Aim: To assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are Staphylococcus aureus carriers undergoing different types of surgeries and diverse measures of decolonization. Methods: Relevant randomized controlled trials (RCTs) were identified through systematic searches of the PubMed, Embase, Web of science, and the Cochrane Library databases. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated and the effects model was chosen according to the heterogeneity. Subgroup analyses were performed according to different types of surgeries and measures of decolonization that Staphylococcus aureus carriers were applied. Results: Twenty RCTs published between 1996 and 2019 involving 10,526 patients were included. Pooled results showed that the overall SSIs and pulmonary surgery SSIs presented with a statistical difference in measures of nasal decontamination (RR = 0.59 and 0.47, respectively, both p < 0.01). However, the associations between nasal decolonization and increased risks of SSIs in orthopedics surgery or cardiovascular surgery remained insignificant in studies. As for the diverse measures of nasal decontamination, 50% used mupirocin, 15% used chlorhexidine, 30% used different types of antimicrobial drugs, and 5% use others. The SSIs rate were decreased after chlorhexidine (RR = 0.474, 95% CI 0.259-0.864), while no significant difference was shown in the use of mupirocin (RR = 0.871, 95% CI 0.544-1.394). Conclusion: It seems that nasal decolonization of Staphylococcus aureus may be associated with a reduction of SSIs in these patients, especially in patients who have been administered by pulmonary surgeries or treated with chlorhexidine.

Aim: To assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are Staphylococcus aureus carriers undergoing different types of surgeries and diverse measures of decolonization. Methods: Relevant randomized controlled trials (RCTs) were identified through systematic searches of the PubMed, Embase, Web of science, and the Cochrane Library databases. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated and the effects model was chosen according to the heterogeneity. Subgroup analyses were performed according to different types of surgeries and measures of decolonization that Staphylococcus aureus carriers were applied.Results: Twenty RCTs published between 1996 and 2019 involving 10526 patients were included. Pooled results showed that the overall SSIs and pulmonary surgery SSIs presented with a statistical difference in measures of nasal decontamination (RR=0.59 and 0.47, respectively, both p<0.01). However, the associations between nasal decolonization and increased risks of SSIs in orthopedics surgery or cardiovascular surgery remained insignificant in studies. As for the diverse measures of nasal decontamination, 50% used mupirocin, 15% used chlorhexidine, 30% used different types of antimicrobial drugs, and 5% use others. The SSIs rate were decreased after chlorhexidine (RR=0.474, 95% CI: 0.259-0.864), while no significant difference was shown in the use of mupirocin (RR=0.871, 95% CI: 0.544-1.394).Conclusion: It seems that nasal decolonization of Staphylococcus aureus may be associated with a reduction of SSIs in these patients, especially in patients who have been administered by pulmonary surgeries or treated with chlorhexidine.

Background Patients infected with HIV are at high risk of developing Epstein-Barr Virus (EBV)-related diseases. The genotype and viral biological behavior of EBV infection in patients with human immunodeficiency virus-1 (HIV) in China remain unclear. This study analyzed the characteristics of EBV in patients infected with HIV in southeastern China. Methods A total of 162 HIV-infected patients and 52 patients without HIV were enrolled in this study. EBV viral load in blood was determined by fluorescence quantitative PCR. EBV typing was performed using saliva according to polymorphisms in the EBNA3C region. EBV LMP-1 carboxy terminus (C-ter) was sequenced, and compared with the epidemic strains in the world. Results Among HIV infected patients, the EBV strain variant was mainly EBV-1, while EBV-2 had a higher viral load than EBV-1 (P = 0.001) and EBV-1/2 (P = 0.002). HIV infected patients had higher active virus replication. The EBV LMP-1 variants were mainly the China1 variant. HIV-infected patients had different nucleic acid positions of 30-bp deletion (del30) and had a higher incidence of high 33-bp tandem repeats (rep33) copies than non-HIV-infected patients. There was a difference in the mutations of EBV LMP-1 C-ter del30 and ins15 between HIV infected patients and the control group (P < 0.001). Conclusion In southeastern China, EBV in HIV-infected patients had higher active virus replication; EBV infection was mainly EBV-1, and EBV-2 infection has higher EBV virus load; hotspot mutations of LMP-1 C-ter were different between HIV-infected patients and non-HIV-infected patients. Trial registration: This study was approved by the ethics committee of the First Affiliated Hospital of Zhejiang University School of Medicine (Approval No. 2018764), and registered in Chinese Clinical Trial Registry on 3 June 2019 (ChiCTR, ChiCTR1900023600, http://www.chictr.org.cn/usercenter.aspx).

Background Several HIV-associated cryptococcal meningitis (HIV-CM) patients were found to have persistent intracranial inflammation despite negative Cerebrospinal fluid (CSF) fungal cultures after being optimally treated for CM, which could be devastating for the central nervous system. However, there is no definitive treatment strategy for this condition. Method We identified 14 HIV-CM patients with persistent intracranial inflammation and conducted a 24 weeks, prospective cohort study. All participants received oral lenalidomide 25 mg on days 1 to 21 of a 28-day cycle. The follow-up lasted for 24 weeks with visits performed at the baseline, week 4,8,12,24. The primary endpoint was the efficacy of lenalidomide therapy which was determined by the clinical manifestations, the changes in routine CSF parameters, and radiological findings within 24 weeks post-treatment. In addition, an exploratory analysis was made on the changes of CSF cytokine. Safety and efficacy analysis was performed in patients who received at least one dose of lenalidomide. Results Of the 14 participants, 11 patients completed the 24 weeks of follow-up. it was observed that rapid clinical remission followed lenalidomide therapy, clinical presentation such as fever, headache, and cognitive impairment was fully recovered at week 4 and remained stable during follow-up. And a significant reduction of CSF white blood cell (WBC) count occurred at week 4 [Median count 3.00×10 6 /L (IQR 0-45.00 P=0.009)] from baseline [35×10 6 /L (IQR 4.50 to 90.00)]. Median CSF protein concentration decreased from 1.39 g/L (IQR 0.74-3.23) at baseline to 0.91 g/L (IQR 0.63-1.41) at week 4 (P=0.004). CSF WBC count, CSF protein remained stable and approached the normal range through week 24. And after the 24‐week lenalidomide therapy, CSF IgG levels were also decreased, though not statistically significant. Brain MRI demonstrated that the multiple lesions were also absorbed post-therapy. In addition, it was observed that TNF-α G-CSF, IL-6, IL-17A decreased significantly during the 24-week follow-up. 2(14.3%) patients had a mild skin rash, which resolved spontaneously without drug interruption. No study drug-related serious adverse events were observed and no patient withdrew from therapy because of unacceptable toxicity. Conclusion Our study found that lenalidomide can significantly improve persistent intracranial inflammation of HIV-CM patients and have well tolerance and without notable side effects.