Preoperative CD4 Research Articles

Analysis of the Efficacy of LNSRH Surgery for Early Cervical Cancer Based on T, B, and NK Lymphocytes

Background: The analysis is based on the level of T, B, NK lymphocytes to evaluate the efficacy of laparoscopic nerve-sparing radical hysterectomy (LNSRH) for early cervical cancer. Methods: Selected 30 patients with early cervical cancer who underwent LNSRH surgery in Tianjin Fifth Central Hospital from December 2019 to January 2021 as the cervical cancer group, and 30 healthy female who underwent physical examination in our hospital during the same period were selected as the control group. The expressions of CD4+, CD8+, CD20+, and CD57+ were detected by flow cytometer, female sexual function index (FSFI) and overall assessment scale of cancer treatment function (FACT-G) score were used to evaluate female sexual function and quality of life, and the receiver operating characteristic curve (ROC) was used to analyze the expression predictive value of CD4+, CD8+, CD20+, and CD57+ in LNSRH of early cervical cancer. Results: The expression of CD4+ and CD57+ in the cervical cancer group was lower than that in the healthy group,and the expression of CD8+ and CD20+ was higher than that in the healthy group (p < 0.05). The expression of preoperative CD4+ and CD57+ was higher for postoperative, and the expression of preoperative CD8+ and CD20+ was lower (p < 0.05) for postoperative. The expression of postoperative 1 day CD4+ and CD57+ was higher for at 3 days postoperative, and the expression of postoperative 1 day CD8+ and CD20+ was lower at 3 days postoperative (p < 0.05). CD4+, CD57+ expression was positively correlated with FSFI score, and CD8+, and CD20+ expression was negatively correlated with FSFI score, CD4+, and CD57+ expression was positively correlated with FACT-G score, and CD8+, and CD20+ expression was negatively correlated with FACT-G score (p < 0.05). ROC analysis of CD4+, CD8+, CD20+, CD57+ expression sensitivity was lower than the four-item combination, the specificity was higher than the four-item combination and the results with significant statistical difference (p < 0.05) and the four combined tests have good predictive value for the efficacy of LNSRH for early cervical cancer (p < 0.05). Conclusions: Cervical cancer patients were mainly cellular immunity and performed low expression of CD4+, high expression of CD8+, high expression of CD20+, and low expression of CD57+. T, B, and NK lymphocytes could be used for immunological detection of cervical cancer.

Serum immune biomarker levels combined with hepatitis B virus infection status predict early recurrence of early-stage hepatocellular carcinoma with microvascular invasion after liver resection

Introduction The tumor immune response plays a vital role in cancer recurrence in patients with malignancies. We aim to clarify the risk factors for early recurrence and investigate the efficacy of blood-based biomarkers to predict the risk of early recurrence in early-stage hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI) after hepatectomy. Materials and methods A total of 101 cases of HCC with MVI who underwent liver resection were enrolled. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors of early recurrence. We calculated the area under the receiver operating characteristic curve to evaluate the performance of the four biomarkers identified as risk factors for early recurrence. Results Multiple logistic regression analysis indicated that complement (C)4, cluster of differentiation (CD)4+, immunoglobulin A (IgA), and hepatitis B virus (HBV) DNA of greater than 500 IU/mL were correlated with early recurrence of HCC. The area under the curve was greater for the combination model than for the HBV DNA, CD4+, IgA, or C4 models alone. Conclusion Preoperative serum CD4+, C4, IgA, and HBV DNA levels were linked with early recurrence of early-stage HCC with MVI and the combination model was of considerable predictive value for the prognosis of HCC with MVI.

Multidimensional modulation of systemic immune by neurosurgical tumor resection in patients with brain tumors.

ObjectivesImmune perturbation induced by tumor burden has been showed as the hallmark of brain tumors. To date, the vast majority of studies have focused heavily on local immune responses in the tumor microenvironment. Little is known about how the systemic immune macroenvironment is modulated by neurosurgical tumor resection in patients with brain tumors.MethodMedical records from patients with brain tumors admitted to the Department of Neurosurgery at the National Cancer Center, Cancer Hospital of Chinese Academy of Medical Sciences between January 2021 and March 2022 were retrospectively reviewed. Forty‐nine patients who have lymphocyte subsets, serum immunoglobulins, C‐reactive protein, and complements levels before neurosurgical tumor resection and at least once test after surgery were included into the final analysis.ResultsPostoperative CD3+ lymphocytes, CD4+ lymphocytes and CD4+ /CD8+ lymphocyte ratio presented bi‐phasic changes, which indicated an initial decrease and a subsequent increase after neurosurgical tumor resection. Moreover, neurosurgical tumor resection induced a decrease in natural killer lymphocytes and an increase in B lymphocytes that persisted through the entire observation period after surgery. Meanwhile, significant changes in humoral immunity characterized by a decrease in immunoglobulins (IgA, IgG, and IgM) levels and an increase in the CRP level occurred after neurosurgical tumor resection. In addition, patients with postoperative infection complication had a lower preoperative CD4+ /CD8+ lymphocyte ratio.ConclusionsThese findings provide evidence that either cellular immunity or humoral immunity can be remodeled by neurosurgical tumor resection, and patients with disturbed systemic immunity have increased risk of infection after surgery.

Incidence of complicationsand revisionsurgery in HAARTcompliant HIV patients undergoing primarytotal hip and knee arthroplasty: an institutional review.

Human immunodeficiency virus (HIV) positivepatients are at high risk for osteonecrosis along with age-related osteoarthritis, resulting in a high number of joint reconstruction surgeries at younger ages in these immunosuppressed patients. Few previous studies have reported on patient outcomes in HAART(highly active antiretroviral therapy)compliant patients undergoingprimary arthroplasty.The aim of this study is to report one institution's overall rate of complicationsand revision in HAART-compliant patients after primaryhip and knee arthroplasty. A retrospective chart review was performed spanning a 4year period. This study included 50 primary joint arthroplasty patients diagnosed with HIV including 13 TKA(total knee arthroplasty) and 37 THA(total hip arthroplasty) with a prior diagnosis of HIV infection. Preoperative CD4 count and viral loads were recorded. Charts were reviewed for post-operative complications including infection and revision. The were a total of 11 postoperative complications (22%). There were 3 cases (6%) of soft tissue infection, 3 cases (6%) of implant loosening, 2 cases (4%) of dislocation, 1 case (2%) of lower extremity weakness, 1 case (2%) of venous thrombosis, and 1 case (2%) of arthrofibrosis. Of all patients, there were 6 cases of revision in this cohort (12%), 5 of which were aseptic etiology. All 3 infected patients had a history of IVDU. Two of these infected patients resolved with IV antibiotics while 1 underwent two-stage revision (2%). Patients that experienced post-operative complications had significantly elevated preoperative CD4 levels (983 versus 598, p = 0.003). Arthroplasty is a viable option for HAART-compliant patients. Most previous studies showing a higher risk for deep tissue infection and revision in HIV patients have not accounted for modern HAART. Our results show that compliance with HAART has vastly improved the outcomes of arthroplasty in these patients, while a history of IVDU is likely the largest risk factor for infection in this population.

Association of Apoptosis-Mediated CD4+ T Lymphopenia With Poor Outcome After Type A Aortic Dissection Surgery

Background: Many patients with type A aortic dissection (AAD) show low lymphocyte counts pre-operatively. The present study investigated the prognostic values of lymphopenia and lymphocyte subsets for the postoperative major adverse events (MAEs) in AAD patients undergoing surgery, and explore mechanisms of lymphopenia.Methods: We retrospectively analyzed pre-operative lymphocyte counts in 295 AAD patients treated at two hospitals, and evaluated their correlation with MAEs. We prospectively recruited 40 AAD patients and 20 sex- and age-matched healthy donors (HDs), and evaluated lymphocyte subsets, apoptosis, and pyroptosis by flow cytometry.Results: Multivariable regression analysis of the retrospective cohort revealed pre-operative lymphopenia as a strong predictor of MAEs (odds ratio, 4.152; 95% CI, 2.434–7.081; p < 0.001). In the prospective cohort, lymphocyte depletion in the AAD group was mainly due to loss of CD4+ and CD8+ T cells as compared with HDs (CD4+ T cells: 346.7 ± 183.6 vs. 659.0 ± 214.6 cells/μl, p < 0.0001; CD8+ T cells: 219.5 ± 178.4 vs. 354.4 ± 121.8 cells/μl, p = 0.0036). The apoptosis rates of CD4+ and CD8+ T cells were significantly higher in AAD patients relative to HDs (both p < 0.0001). Furthermore, the pre-operative CD4+ T cells count at a cut-off value of 357.96 cells/μl was an effective and reliable predictor of MAEs (area under ROC curve = 0.817; 95% CI, 0.684-0.950; sensitivity, 74%; specificity, 81%; p < 0.005). Pre-operative lymphopenia, mainly due to CD4+ T cells exhaustion by apoptosis, correlates with poor prognosis in AAD patients undergoing surgery.Conclusion: Pre-operative lymphopenia in particular CD4+ T lymphopenia via apoptosis correlates with poor prognosis in AAD patients undergoing surgery.

Establishing the significance of a pre-operative day absolute CD4 count in patients booked for elective brain tumor surgery – A prospective cohort study from a single neurosurgical center in South Africa

IntroductionUnlike the situation in many 1st World-countries, new HIV infections in South Africa continue to rise. While mandatory HIV testing is unethical, a pre-operative absolute CD4 count can be performed in patient’s pre-elective brain tumour surgery. Materials and methodsThis was a prospective cohort study performed by consecutively enrolling 78 patients admitted to the adult neurosurgical wards at our hospital, from the 01 July 2018–30 March 2020, with neoplastic brain tumours that were taken for elective resection. Data collected and analysed in this study included subject age, gender, HIV status, admission absolute CD4 count, admission Glasgow Coma Score, pre-operative corticosteroid therapy, length in in-hospital stay prior to surgery, pre-operative day absolute CD4 count, operative day Glasgow Coma Score, intra-operative blood loss, duration of surgery, extent of resection, histological diagnosis, day-7 nosocomial infection incidence, and Glasgow Outcome Score. ResultsHigh significance was demonstrated between admission absolute CD4 count and the pre-operative day absolute CD4 count (p < 0.0001). With regards elective brain tumour surgery the relationship between the use of pre-operative steroids and the pre-operative absolute CD4 count is insignificant (p = 0.73). While no significance was demonstrated (p = 0.93), a clinical trend was suggested that the lower the pre-operative day absolute CD4 count, the longer the duration of surgery. No significance was demonstrated between pre-operative CD4 count and histology result (p = 0.45), although our results suggested a trend for cancers, of known and suspecting links to infective aetiology, to cluster in subjects with a pre-operative CD4 count < 500 cells/mm. No significance was demonstrated between pre-operative CD4 count and day 7 nosocomial infection incidence (p = 0.59). ConclusionHIV infection, and its complications, remain very real to HIV positive patients presenting with brain tumours in South Africa. Through the trends demonstrated we recommend the use of a pre-operative absolute CD4 count in the work-up of these patients.

The clinical value of a day one post-operative absolute CD4 count in elective neoplastic brain tumor surgery – A prospective cohort study from a single South African neurosurgical center

IntroductionMultiple simultaneously occurring intra-operative immune modulating interventions make it impossible to compare, the pre-operative day and day one post-operative absolute CD4 counts, and assume one has a measure of the pure surgical impact on this variable. Materials and methodsWe conducted a prospective cohort study by consecutively enrolling 41 elective subjects, with neoplastic brain tumours, in which we obtained a pre-operative day CD4 count and a day one post-operative CD4 count. Data collected included age, HIV status, pre-operative corticosteroid therapy, pre-operative day CD4 count, type of craniotomy, blood loss, duration of surgery, extent of resection, day one post-operative CD4 count, histological diagnosis, day-7 nosocomial infection incidence and Gram-stain result, and Glasgow Outcome Score. ResultsRegarding HIV status 29/41 (71%) subjects were HIV negative and 12/41 (29%) subjects were HIV positive. High significance was demonstrated between the pre-operative day CD4 count and the post-operative day CD4 count (p = 0.0001). While no significance was demonstrated (p = 0.51), a clinical trend was suggested where more than 1000 ml of blood loss had a detrimental effect on the day one post-operative CD4 count, which was often below 500 cells/mm. Again, while no significance was demonstrated (p = 0.13), a clinical trend was suggested where the longer the duration of surgery, the lower the day one post-operative CD4 count would be. No significance was demonstrated between day one post-operative CD4 count and day 7 nosocomial infection incidence (p = 0.35). A clinical trend was however demonstrated where a lower day one post-operative CD4 count suggested an increased risk of incurring this complication. Finally, significance was demonstrated between the day one post-operative CD4 count and the nosocomial infection gram stain result (p = 0.0058). ConclusionThe highly significantly similar pre-operative day CD4 count, to the day one post-operative CD4 count indicated that overall, the elective surgical procedures considered, had an insignificant effect.

The clinical relevance of performing a day seven post-operative absolute CD4 count in elective brain tumor surgery – A prospective cohort study from a single South African neurosurgical center

IntroductionThe co-morbid presence of a neoplastic brain tumor, in a patient who is HIV positive, is not uncommon in South Africa. The day-7 post-operative absolute CD4 count offers a unique window into the immunological status of an individual post elective brain tumor surgery. Materials and methodsWe performed a prospective cohort study consecutively enrolling all elective adult patients admitted tom our wards from the 01 July 2018–30 March 2020, with neoplastic brain tumors. In total 19 subjects that underwent elective operative intervention had a day seven post-operative absolute CD4 count performed. Data collected and analyzed in this study included age, HIV status, pre-operative corticosteroid therapy, pre-operative day CD4 count, timing of prophylactic antibiotic administration, craniotomy type, blood loss, duration of surgery, extent of resection, day seven post-operative CD4 count, post-operative corticosteroid therapy, histology, day-7 nosocomial infection incidence, Gram-stain result, and Glasgow Outcome Score. ResultsSignificance was demonstrated between the pre-operative day CD4 count and the day 7 post-operative CD4 count (p = 0.03). This allowed us to conclude the immunological impact of the surgery to have been insignificant. Significance was demonstrated between craniotomy type and day-7 post-operative CD4 count (p = 0.04). Significance was also demonstrated between extent of resection and the day-7 post-operative absolute CD4 count (p = 0.0018). A clinical trend was demonstrated for subjects with a lower day-7 post-operative CD4 count to have an increased risk of acquiring a day-7 nosocomial infection and a trend that this would be a Gram- negative infection. ConclusionAs per a PubMed review of the literature we are the first to report the relationship of the skull base surgical approaches, and a subtotal resection, and the statistically significantly delirious effect that these have on a day-7 absolute CD4 count. We further exclude increased intra-operative blood loss as an underlying cause behind the significance of these relationships.

The predictive value of an admission CD4 count in HIV positive and HIV negative patients with brain tumours at a single Neurosurgical centre in South Africa – A prospective cohort study

IntroductionIrrespective of HIV status, the absolute CD4 count is a useful marker of the strength of an individuals’ immune system. Whatever the cause, a declining absolute CD4 count incurs a known set of infective and neoplastic complications. While neoplasms with a known infective cause clearly demonstrate an increased incidence, reports of neoplasms with no infective aetiology increasing in incidence are controversial. We aimed to establish the significance of the admission absolute CD4 count by comparing it to each of the other variables recorded. Materials and methodsWe conducted a prospective study, consecutively enrolling 101 subjects who presented to our Neurosurgical unit from the 01 July 2018 – 30 March 2020, with neoplastic brain tumours planned for elective resection. The data collected and analysed in this study included age, gender, HIV status, admission absolute CD4 count, radiological tumour diagnosis, length of in-patient stay prior to surgery, pre-operative absolute CD4 count, intra-operative blood loss, length of surgery, extent of resection, histological diagnosis, nosocomial infection incidence, total length of in-hospital stay, and Glasgow Outcome Score. ResultsA highly significant was demonstrated between admission absolute CD4 count and pre-operative day absolute CD4 count (p < 0.001). While no significance between admission absolute CD4 count and radiological diagnosis (p = 0.19), nor between admission absolute CD4 count and histological diagnosis (p = 0.10) was demonstrated, similar trends were suggested in both analyses. A further trend was suggested between admission absolute CD4 count and extent of resection, favouring gross total resection in the HIV negative group, and subtotal resection in the HIV positive group. ConclusionOur study suggests a new finding with regards neoplastic brain tumour histology and absolute CD4 counts that has never been reported before. We accept that the findings are preliminary and need to be supported through larger studies.

Evaluating Outcome in HIV positive and HIV negative patients post elective brain tumor surgery at a single South African neurosurgical center – A prospective cohort study

IntroductionMultiple simultaneously occurring variables are recognized to have an impact on eventual outcome in patient presenting with neoplastic brain tumors that undergo elective resection. Materials and methodsWe conducted a prospective cohort study by consecutively enrolling 78 patients, from the 01 July 2018–30 March 2020, with neoplastic brain tumors that were taken for elective resection. Data collected and analyzed included age, gender, medical co-morbidities, HIV status, admission CD4 count, admission Glasgow Coma Score, length of stay prior to surgery, pre-operative corticosteroid therapy, pre-operative day CD4 count, timing of prophylactic antibiotic administration before skin incision, type of craniotomy, blood loss, duration of surgery, extent of resection, duration of post-operative steroid therapy, histological diagnosis, early nosocomial infection incidence, total length of in-hospital stay, and Glasgow Outcome Score. ResultsRegarding subject age, significance was demonstrated with Glasgow Outcome Score (p = 0.04). A clinical trend was suggested where subjects with medical co-morbidities had an unfavourable outcome. A further clinical trend was suggested whereby subjects who were HIV negative, as well as subjects with an absolute CD4 count > 500 cells/mm, tended to have a more favourable outcome than HIV positive subjects, or subjects with an absolute CD4 count < 500 cells/mm. Significance was demonstrated between histological tumor type and Glasgow Outcome Score (p = 0.04). Further trends were suggested where acquiring a day-7 nosocomial infection, and a prolonged length of in-patient stay, both suggested an increased chance of having an unfavourable outcome, although neither demonstrated significance. ConclusionIn our study the primary determinant of patient outcome was histological tumor type, and due to age clustering of specific histological tumor types, subject age was similarly demonstrated to be significantly associated with outcome. Our study furthermore demonstrated that HIV status, and absolute CD4 count, both demonstrated insignificance in relation to outcome.

Early nosocomial infection post-elective brain tumor surgery at a single South African neurosurgical center - a prospective cohort study

IntroductionIncurring a nosocomial infection post elective brain tumor surgery can be a devastating complication. Unfortunately, patient demographics, co-morbidities, nature of the neurosurgical procedures performed, and post-operative interventions in the Neurosurgical Intensive Care Unit, are all recognized independent risk factors. Materials and methodsWe performed a prospective study by consecutively enrolling 78 elective patients admitted to our hospital with neoplastic brain tumors, from the 01 July 2018 to the 31 March 2020, that were taken for operative resection. Data collected and analyzed in all 78 subjects included age, gender, HIV status, admission Glasgow Coma Score, admission CD4 count, pre-operative steroid treatment, in-hospital stay prior to surgery, pre-operative day CD4 count, operative day Glasgow Coma Score, time between prophylactic antibiotic administration and skin incision, craniotomy type, blood loss, duration of surgery, post-operative steroid therapy, day-7 post-operative nosocomial infection incidence, histological diagnosis, and total length of in-hospital patient stay. ResultsOur study results suggest that subjects over the age of 40-years, having an admission and/or pre-operative day absolute CD4 count < 500 cells/mm, having a suboccipital craniotomy/craniectomy performed, and surgery of over 5 h duration, to all suggest trends towards an increased risk of acquiring a day-7 nosocomial infection. Our study results further suggest that being GCS 15/15 on the day of surgery, suggested a trend towards being protective against acquiring a day-7 nosocomial infection. We further report the trend that acquiring a day-7 nosocomial infection leads to a longer total length of in-patient stay. ConclusionWhile the clinical trends in our study are largely supported by the literature, according to our PubMed review of the literature we are the first to report the trend that being GCS 15/15 on the day of an elective brain tumor resection procedure is protective against acquiring a day-7 nosocomial infection.

The Effects of Preoperative Oral Carbohydrate on Frequency of T and NK Cells in Patients with Cervical Cancer Treated Using Neoadjuvant Chemotherapy and Surgery: A Prospective Cohort Study.

Background Immune dysfunction can occur after neoadjuvant chemotherapy (NAC) and surgery for cancer. We investigated whether preoperative oral carbohydrate affected the postoperative percentages of T cells (CD4+ and CD8+) and natural killer (NK) cells in patients with cervical cancer treated with NAC and surgery. Methods This prospective cohort study enrolled consecutive patients with cervical cancer treated by radical hysterectomy with PLND at the Gynecologic Oncology Department of Fujian Provincial Cancer Hospital (China) between January 2018 and December 2018. Patients were divided into three groups according to the treatment method: NAC (two cycles, surgery 1 month later), NAC+CHO (chemotherapy and surgical methods same as with the NAC group but with 300 mL of oral carbohydrate administered 2 h before surgery), and non-NAC (surgery alone). Percentages of NK, CD3+, CD4+, and CD8+ cells were evaluated by flow cytometry the day after the first admission, just before surgery, immediately after tracheal tube removal, and the day after surgery. This trial is registered with NCT03872635 at clinicaltrials.com. Results The final analysis included 77 patients (non-NAC group, n = 26; NAC group, n = 25; and NAC-CHO group, n = 26). Baseline characteristics and preoperative NK, CD3+, CD4+, and CD8+ cell percentages were similar between groups. Postoperatively, all groups exhibited reductions in NK, CD3+, and CD4+ cell percentages and increases in CD8+ cell percentages (all P < 0.05). The changes in NK, CD3+, CD4+, and CD8+ cell percentages were attenuated in the NAC-CHO group (P < 0.05 vs. both other groups). Conclusion Preoperative oral carbohydrate can improve the postoperative populations of NK and T cells after the treatment of cervical cancer by NAC and surgery.

Preoperative CD4+CD25+/CD4+ and tumor diameter predict prognosis in male patients with bladder cancer.

Aim: The value of the peripheral blood lymphocyte subpopulation ratios and tumor diameter for prognosis in bladder cancer (BC) patients needs to be explored. Materials & methods: A total of 161 male BC patients and 68 male normal controls were retrospectively reviewed. The value of combining predictor consisted of both CD4+CD25+/CD4+ and computed tomography urography tumor diameter (CTU-D) on stage, overall survival (OS) and recurrence probability was analyzed by logistic regression, Kaplan-Meier method and log-rank test. Results: The combining predictor was a statistically independent risk for stage; dramatic differences in OS and recurrence probability were found between the combining predictor-high (cut-off point >0.08) and combining predictor-low groups (cut-off point ≤0.08). Conclusion: The combining predictor could be a significant predictor for advanced stage, OS and recurrence probability in male patients with BC.

Association of Preoperative Peripheral CD4+ T Cells Percentage and the Recurrence after 2 Years Following Surgery in Colorectal Cancer - A Retrospective Cohort Study

Background: Association of preoperative peripheral CD4+ T cells percentage and recurrence in colorectal cancer(CRC) remains to be explored. Therefore, we aimed to investigate the association between the preoperative peripheral CD4+ T cells percentage and recurrence in CRC patients. Patients and Methods: Consecutive stage I-III CRC patients undergoing curative resection from January 2010 to July 2016 were identified. Preoperative peripheral CD4+ T cells percentage was measured within one week before surgery. The association between the preoperative CD4+ T cells percentage and recurrence-free survival(RFS) was analyzed. Results: A total of 1248 patients were identified. Normal preoperative CD4+ T cells percentage was present in 47.8% of patients and was associated with a better survival (median RFS: 49 months vs. 43 months in patients with elevated percentage, P=0.33; vs. 46 months in those with reduced percentage, P=0.008). Patients with normal percentage had a 5- year RFS of 80.7% versus 75.4% in those with elevated percentage (hazard ratio[HR]:1.19, 95%CI:0.86-1.66; P=0.31) and 72.1% in those with reduced percentage (HR:1.47, 95%CI:1.12-1.92; P=0.005). In terms of the >2-5 years RFS, it was 93.3% in patients with normal percentage versus 86.2% in those with elevated percentage (HR:1.96, 95% CI:1.12-3.43; P=0.02) and 86.4% in those with reduced percentage (HR:2.02, 95%CI:1.25-3.28; P=0.004). Elevated and reduced preoperative CD4+ T cells percentage remained significant for >2-5 years RFS on multivariate analysis. Conclusion: Preoperative peripheral CD4+ T cells percentage was associated with the recurrence after 2 years following surgery in CRC. Funding Statement: This work was supported by grants from the National Key Research and Development Program of China [2017YFC1309100], the National Natural Scientific Foundation of China [81771912], and the Applied Basic Research Projects of Yunnan Province, China [2018FE001-065 and 2018FE001-251]. Declaration of Interests: The authors declare that they have no potential conflicts of interest. Ethics Approval Statement: This retrospective study was approved by the institutional review board of the Yunnan Cancer Center. The requirement for informed consent was waived by the board, owing to the study's retrospective nature. All the patient data in the survey were anonymized.

Are Prophylactic Antibiotic Agents Indicated in Anorectal Surgery for Patients with Human Immunodeficiency Virus?

With increased survival among patients with human immunodeficiency virus (HIV), surgeons have been seeing more cases of anal dysplasia and cancer. There is, however, no data on the incidence of surgical site infections (SSIs) in HIV-positive patients undergoing elective anorectal procedures, nor on the administration of prophylactic antibiotic agents. We reviewed a HIV-positive population that has undergone elective anorectal biopsy of areas of dysplasia observed on office anoscopy to assess the need for antibiotic prophylaxis. A retrospective chart review was performed of all HIV-positive patients seen as outpatients in the Colorectal Surgery Division from 2007-2016. Demographics, dates of surgery and follow-up, antibiotic prophylaxis, and pre-operative CD4 count and HIV viral load were recorded for 229 patients. Post-operative examination notes were reviewed to determine the presence of SSIs. The proportion of patients who received prophylaxis was assessed and the SSI rate was calculated. Surgical site infections occurred in 2 of 237 (0.8%) cases without antibiotic prophylaxis and in none of the 38 cases with prophylaxis. This infection rate was found to be lower than that of the general surgery population, with no statistical difference from hemorrhoidectomy patients without HIV. One SSI occurred in a 51-year-old male with a pre-operative CD4 count of 612 per microliter and viral load of zero. Another occurred in a 57-year-old female with an unknown CD4 count and viral load. A χ2 analysis showed the incidence of SSIs in the groups with and without prophylaxis was not significantly different (p = 0.563). Surgical site infection rates in HIV-positive patients undergoing biopsies for anal dysplasia were similar to patients without HIV undergoing similar minor anorectal procedures, and no difference was noted in the rate of SSI with the administration of prophylactic antibiotic agents. We do not recommend routine use of prophylactic antibiotic agents in this population.

Esophagectomy in Patients with Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome: A Viable Option

The objective of this study was to assess the outcomes for patients with human immunodeficiency virus (HIV) and acquired immune deficiency virus (AIDS) who had esophagectomy done for both benign and malignant conditions. A retrospective chart review of patients with HIV and AIDS undergoing esophagectomy at a rural referral hospital was done for the period of 2009-2014. Patient postoperative complications, outcomes, and follow-up data were charted. All procedures were done by a single lead surgeon. Nine patients met the study criteria, 7 of whom had esophageal cancer, and 2 with strictures. Four patients had received nutritional self-expanding metal stent preoperatively. The mean stent duration was 61 days. Three patients had been on antiretroviral therapy before surgery. Preoperative CD4 counts were available in 7 patients. Eight patients underwent a 3-field esophagectomy and 1 was unresectable. Seven of these patients had successful outcomes, with varying follow-up times. One patient died post procedure while in the hospital. Complications included stricture and anastomotic leak. Although HIV-positive patients face increased risk during surgical procedures, this status should not be a firm contraindication to surgery. Quality nutritional status, antiretroviral use, and overall CD4 count levels remain important parameters in considering surgical treatment for these patients. With careful patient evaluation and planning, esophagectomy in an HIV and AIDS setting is feasible with successful outcomes.

Severe perioperative hyperglycemia attenuates postoperative monocytic function, basophil count and T cell activation.

Hyperglycemia in hospitalized patients is associated with increased morbidity and mortality. Postoperative infections are particularly common in the setting of perioperative hyperglycemia; however, the relationship between perioperative glucose levels and the innate immune system remains unclear. Immune cells, monocytic respectively T cell function and T cell subspecies of 32 patients after esophageal or pancreatic resection were analyzed preoperatively and on the first day after surgery (POD 1). Perioperative blood glucose was measured hourly via arterial blood gas analyses. Groups were classified by maximum perioperative glucose levels: <180 mg/dL versus at least one episode of ≥180 mg/dL. The suppression of immune cells and cytokines was defined as the difference between pre- and postoperative values. In perioperative hyperglycemic patients, preoperative CD4+/CD8+ ratio (P=0.039), count of CD4+ T cells (P=0.039) and release of IFN-γ (P=0.013) and TNF-α (P=0.045) after ex-vivo T cell stimulation of whole blood were significantly higher. Furthermore, the postoperative count of basophils was significantly lower (P=0.011), HLA-DR expressing CD8- T cells were tendentially lower (P=0.058) and more suppressed (P=0.035). The suppression of IFN-γ (P=0.003) and TNF-α (P=0.006) was significantly higher in these patients after ex-vivo T cell stimulation but absolute values were similar between the groups. IL-10 release of lipopolysaccharide-stimulated whole blood was tendentially more suppressed after perioperative hyperglycemia (P=0.084). Severe perioperative hyperglycemia attenuated postoperative basophil count, T cell activation and monocytic function. These patients were also at preoperative higher immune activation.

Effect of Peripheral Blood CD4 + CD25 + Regulatory T Cell on Postoperative Immunotherapy for Patients with Renal Carcinoma.

To investigate the effect of peripheral blood CD4 + CD25 + regulatory T cell on postoperative immunotherapy in patients with renal carcinoma. 38 patients with renal cell carcinoma were recruited, and 20 patients from the operation group purely underwent the radical nephrectomy therapy, 18 patients from the combined group successively underwent the radical nephrectomy therapy and IFN-α adjuvant immunotherapy. Additionally, 12 healthy subjects were recruited in the same period of time and regarded as the control group. Flow cytometry was used to detect CD4 +, CD8 +, CD4 + CD25+ T lymphocyte subset content and the ratio of all parts in the pre-operative period, in the first post-operative week and in the third post-operative month, compare and analyze its variation trend. The CD4+CD25+ T lymphocyte subset content of individual renal carcinoma patients was significantly higher than that of the control group, also increases with the progression in the tumor stage (<0.05). The post-operative CD4 + CD25+T lymphocytes of individual operation group and combined group patients showed different degrees of increment, but the increment of the combined group was significantly lower than that of the operation group (<0.05). For the combined group patients with less pre-operative CD4 + CD25+T lymphocytes, their levels would increase after the immunotherapy, while the pre-operative patients with more CD4 + CD25+ T lymphocytes were the opposite situation. The detection of peripheral blood CD4+CD25+ regulatory T lymphocyte subset can reflect the anti-tumor immune status of renal cell carcinoma patient body. It can contribute to predict the prognosis of immunotherapy and provide reference for the choice of renal carcinoma post-operative adjuvant immunotherapy.

Effects of different anesthetic approaches on postoperative complications in HIV-infected patients.

The aim of this study was to investigate the effects of three different methods of anesthesia on patients with human immunodeficiency virus (HIV) infection, which could lead to an improvement in postoperative outcomes in these patients. A total of 90 patients undergoing an operation while being treated for an HIV infection were included in this study. Patients were divided into three groups (N = 30/group) based on the type of anesthesia administered: general anesthesia, local anesthesia, and combined spinal epidural anesthesia (CSEA). The effects of local infiltration of anesthesia and peripheral nerve block local anesthesia were examined in the local anesthesia group. The CSEA group examined the effects of spinal anesthesia in HIV-infected patients. We compared the vital signs of the three groups during the preoperative period, at incision, and during the postoperative recovery period. The CSEA group had a significantly higher mean preoperative CD4(+) T lymphocyte count compared with the general anesthesia and local anesthesia groups (P < 0.05). We found that the three kinds of anesthesia methods administered to HIV-infected patients could be used with considerable safety and can be selected according to the clinical need and type of surgical procedure.

Preoperative blood CD4+/CD8+ ratio as an independent predictor of postoperative recurrence after hepatectomy for hepatocellular carcinoma

Objective To study the predictive value of preoperative blood CD4 +/CD8 + ratio in postoperative recurrence after hepatectomy for patients with hepatocellular carcinoma.Methods The clinical data of 67 patients who underwent hepatectomy for hepatocellular carcinoma at The Fifth Hospital Affiliated to Sun Yat-sen University were analyzed retrospectively.Using the preoperative blood CD4 +/CD8 + ratio,these patients were divided into 2 groups,the CD4 +/CD8 + ＜ 1 group and the CD4 +/CD8 + ≥ 1 group.These patients were followed up at the outpatient clinic and/or by telephone till June 2013.The Cox ratio risk pattern analysis was used to determine the significant risk factors of tumor recurrence.Results On univariate analysis,preoperative AFP ≥400 μg/L,maximum diameter of tumor ＞ 5 cm,number of tumor ＞ 3,CD4 +/CD8 + ＜ 1,vascular invasion,positive resection margin,and portal vein tumor thrombus were risk factors of poor disease-free survival (P ＜ 0.05).On multivariant analysis,CD4 +/CD8 + ＜ 1,number of tumor ＞ 3,and portal vein tumor thrombus were independent predictors of poor disease-free survival after hepatectomy for hepatocellular carcinoma (P ＜ 0.05).Conclusions Preoperative CD4 +/CD8 + ＜ 1 was an independent adverse predictor of poor disease-free survival.It was valuable in predicting postoperative recurrence of hepatocellular carcinoma. Key words: Hepatocellular carcinoma; T lymphocytes, CD4+/CD8+ ratio; Postoperative recurrence