4% of TDF+ patients vs 0% of TDF-patients developed grade 3 hypophosphataemia (1.0-1.9 mg/dL); none developed grade 4 hypophosphataemia (<1.0 mg/dL). The incidence of grade 2 or higher hypophosphataemia was 16.7 per 100 person-years among TDF+ patients vs 8.0 per 100 person-years among TDF-patients (P = 0.11). CONCLUSIONS:The incidence of hypophosphataemia was somewhat elevated in HOPS patients who took TDF-containing HAART compared with those who took TDF-sparing HAART during the first 1 to 2 years of observation, but the difference was not statistically significant. Longer follow-up of a larger population is needed to determine if this trend towards an association achieves statistical significance and to evaluate the clinical consequences of hypophosphataemia.

背景与目标： 目的：已经报道了接受替诺福韦二富马酸富马酸酯（TDF）感染HIV的患者发生低血磷的情况（通常与肾功能不全同时发生），但基线肾功能正常的HIV感染者的随机安慰剂对照试验发现TDF和安慰剂组的低磷血症。我们在HIV门诊研究（HOPS）中评估了2级和更高的低血磷的发生率。
方法：我们分析了开始采用含TDF的高活性抗逆转录病毒疗法（HAART）方案[TDF暴露（TDF）组）的患者的前瞻性队列研究。 n = 165]或保留TDF的HAART方案[未暴露TDF（TDF-）的组； n = 90]，并且基线磷酸盐和肌酐值正常。
结果：TDF和TDF-组的中位随访时间（分别为10.9和8.8个月； P = 0.18）和磷酸盐测量次数（两者的中位数= 3）具有可比性，并且在大多数临床和人口统计学因素上相似。在随访期间，TDF的12.7％与TDF的患者的6.7％发生了2级低血磷（2.0-2.4 mg / dL），TDF的2.4％vs TDF的患者中出现了3级的低血磷（1.0-1.9 mg） / dL）;没有一个发生4级低血磷（<1.0 mg / dL）。 TDF患者中2级或更高水平低血磷的发生率为每100人年16.7人，而TDF患者为每100人年8.0人（P = 0.11）。
结论：在观察的头1至2年中，与含TDF的HAART的HOPS患者相比，接受含TDF的HAART的HOPS患者的低磷酸盐血症发生率有所升高，但差异无统计学意义。需要对更大的人群进行更长时间的随访，以确定这种联系趋势是否达到统计学意义并评估低血磷的临床后果。

BACKGROUND & AIMS: :A new inhibitor of human immunodeficiency virus (HIV) has been isolated and purified to homogeneity from the seeds and fruits of the Momordica charantia. This compound, MAP 30 (Momordica Anti-HIV Protein), is a basic protein of about 30 kDa. It exhibits dose-dependent inhibition of cell-free HIV-1 infection and replication as measured by: (i) quantitative focal syncytium formation on CEM-ss monolayers; (ii) viral core protein p24 expression; and (iii) viral-associated reverse transcriptase (RT) activity in HIV-1 infected H9 cells. The doses required for 50% inhibition (ID50) in these assays were 0.83, 0.22 and 0.33 nM, respectively. No cytotoxic or cytostatic effects were found under the assay conditions. These data suggest that MAP 30 may be a useful therapeutic agent in the treatment of HIV-1 infections. The sequence of the N-terminal 44 amino acids of MAP 30 has been determined.

背景与目标： ：已从苦瓜种子和果实中分离出一种新的人类免疫缺陷病毒（HIV）抑制剂并将其纯化至同质。该化合物MAP 30（Momordica抗HIV蛋白质）是约30 kDa的碱性蛋白质。它通过以下方式表现出对无细胞HIV-1感染和复制的剂量依赖性抑制作用：（i）在CEM-ss单层上的定量局灶性合胞体形成； （ii）病毒核心蛋白p24表达； （iii）HIV-1感染的H9细胞中的病毒相关逆转录酶（RT）活性。在这些试验中，抑制50％（ID50）所需的剂量分别为0.83、0.22和0.33 nM。在测定条件下未发现细胞毒性或细胞抑制作用。这些数据表明，MAP 30可能是治疗HIV-1感染的有用治疗剂。已经确定了MAP 30的N-末端44个氨基酸的序列。

BACKGROUND & AIMS: INTRODUCTION:STDs are a significant cause of illness throughout the world. Female sex workers (FSWs) are commonly perceived as belonging to a social group which may engage in high-risk behaviour for acquiring or transmitting HIV and other STDs. The number of immigrant women engaged in sex work has increased in Catania, Sicily, over the last 10 years. This study aims to estimate the prevalence of HIV, HBV, HCV and syphilis among Colombian and Dominican FSWs. METHODS:In total 118 (63.78%) of the FSWs contacted in the course of the project agreed to participate in the study. All women enrolled were counselled on STDs/HIV, safer sex practices and the use of condoms. Blood samples were taken and tested for HIV, HBV, HCV and syphilis. RESULTS:Of the 118 FSWs enrolled, all were negative for both HIV and HCV infection. Two women (1.6%) were positive for hepatitis B (HbsAg). Syphilis testing by VDRL showed three positive results (2.5%), which was confirmed by TPHA. DISCUSSION:This study showed that HIV, HBV, HCV and syphilis seroprevalence among Colombian and Dominican FSWs remains low or very rare. It also indicates that these women were healthy when they arrived in Italy and that condom use with clients is high.

背景与目标： 简介：性病是世界范围内引起疾病的重要原因。女性性工作者（FSWs）通常被认为属于一个社会群体，该群体可能会为获取或传播艾滋病毒和其他性传播疾病而从事高风险行为。在过去的十年中，西西里岛卡塔尼亚从事性工作的移民妇女人数有所增加。这项研究的目的是估计哥伦比亚和多米尼加的FS​​W中HIV，HBV，HCV和梅毒的患病率。
方法：在该项目过程中，总共有118名（63.78％）的FSW同意参与研究。为所有入选妇女提供性传播疾病/艾滋病毒，更安全的性行为和使用安全套方面的咨询。抽取血样并测试HIV，HBV，HCV和梅毒。
结果：在118个FSW中，所有的HIV和HCV感染均为阴性。两名女性（1.6％）的乙型肝炎（HbsAg）阳性。 VDRL进行的梅毒测试显示三项阳性结果（2.5％），这已被TPHA证实。
讨论：这项研究表明，哥伦比亚和多米尼加地区FSW中的HIV，HBV，HCV和梅毒血清阳性率仍然很低或非常罕见。这也表明这些妇女到达意大利后就很健康，而且与客人一起使用避孕套的比例很高。

BACKGROUND & AIMS: :Descriptions of primary HIV-1 infection have so far been based on Caucasians living in industrialized nations. Due to studies of leptospirosis in the predominantly black population of Barbados, serum was available for patients admitted with acute febrile illnesses to the Queen Elizabeth Hospital (QEH). By searching the medical records of 510 adult patients with known HIV-1 infection we identified 10 patients who had stored serum from an admission for an acute febrile illness that predated or coincided with their first HIV-1-positive test. Serological testing confirmed primary HIV-1 infection in 9 and was suggestive in the 10th patient. The clinical features of these 10 patients were in keeping with previous descriptions of primary HIV-1 infection but differed from leptospirosis cases seen at the QEH. One patient died during his seroconversion illness and another died 3 months after seroconversion. The findings suggest that severe primary HIV-1 infection could be a relatively uncommon occurrence, that the condition may be misdiagnosed, and that cases may not occur until the AIDS epidemic is established. :A retrospective review was conducted of the medical records of 510 HIV-1-positive adult patients who had attended the Queen Elizabeth Hospital (QEH) to determine whether any had been admitted for an illness compatible with a diagnosis of primary HIV-1 infection. A serum bank, created from patients who had been admitted with acute febrile illnesses and investigated for leptospirosis, provided serological evidence for primary HIV-1 infection in 10 patients. Serological testing of the serum samples confirmed primary HIV-1 infection in nine patients and was suggestive in the tenth. The clinical features of the 10 patients fit the earlier descriptions of primary HIV-1 infection, but differed from the leptospirosis cases seen at the QEH. One patient died during his seroconversion illness and another died 3 months after seroconversion. These findings suggest that severe primary HIV-1 infection could be a relatively uncommon occurrence, that the condition may be misdiagnosed, and that cases may not occur until the AIDS epidemic is established.

背景与目标： ：到目前为止，主要针对HIV-1感染的描述都是基于生活在工业化国家中的高加索人。由于对巴巴多斯主要是黑人人群的钩端螺旋体病进行了研究，因此伊丽莎白女王医院（QEH）接受了急性发热性疾病的患者可获得血清。通过搜索510例已知HIV-1感染的成年患者的病历，我们确定了10例在首次发热HIV-1阳性测试之前或与其同时发生的急性发热疾病患者入院时就储存了血清的患者。血清学检查证实了9例原发性HIV-1感染，并提示第10例患者。这10例患者的临床特征与原发性HIV-1感染的先前描述相符，但与QEH所见的钩端螺旋体病病例有所不同。一名患者在血清转化疾病中死亡，另一名患者在血清转化后3个月死亡。研究结果表明，严重的原发性HIV-1感染可能是相对罕见的事件，该病可能被误诊，只有在AIDS流行之前，病例才可能发生。
：回顾性分析了510例曾在伊丽莎白女王医院（QEH）住院的HIV-1阳性成年患者的病历，以确定是否有人因与原发性HIV-1感染诊断相符的疾病而入院。由被接纳患有急性发热性疾病的患者创建的血清库，并研究了钩端螺旋体病，为10例患者的原发性HIV-1感染提供了血清学证据。血清样本的血清学检测证实了9名患者的原发性HIV-1感染，而第十名患者则具有启发性。这10例患者的临床特征符合原发性HIV-1感染的早期描述，但与QEH所见的钩端螺旋体病病例有所不同。一名患者在血清转化疾病中死亡，另一名患者在血清转化后3个月死亡。这些发现表明，严重的原发性HIV-1感染可能是相对罕见的事件，可能会误诊该病，并且直到艾滋病流行才可能发生。

BACKGROUND & AIMS: :Zalcitabine is a dideoxynucleoside antiretroviral agent that is phosphorylated to the active metabolite 2',3'-dideoxycytidine 5'-triphosphate (ddCTP) within both uninfected and HIV-infected cells. At therapeutic concentrations, ddCTP inhibits HIV replication by inhibiting the enzyme reverse transcriptase and terminating elongation of the proviral DNA chain. The results of 3 large pivotal trials comparing zidovudine monotherapy with combination therapy have now clearly established that zalcitabine plus zidovudine combination with an improvement in viral load and CD4+ cell count compared with zidovudine monotherapy. More recently, clinical end-point and surrogate marker data have established the efficacy of zalcitabine in combination with the protease inhibitor saquinavir in zidovudine-experienced patients. Other studies have demonstrated the utility of zalcitabine in combination with ritonavir and the nucleoside analogue lamivudine. Importantly, early use of zalcitabine in the treatment sequence does not appear to limit the therapeutic efficacy of subsequent therapy with other nucleoside analogues such as lamivudine. Peripheral neuropathy is the most frequent dose-limiting adverse effect associated with zalcitabine therapy and is generally reversible on discontinuation of treatment. Stomatitis and mouth ulcers may occur frequently with zalcitabine therapy but tend to resolve with continuing treatment. Haematological toxicity, which is a common adverse effect associated with zidovudine, is reported infrequently with zalcitabine. Overall, combination therapy with zalcitabine plus zidovudine or saquinavir has been shown to have a tolerability profile comparable to that of either agent alone, although treatment with zidovudine plus zalcitabine was associated with a significant increase in the incidence of haematological toxicity compared with zidovudine monotherapy in one study. Therefore, current data suggest that zalcitabine is a useful antiretroviral agent for inclusion as a component of initial double combination therapy with zidovudine or as part of triple combination therapy including zidovudine plus a protease inhibitor in the management of patients with HIV infection.

背景与目标： 扎西他滨是一种双脱氧核苷抗逆转录病毒药，在未感染和感染HIV的细胞中均被磷酸化为活性代谢物2'，3'-二脱氧胞苷5'-三磷酸（ddCTP）。在治疗浓度下，ddCTP通过抑制酶逆转录酶并终止原病毒DNA链的延伸来抑制HIV复制。齐多夫定单一疗法与联合疗法比较的3个大型关键试验的结果现已清楚地确定，与齐多夫定单一疗法相比，齐西他滨加齐多夫定联合疗法可改善病毒载量和CD4细胞计数。最近，临床终点和替代标记数据已经确定了扎西他滨与蛋白酶抑制剂沙奎那韦联合在齐多夫定患者中的疗效。其他研究表明扎西他滨与利托那韦和核苷类似物拉米夫定联合使用。重要的是，在治疗顺序中早期使用扎西他滨似乎没有限制后续用其他核苷类似物如拉米夫定进行治疗的疗效。周围神经病变是与扎西他滨治疗相关的最常见的剂量限制性不良反应，通常在停药后可逆。扎西他滨治疗可能会经常发生口腔炎和口腔溃疡，但继续治疗后往往会缓解。扎西他滨很少报道血液毒性，这是与齐多夫定有关的常见不良反应。总的来说，与齐多夫定单一疗法相比，齐多夫定+齐多夫定或沙奎那韦联合治疗的耐受性与单独使用任一种药物相当，尽管与齐多夫定单一疗法相比，齐多夫定+齐西他滨治疗的血液学毒性发生率显着增加。学习。因此，目前的数据表明，扎西他滨是一种有用的抗逆转录病毒药物，可作为包含齐多夫定的初始双重联合疗法的组成部分或包含齐多夫定加蛋白酶抑制剂在内的三重联合疗法的一部分用于治疗HIV感染患者。

BACKGROUND & AIMS: :A prospective collection of positive antimicrobial cultures was performed over 12 consecutive months in the medical intensive care unit of a cancer hospital. In all, 144 infections and 163 pathogens were documented during 87 of the 528 admissions. Lung, urinary, ENT (ear, nose and throat) infections and bacteraemia were the most frequently documented. Staphylococcus species, Streptococcus species, Escherichia coli, Klebsiella species and Pseudomonas species were the most common pathogens. Gram-positive strains were observed predominantly during monomicrobial bacteraemia (48.9%). Methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) were found in 58% and 92% of the isolated strains respectively. No particular outbreak was identified. A further prospective study will be necessary to evaluate the impact of the antibiotic use on the selection of resistant strains in our ICU.

背景与目标： ：在癌症医院的医疗重症监护室连续12个月进行了前瞻性抗菌药物阳性培养。在528例入院病例中，总共记录了144例感染和163种病原体。肺，尿，耳鼻喉（耳，鼻和喉）感染和菌血症的记录最频繁。葡萄球菌，链球菌，大肠杆菌，克雷伯菌和假单胞菌是最常见的病原体。革兰氏阳性菌株主要在单微生物菌血症期间观察到（48.9％）。分别在58％和92％的分离菌株中发现了耐甲氧西林的金黄色葡萄球菌（MRSA）和表皮葡萄球菌（MRSE）。没有发现特定的爆发。有必要进行进一步的前瞻性研究，以评估抗生素使用对我们ICU中耐药菌株选择的影响。

BACKGROUND & AIMS: :The TIM (T cell/transmembrane, immunoglobulin and mucin) proteins are crucial regulators of Th1/Th2 immune responses and have been implicated in several diseases including HIV-1/AIDS. The TIM1 exon 4 that codes for mucin domain is highly diverse, with sequence variants associated with varying phenotypes. In this study, TIM1 exon 4 was sequenced among 227 HIV-1 seroprevalent and 288 healthy non infected individuals from North Indian population and haplotypes established. A novel but rare haplotype D1(∗) was identified among the healthy and differed from D1 by a synonymous substitution G>T at Thr208Thr. The TIM1 haplotype diversity showed no association with susceptibility to HIV-1 infection. The seroprevalent individuals carrying D3A had relatively higher median CD4+T cell counts (368/μl) than those without (313/μl; p=0.02). A comparison of CD4+T counts between D3-A individuals on ART or ART naïve did not show any significant difference plausibly due to confounding nature of ART and other factors.

背景与目标： TIM（T细胞/跨膜，免疫球蛋白和粘蛋白）蛋白是Th1 / Th2免疫反应的关键调节剂，并与包括HIV-1 / AIDS在内的多种疾病有关。编码粘蛋白结构域的TIM1外显子4高度多样化，具有与不同表型相关的序列变体。在这项研究中，TIM1外显子4在来自北印度人口的227个HIV-1血清流行和288个健康的未感染个体中进行了测序，并建立了单倍型。在健康人群中鉴定出一种新颖但罕见的单倍型D1（∗），与D1的区别在于在Thr208Thr处的同义替代G> T。 TIM1单倍型多样性表明与HIV-1感染的易感性无关。携带D3A的血清流行个体的CD4 T细胞计数中位数相对较高（不含313 /μl； p = 0.02）。由于ART和其他因素的混杂，D3-A个体或未接受过ART的D3-A个体之间CD4 T计数的比较似乎没有显示任何显着差异。

BACKGROUND & AIMS: :Vulvovaginitis is the most frequent gynecologic pathology among prepubertal females. An infectious cause is found in 30% of cases and is highly associated with the presence of vaginal discharge upon examination. Neisseria gonorrhoeae may be one of the causative agents. Since N. gonorrhoeae is a common sexually transmitted disease, sexual abuse should be considered in the pediatric setting. We report the case of a 5-year-old girl with N. gonorrhoeae vulvovaginitis. Her previous history, multiple interviews with the patient and her parents, and clinical examination showed no evidence or signs of sexual abuse. Both parents presented gonorrhea, urethritis for the father and vaginitis for the mother. The discrepancy between pediatric evaluation and the presence of a bacterium associated with sexually transmitted disease led us to consider other means of contamination. Previous studies have shown that other routes of transmission are possible but are often neglected. Hence, contamination can be transmitted by the hands or mostly through passive means (towels, rectal thermometer, etc.). Many epidemics have been noted in group settings with young girls with no evidence of sexual transmission. Therefore, we concluded that this patient's infection was likely an accidental transmission within her family. The acknowledgement of these transmission routes is very important in order to avoid misguided suspicion of sexual abuse and the possible traumatic family and psychosocial consequences.

背景与目标： ：阴道炎是青春期前女性中最常见的妇科病理学。在30％的病例中发现了感染原因，并且与检查时是否存在白带高度相关。淋病奈瑟菌可能是其病原体之一。由于淋病奈瑟氏球菌是一种常见的性传播疾病，因此在儿科环境中应考虑性虐待。我们报告了一名5岁女孩患有淋病奈瑟菌性阴道炎的病例。她以前的病史，与患者及其父母的多次访谈以及临床检查均未发现任何性虐待迹象或迹象。父母双方均表现为淋病，父亲为尿道炎，母亲为阴道炎。儿科评估和与性传播疾病相关的细菌的存在之间的差异，导致我们考虑其他污染手段。先前的研究表明，其他传播途径也是可能的，但常常被忽略。因此，污染物可以通过手传播，或者主要通过被动方式（毛巾，直肠温度计等）传播。在没有女孩发生性传播迹象的年轻女孩的集体场合中，已经注意到许多流行病。因此，我们得出的结论是，该患者的感染很可能是其家庭内部的意外传播。为了避免误导性怀疑性虐待以及可能造成的家庭和社会心理后果，对这些传播途径的认识非常重要。

BACKGROUND & AIMS: :While antiretroviral therapy (ART) can reduce HIV-1 to undetectable levels, the virus generally reappears if treatment is stopped. Resurgence of the virus is due to the reactivation of T cells harboring latent integrated provirus, and recent studies indicate that proliferation of these latently infected cells helps maintain the HIV-1 reservoir. In this issue of the JCI, Lee et al. evaluated CD4+ T cell subsets to determine whether certain populations are more likely to harbor full-length, replication-competent provirus. The authors identified an enrichment of clonally expanded Th1 cells containing intact HIV-1 proviruses, suggesting that this polarized subset contributes to the persistence of the reservoir. Strategies to target these provirus-harboring cells need to be considered for future therapies aimed toward HIV-1 cure.

背景与目标： ：尽管抗逆转录病毒疗法（ART）可以将HIV-1降至无法检测的水平，但是如果停止治疗，病毒通常会重新出现。病毒的复发归因于带有潜伏性整合前病毒的T细胞的重新活化，最近的研究表明，这些潜伏感染的细胞的增殖有助于维持HIV-1的储存。在本期JCI中，Lee等人。评估了CD4 T细胞亚群，以确定某些人群是否更有可能携带全长，具有复制能力的原病毒。作者确定了含有完整HIV-1前病毒的克隆扩增Th1细胞的富集，表明该极化的子集有助于水库的持久性。在未来针对HIV-1的治疗中，需要考虑针对这些携带前病毒的细胞的策略。

BACKGROUND & AIMS: :Wound infections are an infrequent but serious complication of total knee arthroplasty. Between January 1984 and November 1987, 20 of 243 (8.2%) patients at two affiliated hospitals developed surgical wound infections following 259 total knee arthroplasty procedures performed in clean-air operating rooms. Eighteen (90%) of the patients had deep infections; nine required removal of the prosthesis. A single surgeon (surgeon X) was associated with 18 of the procedures that had subsequent infection (risk ratio (RR) = 9.4, 95% confidence interval (CI) 2.2-39), and an investigation was carried out in an effort to explain the difference in infection rates between surgeon X and other surgeons. In a cohort study, stratified analyses identified a preoperative American Society of Anesthesiologists (ASA) physical status class greater than or equal to 3, surgeon X, and early postoperative use of a continuous passive motion device as risk factors associated with surgical wound infection following total knee arthroplasty procedures. Logistic regression analyses identified being a patient operated on by surgeon X with an ASA class greater than or equal to 3 as the only significant independent risk factor for total knee arthroplasty-associated surgical wound infections (RR = 9.3, 95% CI 2.8-31). The effect due to surgeon X could not be explained by receipt or timeliness of administration of antimicrobial prophylaxis, type of prosthesis inserted, duration of operation, postoperative use of continuous passive motion, or underlying etiology of joint disease. The authors conclude that surgical technique and patient's severity of illness were the primary determinants of surgical wound infection after total knee arthroplasty. This study demonstrates the complexity of epidemiologic investigation of surgical wound infections and the importance of considering patient severity of illness when interpreting surgeon-specific infection rates.

背景与目标： ：伤口感染是全膝关节置换术的一种罕见但严重的并发症。在1984年1月至1987年11月之间，两家附属医院的243名患者中有20名（8.2％）在清洁空气手术室中进行了259次全膝关节置换手术后出现了手术伤口感染。 18名（90％）患者患有深部感染；九个需要去除假体。一名外科医生（外科医生X）与18例随后感染的手术相关联（风险比（RR）= 9.4，95％置信区间（CI）2.2-39），并进行了调查以解释X外科医师和其他外科医师之间的感染率差异。在一项队列研究中，分层分析将术前美国麻醉师学会（ASA）身体状况等级大于或等于3，X医师和术后早期使用连续被动运动装置作为与总手术后伤口感染相关的危险因素膝关节置换手术。 Logistic回归分析确定是由ASA级大于或等于3的X外科医师手术的患者，是全膝关节置换相关手术伤口感染的唯一重要独立危险因素（RR = 9.3，95％CI 2.8-31） 。不能通过接受抗生素预防措施的及时性，插入的假体的类型，手术的持续时间，术后持续使用被动运动或关节病的病因来解释外科医生X的影响。作者得出结论，手术技术和患者疾病的严重程度是全膝关节置换术后手术伤口感染的主要决定因素。这项研究证明了外科伤口感染的流行病学调查的复杂性，以及在解释外科医生特定感染率时考虑患者疾病严重性的重要性。