This case report details the perioperative management of a 27-year-old male patient with AIDS and a rare giant retroperitoneal calcifying fibrous tumor. The tumor's surgical removal posed high risk due to its proximity to vital structures and the patient's human immunodeficiency virus infection. The report highlights the importance of multidisciplinary collaboration in managing such complex cases. Key nursing considerations included providing psychological support to mitigate the stigma associated with AIDS, adhering strictly to infection control and disinfection protocols, closely monitoring for postoperative hypovolemic shock, and managing complications such as gastric motility disorders and renal infarction. Integrating traditional Chinese medicine with Western treatments for gastrointestinal issues proved beneficial. The patient's recovery, achieved through coordinated care, underscores the significance of personalized nursing interventions to optimize patient outcomes. This report provides valuable insights for clinical practice, particularly in handling similar cases of human immunodeficiency virus with complex comorbidities.

Alpha-fetoprotein-producing gastric cancer (AFPGC) is a rare but highly aggressive subtype of gastric cancer. Patients with AFPGC are at high risk of liver metastasis, and the tumor microenvironment (TME) is complex. A multicenter retrospective study is conducted from January 2011 to December 2021 and included 317 AFPGC patients. Using a multivariable logistic regression model, a nomogram for predicting liver metastasis is built. By combining AFP and the neutrophil-lymphocyte ratio (NLR), we developed a novel and easily applicable predictive indicator, termed ANLiM score, for liver metastasis in AFPGC. An integrated multi-omics analysis, including whole-exome sequencing and proteomic analysis, is conducted and revealed an immunosuppressive TME in AFPGC with liver metastasis. Single-cell RNA sequencing and multiplex immunofluorescence identified the potential roles of tumor-associated neutrophils and tertiary lymphoid structures in shaping the immune microenvironment. These findings are validated in a real-world cohort receiving anti-programmed cell death 1 (anti-PD-1) therapy, which showed concordant effectiveness. In addition, the ANLiM score is also identified as a promising biomarker for predicting immunotherapy efficacy. Overall, a blood biomarker-based predictive indicator is developed for liver metastasis and immunotherapy response in AFPGC. The findings on immune microenvironmental alterations for AFPGC with liver metastasis provide new insights for optimizing immunotherapy strategies.

Introduction:Immune reconstitution inflammatory syndrome (IRIS) is closely associated with antiretroviral therapy (ART) and poses a clinical challenge in HIV management. Case Presentation:This report describes an HIV-infected individual who developed Primary immune thrombocytopenia, latent autoimmune diabetes in adults, and Hashimoto thyroiditis after starting ART. Conclusion:Antiretroviral therapy (ART) may result in thrombocytopenia, fluctuations in blood glucose levels, thyroid dysfunction, diabetic ketoacidosis (DKA), or thyroid crisis. Healthcare professionals should evaluate the potential links between immune reconstitution inflammatory syndrome (IRIS) and latent autoimmune diabetes in adults (LADA), immune thrombocytopenia (ITP), as well as Hashimoto thyroiditis (HT).

Objectives: This case-control study aimed to analyze the characteristics and risk factors for death in HIV-positive Talaromycosis marneffei (TSM) patients with sepsis. Methods: We retrospectively reviewed 173 AIDS patients diagnosed with TSM infection from January 1, 2013, to December 1, 2023, at Hangzhou Xixi Hospital. We collected and analyzed clinical characteristics, laboratory findings, bone marrow cytology results, treatment, and prognosis. Results: Out of 173 AIDS-TSM patients, 92 had sepsis while 81 did not. AIDS-TSM patients with sepsis have a higher in-hospital mortality rate (19.6 %) than non-sepsis patients (0 %). The SOFA score showed a significant association with in-hospital mortality in AIDS-TSM patients with sepsis (OR = 1.583, 95 % CI: 1.183–2.118, P = 0.002), indicating an almost linear relationship. After adjusting for the SOFA score, only hemoglobin (Hb) (OR = 0.971, 95 % CI: 0.943–1.000, P = 0.046), international normalized ratio (INR) (OR = 22.33, 95 % CI: 1.84–270.90, P = 0.015), and C-reactive protein (CRP) (OR = 1.014, 95 % CI: 1.001–1.027, P = 0.039) remained significantly associated with in-hospital mortality. The Receiver Operating Characteristic (ROC) curve of the SOFA score, INR, and CRP showed moderately good predictive performance for in-hospital mortality, while Hb had a low predictive performance. The Area Under Curve (AUC) values were 0.834, 0.820, 0.776, and 0.669, respectively. Conclusions: AIDS-TSM patients with sepsis have a higher mortality rate. Moreover, the SOFA score, along with Hb, INR, and CRP, are the risk factors for death in AIDS-TSM patients with sepsis.

Introduction: Kaposi sarcoma (KS) incidence has decreased since the initiation of combination antiretroviral therapy (cART), but it remains the most common cancer in people with HIV/AIDS (PWHA). PWHA with advanced immunosuppression who initiate antiretroviral therapy are susceptible to the occurrence of an immune reconstitution inflammatory syndrome (IRIS). Case Presentation: This report covers the case of a 25-year-old male with AIDS-related KS who relapsed after Liposomal Doxorubicin, but recovered well after administration of nab-paclitaxel (Nab-PTX). Conclusion: This is a rare case in choosing Nab-PTX to treat relapsed AIDS-KS and get good feedback. We report the case to provide a possible solution to treat AIDS-KS.

BACKGROUND:Chlamydia abortus, as a pathogen of atypical pneumonia, is rare in humans, especially in HIV infection patients. CASE PRESENTATION:We present the case of a 48-year-old man with a history of HIV infection who started high fever and developed pneumonia. The pathogen-targeted next-generation sequencing (ptNGS) results of bronchial lavage fluid showed Chlamydia abortus infection. CONCLUSION:This is the first report of Chlamydia abortus infection presented as atypical pneumonia in an AIDS patient.

INTRODUCTION:Talaromycosis is a common invasive fungal disease in patients with HIV. However, its association with bone destruction is unusual in AIDS patients with talaromycosis.CASE PRESENTATION:This report covers the case of a 38-year-old male AIDS patient coinfected with Talaromyces marneffei and Salmonella. The case, which involved bone destruction, was identified via metagenomic next-generation sequencing (mNGS). Following treatment with a combination of amphotericin B and piperacillin-tazobactam, the patient's elbow motion noticeably improved. Imaging findings revealed that the progression of bony destruction had halted.CONCLUSION:Bone damage due to Talaromyces marneffei infection is infrequent in HIV-positive patients. Therefore, healthcare professionals must be vigilant for potential bone lesions associated with this type of infection. Prompt diagnosis and antimicrobial treatment are crucial.

Background Nontuberculous mycobacteria disease is a common invasive infectious disease in patients with HIV. However, Mycobacterium thermoresistibile association with lymphadenectasis is unusual in AIDS patients. Case Presentation This report covers the case of a 25-year-old male AIDS patient infected with Mycobacterium thermoresistibile . The case was identified via pathogen-targeted next-generation sequencing (ptNGS). Conclusion This is the first report of disseminated M. thermoresistibile infection presented with lymphadenectasis in an AIDS patient. Prompt diagnosis and antimicrobial treatment are crucial.

肾病综合征是HIV感染背景下肾小球疾病常见的临床表现，目前该病国内仅见散在报道。HIV感染背景下肾小球疾病主要有以下两种类型：HIV感染背景下免疫复合物肾病（以下简称"免疫复合物肾病"）和HIV相关肾病(HIVAN），前者是指HIV感染患者出现免疫复合物沉积于肾小球引起的肾损害，病理表现为膜性肾病、IgA肾病等免疫复合物沉积的肾小球疾病；HIVAN指占HIV感染肾脏细胞所致，以"塌陷性肾病"为主要病理表现 [1]。本文收集了杭州市西溪医院和杭州市中医院收治的HIV感染合并肾病综合征7例患者，分析其临床及病理特征，现报道如下。

BACKGROUND:Globally, gastric cancer is the third most common cancer and the third leading cause of cancer death. Proximal and distal gastric cancers have distinct clinical and biological behaviors. The microbial composition and metabolic differences in proximal and distal gastric cancers have not been fully studied and discussed.METHODS:In this study, the gastric microbiome of 13 proximal gastric cancer tissues, 16 distal gastric cancer tissues, and their matched non-tumor tissues were characterized using 16S rRNA amplicon sequencing. Additionally, 10 proximal gastric cancer tissues, 11 distal gastric cancer tissues, and their matched non-tumor tissues were assessed by untargeted metabolomics.RESULTS:There was no significant difference in microbial diversity and richness between the proximal and distal gastric cancer tissues. At the genus level, the abundance of Rikenellaceae_RC9_gut_group, Porphyromonas, Catonella, Proteus, Oribacterium, and Moraxella were significantly increased in Proximal T, whereas that of Methylobacterium_Methylorubrum was significantly increased in Distal T. The untargeted metabolomics analysis revealed 30 discriminative metabolites between Distal T and Distal N. In contrast, there were only 4 discriminative metabolites between Proximal T and Proximal N. In distal gastric cancer, different metabolites were scattered through multiple pathway, including the sphingolipid signaling pathway, arginine biosynthesis, protein digestion and absorption, alanine, aspartate and, glutamate metabolism, etc.In proximal gastric cancer, differential microbial metabolites were mainly related to hormone metabolism.CONCLUSION:Methylobacterium-Methylorubrum was significantly increased in Distal T, positively correlated with cancer-promoting metabolites, and negatively correlated with cancer-inhibiting metabolites. Rikenellaceae_RC_gut_group was significantly increased in Proximal T and positively correlated with cancer-promoting metabolites. Further studies regarding the functions of the above-mentioned microorganisms and metabolites were warranted as the results may reveal the different mechanisms underlying the occurrence and development of proximal and distal gastric cancers and provide a basis for future treatments.IMPORTANCE:First, the differences in microbial composition and metabolites between the proximal and distal gastric cancers were described; then, the correlation between microbiota and metabolites was preliminarily discussed. These microbes and metabolites deserve further investigations as they may reveal the different mechanisms involved in the occurrence and development of proximal and distal gastric cancers and provide a basis for future treatments.

Background Patient-derived xenograft (PDX) models have shown a great efficiency in preclinical and translational applications. Gastrointestinal (GI) tumors have a strong heterogeneity, and the engraftment rate of PDX models remarkably vary. However, the clinicopathological and molecular characteristics affecting the engraftment rate still remain elusive. Methods A total of 312 fresh tumor tissue samples from patients with GI cancer were implanted into immunodeficient mice. The median follow-up time of patients was 37 months. Patients’ characteristics were compared in terms of PDX growth and overall survival. PDX models of 3-6 generations were used for drug evaluation. Results In total, 171 (54.8%, 171/312) PDX models were established, including 85 PDX models of colorectal cancer, 21 PDX models of esophageal cancer, and 65 PDX models of gastric cancer. Other than tumor site, histology, differentiation degree, and serum alpha-fetoprotein (AFP) level, no significant differences were found between transplantation of xenografts and patients’ characteristics. For patients who had undergone neoadjuvant therapy, the incidence of tumor formation was higher in those with progressive disease (PD) or stable disease (SD). In gastric cancer, the results showed a higher transplantation rate in deficient mismatch repair (dMMR) tumors, and Ki-67 could be an important factor affecting the engraftment rate. The gene mutation status of RAS and BRAF, two important molecular markers in colorectal cancer, showed a high degree of consistency between patients’ tumors and PDXs. However, no significant effects of these two mutations on PDX engraftment rate were observed. More importantly, in this study although KRAS mutations were detected in two clinical cases, evident tumor inhibition was still observed after cetuximab treatment in both PDX models and patients. Conclusion A large-scale PDX model including 171 cases was successfully established for GI tumors in our center. The relationship between clinicopathological and molecular features and engraftment rates were clarified. Furthermore, this resource provides us with profound insights into tumor heterogeneity, making these models valuable for PDX-guided treatment decisions, and offering the PDX model as a great tool for personalized treatment and translation research.

Diagnosis of neurosyphilis is currently based on the cerebrospinal fluid (CSF) assessments and CSF-Venereal Disease Research Laboratory (CSF-VDRL) is the traditional "gold standard." In the real world, CSF assessments and CSF-VDRL are not always available. This study aimed to identify noninvasive predictors of neurosyphilis based on real-world clinical parameters and diagnostic criteria in populations with different HIV status. In this retrospective cohort study, syphilis patients with different HIV statuses hospitalized for neurosyphilis screening were retrospectively recruited at an infectious disease hospital. Neurosyphilis was defined by real-world diagnostic criteria. Logistic regression and receiver operating characteristic curve analysis were used to investigate and evaluate predictors of neurosyphilis. In total, 528 patients were enrolled, including 143 syphilis patients without HIV infection and 385 HIV/syphilis-co-infected patients. One hundred twelve and 304 neurosyphilis patients were identified in the HIV-negative and HIV-positive groups, respectively. A high serum toluidine red unheated serum test (TRUST) titer was a robust predictor of neurosyphilis in all participants. An age >= 50 years old [adjusted odds ratio (aOR) = 5.062, 95% confidence interval (CI), 1.449-17.680] in the HIV-negative group and CD4(+) T cell count <330/mu L (<300 as reference, aOR = 0.552, 95% CI, 0.315-0.966) in the HIV-positive group were predictors of asymptomatic neurosyphilis. In real-world situations, for asymptomatic syphilis patients, relatively old age and a high serum TRUST titer in HIV-negative populations, and CD4(+) T cells 1:64 in HIV-positive populations might predict neurosyphilis.

Carcinosarcoma is a rare malignant neoplasm comprising both epithelial and mesenchymal components. Hepatoid adenocarcinoma (HAC) is another rare type of cancer. To date, there are only four reported cases of concurrent carcinosarcomas with HAC across all tumor types, all of which were observed in uterine tumors. Here, we report an unusual case of gastric carcinosarcoma associated with alpha-fetoprotein (AFP)-producing HAC in a 76-year-old woman. Upon admission, the patient had an elevated serum AFP concentration (448 µg/L), a necrotic polypoid tumor of the central gastric cardia revealed by endoscopy, and no evidence of distant metastasis indicated by computed tomography (CT). Owing to malignancy indicated by biopsy, the patient underwent proximal subtotal gastrectomy. The resected tumor was composed of both an HAC component and a sarcoma component, microscopically. The sample was positive for AFP, hepatocyte paraffin (Hep-Par) 1, glypican-3, SALL4, CDX2, cytokeratin (CK) (pan), CK18, desmin, and vimentin staining immunohistochemically. In summary, the tumor was diagnosed as carcinosarcoma of the stomach with AFP-producing HAC. To our knowledge, this is the first report of gastric carcinosarcoma with AFP-producing HAC in the English literature describing gastric tumors.

目的 探讨新型冠状病毒肺炎(COVID-19)和肺孢子菌肺炎(PCP)患者临床症状及肺部影像的异同点.方法 纳入本院收治的确诊为普通型和重型COVID-19患者97例,艾滋病合并确诊的肺孢子菌肺炎患者40例.收集患者的一般情况、主要症状及肺部CT影像.结果 COVID-19组平均年龄(45.24±15.98)岁,大于PCP组的平均年龄(39.48±11.23)岁(P=0.04).COVID-19组患者男43例(44.33％)、咳嗽53例(54.64％)、气促5例(5.15％)均少于PCP组男35例(87.50％),咳嗽37例(92.50％),气促34(85.00％)(P均<0.001).两组患者均发热,肺部影像均有斑片状高密度影、结节影及胸膜增厚特点,两组差异无统计学意义.两组均有磨玻璃样改变,但COVID-19组为点状/斑片状磨玻璃影,而PCP组为弥漫磨玻璃影.COVID-19组胸膜下病变31例(31.96％)多于PCP组1例(2.5％)(P均<0.001).两组肺部影像实变、网格状影、胸腔积液、空洞、钙化、小叶间隔增厚、纵膈淋巴结肿大均少见,且差异无统计学意义(P>0.05).结论 COVID-19与PCP临床表现相似.影像学COVID-19主要为点状/斑片状磨玻璃影,以肺外带及胸膜下病变多见,而PCP为以肺门周围及两肺中、下部分布为主的两肺弥漫性磨玻璃影.

Introduction: Pneumocystis pneumonia (PCP) is one of the most common opportunistic infections in HIV-infected patients. However, coinfection with Tropheryma whipplei is infrequent in AIDS patients with PCP. Case Presentation: We report a 28-year-old male AIDS patient coinfected with T. whipplei and Pneumocystis jirovecii diagnosed in the bronchoalveolar lavage. After sulfamethoxazole–trimethoprim and meropenem treatment, the patient showed clinical improvement in 2 weeks. Conclusion: Clinicians need to be alert to the occurrence of T. whipplei infection in AIDS patients with PCP and timely diagnosis and antibacterial treatments are essential. This case may help clinicians for timely diagnosis of the coinfection of T. whipplei and P. jirovecii in AIDS patients.

目的 对比HIV阳性与HIV阴性神经梅毒的临床特点.方法 回顾性纳入2013年1月至2019年12月我院收治的HIV阳性和HIV阴性经腰椎穿刺明确为神经梅毒患者.收集患者的一般情况、梅毒治疗史、病程、实验室检查结果、神经梅毒分型等临床资料进行统计分析.结果 HIV+组375例,HIV-组141例.HIV+组男性363例(96.80％)多于HIV-组的92例(65.25％)(P<0.001),HIV+组中位年龄35(30,42)岁小于HIV-组的56(48,64)岁(P<0.001).HIV+组Log2血RPR滴度的倒数≥32共282例(75.20％)多于HIV-组的67例(45.16％)(P<0.001).HIV+组脑脊液TPPA阳性260例(53.33％)及Log2脑脊液RPR滴度的倒数≥1的共53例(14.13％)均少于HIV-组的131例(92.91％)及72例(51.06％)(P<0.001).HIV+组脑脊液糖、氯化物均低于HIV-组(P<0.001).HIV+组无症状神经梅毒345例(92.00％)多于HIV-组的60例(42.55％)(P<0.001).HIV+组脑血管炎型8例(2.13％)、脑实质型7例(1.87％)均少于HIV-组的22例(15.60％)、56例(39.72％)(P<0.001).结论 HIV阳性神经梅毒中男性患者、血RPR>1:32、无症状神经梅毒均多于HIV阴性者.而HIV阴性神经梅毒的年龄、脑脊液TPPA阳性率、RPR阳性率、细胞数、蛋白、糖、氯化物、脑血管型和脑实质型发病率均高于HIV阳性者.

Objective:To explore the clinical efficacy of ventriculo peritoneal (V-P) shunt for intracranial hypertension in human immunodeficiency virus (HIV)-associated cryptococcus meningitis (CM).Methods:A retrospective analysis was conducted on the data of 59 HIV-associated CM patients in the Second Department of Infection Disease, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine from May 2015 to April 2019. Among those patients, 10 cases underwent V-P shunt due to intracranial hypertension, meanwhile underwent antifungal therapy including amphotericin B, flucytosine, fluconazole and itraconazole was given according to the guidelines. The intracranial pressure and alleviation of intracranial hypertension symptoms were taken as observation indexes.Results:All patients with shunt were stopped with mannitol, glycerin fructose and other drugs, and the intracranial pressure was lower than 200 mmH2O (1 mmH2O=0.0098 kPa). The headache, vomiting, consciousness disorder, epilepsy, optic papilledema were all improved significantly.Conclusion:Intracranial hypertension in HIV-associated cryptococcus meningitis should be aggressively treated at early time. It might be safety that placing the lumbago cistern drainage tube for 13 d. Intracranial pressure could be efficiently decreased by V-P shunt in early phase, which could also improve the clinical symptoms and reduce the death rate.

Alpha-fetoprotein producing gastric carcinoma (AFPGC) is a rare and aggressive subtype of gastric cancer. However, little is known about the genomic features of this disease. We perform whole-exome sequencing analysis of AFPGC, and identify 34 significantly mutated genes. Somatic copy number alterations analysis reveals several significant focal amplifications (e.g. 19q12, 17q12) and focal deletions (e.g. 1p36.11, 9p21.3), and some of these negatively affect the patient prognosis. Comparative analyses reveal that AFPGC has distinct genomic features from gastric cancer of The Cancer Genome Atlas as well as four molecular subtypes. Several frequently altered genes with potential as therapeutic targets are identified in AFPGC. Further analysis reveals that AFPGC with amplification of CCNE1 at 19q12 and/or ERBB2 at 17q12 show poorer survival and more aggressive. Subsequently, based on our established patient-derived xenograft models for AFPGC, translational research is performed and the therapeutic value of targeting CCNE1 and ERBB2 is validated. In this work, we provide an understanding of genomic characteristics of AFPGC and propose a platform to explore and validate the genome-guided personalized treatment for this disease.

Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease of the central nervous system caused by JC virus (JCV) and is difficult to diagnose. We report on a male HIV-positive patient with PML finally diagnosed by 3 times lumbar punctures and 2 times brain biopsies. Negative results of JCV-PCR in cerebrospinal fluid (CSF) do not rule out the diagnosis of PML when clinical manifestations and neuroimaging features suspected PML. It is necessary to obtain new CSF and make repeat tests and even perform brain biopsy.

艾滋病(AIDS)合并颅内病变的诊断和治疗依赖脑组织活检,由于病变多位于脑实质深处,手术定位比较困难.而传统的立体定向技术操作复杂,仪器昂贵,很难在基层医院推广,导致很多病人不能得到及时有效的治疗.随着虚拟现实技术发展,利用计算机软件可实现多模态影像融合,实现3D影像重建.结合手机等投影设备,即可实现病变体表投影,甚至实现实时动态辅助导航成为可能.本院是以传染病为基础发展的专科综合医院,并为浙江省艾滋病定点收治医院,每年接诊大量艾滋病病人.在2017年10月通过3D-slicer结合手机神外助手软件(sina)定位对1例艾滋病合并颅脑病变患者进行了脑活检手术,报告如下.