Objective To clarify the genetic diversity of HIV-1 strains currently circulating in Shanghai and establish the molecular epidemiological database of HIV-1 infection.Methods The samples from 114 newly diagnosed HIV-l-infected individuals between June 2004 and June 2005 were investigated.HIV-1 pol gene(protease 1-99 aa and reverse transcriptase 1-252 aa) from plasma sam- ples were amplified by RT-PCR,sequenced and phylogenetieally analyzed.Protease inhibitors(PRIs) and reverse transcriptase inhibitors (RTIs) resistance-associated mutations in protease (PR) and re- verse transcriptase(RT) regions were analyzed.Results (1)Epidemiological survey showed the exist ence of different modes of transmission of HIV-1 including sexual contacts 51(44.74%),intravenous drug users 43 (37.72%),contaminated blood/blood products transfusion 3(2.63%) and unknown in- fection 17(14.91%);(2)Phylogenetic analysis revealed that 9 of the analyzed sequences were identi- fied as subtype B(7.89%),15 as subtype B'(13.16%),1 as subtype C(0.88%),1 as subtype G (0.88%),38 as CRF01 AE(33.33%),46 as CRF07 BC(40.35%) and4 asCRF08 BC(3.51%); (3)Analysis of drug-resistance associated mutation showed that 21 of 114 (18.42%) persons infected with drug-resistant HIV-1,among which major mutations in PR and RT regions accounted for 2.63 (3/114) and 17.54% (20/114),respectively.The frequencies of major mutation in PR region were M46I(66.67%),M46L(33.33%) and in RT region were M41L(7.69%),A62V (7.69%),T69S (7.69%),V75I/L(15.38%),K103R(25.00%),V118I(23.08%),V179D/E/T(33.33%),G190R (8.33%),L210K/M/X(38.46%),227L/I(16.67%),M230R(8.33%),P236R(8.33%).Conclusions The results revealed the current presence of multiple HIV-1 subtypes and recombinants strains infec- ting residents and migrants living in Shanghai.The broad diversity of HIV-1 has been introduced into Shanghai mainly through drug injection and heterosexual contacts.This study also revealed that HIV-1 strains infecting these newly diagnosed treatment-naive persons have acquired major mutations in both PR gene and RT gene of HIV-1.

OBJECTIVETo explore the mechanism of electroacupuncture at Zusanli (ST 36) on regulation of intestinal inflammatory reaction in rats with acute pancreatitis.

METHODSFifty-four SD rats were randomly divided into a severe acute pancreatitis (SAP) group, an electroacupuncture (EA) group and a sham-operation (SO) group, 18 cases in each group. 3.5% sodium cholate was used to made SAP model by retrograde injecting in cholangiopancreatic duct. After the success of model making, the EA group was treated with EA at bilateral Zusanli (ST 36) for 30 min. The SO group and the SAP group were fixed at the same time for 30 min without treatment. All the rats were killed at 3 h, 6 h and 12 h after modeling in batches. The pathological changes of pancreatic tissue and intestinal epithelium were observed, and the expression of small intestinal occludin protein and nuclear factor kappa-B (NF-kappaB) were detected by immunohistochemical SP method.

RESULTSThe pathologic score and the expression of small intestinal NF-kappaB p65 at 3 h, 6 h and 12 h after modeling in the EA group and the SO group were significantly lower than those in the SAP group (all P < 0.05), and the expression of small intestinal occludin protein in the EA group and the SO group were significantly higher than that in the SAP group (all P < 0.05).

CONCLUSIONElectroacupuncture at Zusanli (ST 36) can alleviate pancreatic injury by reducing the expression of NF-kappaB p65 and enhancing the expression of occludin protein in the intestinal epithelium in the SAP model rats.

Acupuncture Points ; Acute Disease ; therapy ; Animals ; Electroacupuncture ; Humans ; Intestine, Small ; metabolism ; Male ; NF-kappa B ; genetics ; metabolism ; Occludin ; genetics ; metabolism ; Pancreatitis ; genetics ; metabolism ; therapy ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo analyze the reason and strategy for failure of posterior pedicle screw short-segment internal fixation on thoracolumbar fractures.

METHODSFrom March 2008 to December 2010,the clinical data of 18 patients with thoracolumbar fracture failed in posterior pedicle screw short-segment internal fixation were retrospectively analyzed. There were 11 males and 7 females with an average age of 37.2 years (ranged, 19 to 63). The time from the first operation to complication occurrence was from 6 to 44 months with an average of 14.3 months. Of them,fusion failure was in 7 cases (combined with screw breakage in 4 cases), the progressive neuro-dysfunction was in 5 cases,the progressive lumbodorsal pain was in 6 cases. All 18 patients with kyphosis were treated with anterior internal fixation remaining posterior fixation (9 cases) and anterior internal fixation after posterior fixation removal (9 cases).

RESULTSAll the patients were followed up from 18 to 50 months with an average of 30.5 months. No intetnal fixation loosening and breakage were found, moreover, X-ray and lamellar CT showed bone healing well. Preoperative, postoperative at 3 months and at final follow-up, ODI score was respectively 31.6+/-5.1, 8.6+/-5.7, 8.3+/-3.2; VAS score was respectively 7.2+/-2.3, 2.3+/-0.7, 2.1+/-1.1; kyphosis angle was respectively (-21.2/-+7.8 degreeso, (-5.3+/-6.8 degrees ), (-5.8+/-7.8 )degrees. Compared with preoperative data ,above-listed items had obviously ameliorated(P<0.05).

CONCLUSIONTreatment of thoracolumbar fracture with posterior pedicle screw short-segment internal fixation may result in the complications such as bone nonunion ,internal fixation breakage and progressive kyphosis. Anterior reconstruction may be a good strategy for the failure of posterior operation.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Retrospective Studies ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; surgery

Aortic Aneurysm, Abdominal ; surgery ; Endovascular Procedures ; adverse effects ; Humans ; Intestinal Fistula ; diagnosis ; etiology ; Male ; Middle Aged

Objective To observe the outcomes of fast track surgery program applied in thoracoscopic/laparoscopic esophagectomy.Methods From March 2010 to December 2012,99 esophagus cancer patients were randomly allocated to receive thoracoscopic/laparoscopic esophagectomy[minimally invasive esophagectomy (MIE) group,50 cases] and open esophagectomy [open esophagectomy (OE) group,49 cases].Same fast track surgery program was applied in both groups.Perioperative data of all patients were collected and analysized.Results The baseline of both groups was similar.Compared with OE group,MIE group got more abdominal lymph nodes resection,13(6-40) vs.4(0-20),P ＜0.05.In both groups,the level of the total albumin,hemoglobin and total cholesterol in the 8th postoperative day was higher than that of the 1 st postoperative day,P ＜0.05.Statistical difference was observed in the 48 h patient controlled analgesia usage,24 h and 48h visual analogue scales score of motion and less motion,postoperative creatine kinase level,the white cell count and C-reaction protein level in the 8th postoperative day,of which the MIE group got better results,P ＜ 0.05.Patients in MIE group took less time to begin oral nutrition (6 days vs.9 days P ＜ 0.05),besides,the parenteral nutrition duration [(7.9 ± 2.4) days vs.(8.6 ± 2.9)days,P ＜ 0.05] and postoperative hospital stay [(12.5 ± 3.1) days vs.(17.1 ± 6.3) days,P ＜ 0.05] were also shorter,P ＜0.05.Conclusion Fast track surgery program is safe and feasible for patients receiving esophagectomy.MIE combined with fast track surgery program can promote early rehabilitation by easing pain,reducing inflammatory response,improving nutrition state,lowering postoperative morbidity,shortening hospital stays,and as a result,have more obviously advantages.

Objective To discuss the feasibility and benefits of staged ureteroscopic laser lithotripsy in complicated cases. Methods From May 2005 to May 2008, the staged ureteroscopic procedure was done in 56 cases for ureteric stricture, kinking, spasm or high mobility of ureteric mucosa. Encountering difficulties, with the guide wire settled in place, the endoscopic procedure was ended and a ureteral stent was set. A second ureteroscopic procedure was carried out two weeks later. Results There was no difficulty for the insertion and the advancing of the ureteroscope two weeks later in all 56 cases. Among the 41 cases previously having the ureteric calculi, the stone was pushed into the kidney by the stent in 16 cases. There was no surgical complication during the second procedure. After three months the complete evacuation rate of the calculus was 96.4%. No patient experienced a fever >39.1 ℃ after the first attempt. Conclusions For complicated cases, such as ureteric stricture, spasm, kinking and high mobility of the ureteric mucosa which hinder the safe advancing of the ureteroscope, staged ureteroscopic procedure might be a safe and effective choice.

After target blood glucose (HbA1C,fasting plasma glucose),serum lipid profiles (total cholesterol,triglyeeride) and control of blood pressure were achieved in 532 patients with type 2 diabetes mellitus, the level of serum uric acid was significantly decreased and the number of case of hyperuricacidemia also reduced (all P<0.01).

Objective To investigate the relationship between serum levels of adiponectin (APN) and retinol binding protein 4 (RBP4) in newly diagnosed type 2 diabetes mellitus (T2DM) patients. Methods 95 newly diagnosed T2DM patients and 55 non-diabetic volunteers from health examination population were studied. The serum concentrations of APN and RBP4 were determined by ELISA. The levels of plasma glucose, lipid profiles and insulin were also measured in fasting samples. Insulin sensitivity was assessed by insulin resistance index (HOMA-IR). The control group and diabetic group were divided into ≥60 years subgroup and <60 years subgroup respectively. According to the guideline designed by Chinese Diabetes Society(CDS)in 2004, the control group and diabetic group were divided into different kinds of abnormal metabolism groups. Results (1)The level of APN was significantly decreased in diabetic group compared with the control group[(7.26±4.69)mg/L vs. (11.93±4.89)mg/L], while the serum level of RBP4 in diabetic group was obviously higher than that in control group[(16.48±7.82) mg/L vs. (10.91±5.26) rag/L]. (2) The prevalence of metabolic syndrome in diabetic group was higher than that in control group (46.3% vs. 7.3%). (3)APN level was decreased with the increasing number of components of MS, and RBP4 level was increased with the increasing number of components of MS. (4) In DM group, APN level was correlated negatively with MS, waist circumference and BMI, and RBP4 level was correlated positively with waist circumference, HOMA-IR, BMI and TG. Conclusions APN and RBP4 levels are significantly associated with metabolic syndrome. Hypoadiponectinemia and higher retinal binding protein 4 may play an important role in the pathogenesis of MS.

Objective To survey the serum level changes of retinal binding protein 4(RBP4)in newly diagnosed type 2 diabetes,and to explore related factors of RBP4 level.Methods According to body mass index(BMI),95 newly diagnosed type 2 diabetes in Beijing Hospital from April to October of 2002 were divided into obese-diabetic group(BMI≥25),normal-weighted diabetic group(BMI

3 month),fluid sign was observed in 2(3 vertebrae,3/26,11.5%). Conclusion Fluid sign is characteristic in acute,subacute and early chronic trauma vertebral compression fracture for bone marrow edema,while it is rare in metastatic tumor vertebral compression fracture.It may paly a role in the differentiation of benign and malignant vertebral compression fracture.