Objective To analyze the character of Pol-specific T lymphocyte responses and identify immunodominant region recognized in Chinese HIV-1 recombinant subtype B/C infectors at different stages of diseases. Methods Eleven Chinese HIV-1 recombinant subtype B/C infectors infected in 18 months, 25 which infected time more than 3 years and 10 HIV-1-seronegative healthy individuals were enrolled. HIV-1-specific T lymphocyte responses were analyzed by an IFN-γ ELISPOT assay against 249 overlapping peptides spanning HIV-1 Pol protein in the present study. Results Pol-specific T lymphocyte responses of IFN-γsecretion were identified in 8 (72.73%) out of 11 infectors infected in 18 months, the specific T lymphocytes are mainly targe-ted at six peptides which amino acid position from Pol 481 to 631 in reverse transcriptase region: Pol5581, Pol5582, Pol5587, Pol5609, Pol5610 and Pol5615. There was a negative correlation between the breadth of re-sponse and peripheral CD4+ T cell count (P=0.0212, r=-0.762) ; Responses were identified in 15 (60%) out of 25 chronic infectors, the specific T lymphocytes are mainly targeted at four peptides which amino acid po-sition from Pol 241 to 295: Pol5521, Pol5525, Pol5526, Pol5531 and another peptide: Pol5638 which amino acid position from Pol 708 to 722 in reverse transcriptase region. There was a positive correlation between the magnitude of Pol-specific IFN-γ secretion T lymphocyte responses and plasma viremia (P = 0.006 95 , r = 0.660) . None of the seronegative healthy individuals gave the positive responses. Conclusion Chinese HIV-1 recombinant subtype B/C infectors at different stages of diseases mainly recognized different re-gions of Pol.

Objective To investigate the effect of the treatment for Maisonneuve fracture with arthroscopicassistant plate-screw fixation ofsyndesmosis.Methods From January 2015 to December 2016,totally 22 patients with Maisonneuve fracture were treated in Shanghai Jiao Tong University Affiliated Six People's Hospital.Eleven patients in minimal invasive surgery (MIS)group were treated by the arthroscopic-assistant plate-screw fixation ofthe syndesmotic injury.Another 11 patients in the control group were performed a classic syndesmosis screw fixation.Plain radiographic examination was carried out during the follow-up.Functional evaluation was measured according to the American Orthopedic Foot Ankle Society (AOFAS) ankle hindfoot score and the Visual analogue scale(VAS).A t test was applied for the statistic analysis of post-operative outcome between the two groups at 6th and 12th month.Results The patients were followed for an average 18 months (range from 12 to 24 months)except one of MIS group.The X-ray demonstrated the solid bone union occurred on the 12th week in MIS group and 12.5th week in the control group.The implants of syndesmosis were removed at 12th week post-operatively.No cases of re-diastasis occurred during the follow-up.There was significant difference with in the groups.In the MIS group,the AOFAS ankle hindfoot score was (85.9 ±4.1) points at 6th month post-operatively,and increased to (90.8 ± 3.7) at 12th month (P ＜ 0.05).VAS score was (2.4 ± 1.2) at 6th month and (1.1 ± 0.7) at 12th month after the operation(P ＜0.05).In the control group,the AOFAS ankle hindfoot score was (81.1 ±4.7) points at 6th month after operation,and increased to (89.1 ± 3.4) at 12th month after operation (P ＜ 0.05).VAS score was (3.2 ± 1.3) at the 6th month and (1.0 ± 1.0) at the 12th month after operation (P ＜ 0.05).However,for the outcome comparison between the two groups,only the AOFAS ankle hindfoot score of 6th month post-operatively in MIS group was better than the control group (P ＜ 0.05),other results,had no significant difference.Nocomplications of implant failure,nonunion,malunion or post-traumatic arthritis were occurred during the followup.Conclusion The treatment of Maisonneuve fracture by arthroscopic-assistant plate-screw fixation proved to have an advantage of minimal invasion and accurate reduction and fixation,which is a safe and effective surgical method.

Objective: To explore drug resistance of different viral loads, and investigate the relationship between drug resistance and CD4⁺T cell counts in patients with HIV antiretroviral therapy (ART) in China from 2003 to 2015. Methods: Data were extracted from the Chinese National HIVDR Surveillance database from 2003 to 2015. For this study, the data collected were as follows: having received ART for ≥12 months; 18 years or older; demographic characteristics, information of ART, CD4⁺T cell counts, viral load (VL) and HIV drug resistance of a total of 8 362 patients were collected. Multi-variables non-conditional logistic regression model was used to study the relationship between viral load, HIV drug resistance and CD4⁺T cell counts. Results: Participants with age of (41.8±10.5) years were enrolled in this study. Among them, 59.9% (5 009 cases) were men. The percentage of CD4⁺T cell counts <200 cells/μl in the total population was 17.9% (1 496 cases), the highest was in VL ≥1 000 copies/ml with drug resistance, which was 43.0% (397/923) , followed by VL 50-999 copies/ml with drug resistance, which was 31.1% (69/222), and the lowest was in VL 50-999 copies/ml without drug resistance 13.2% (273/2 068). Compared to VL 50-999 copies/ml without drug resistance, VL<50 copies/ml, VL 50-999 with drug resistance, VL≥1 000 copies/ml without drug resistance, and VL ≥1 000 copies/ml with drug resistance, the OR (95%CI) of CD4 <200 cells/μl were 0.9 (0.7-1.0), 3.2 (2.3-4.4), 2.6 (2.1-3.2), and 4.9 (4.0-5.9), respectively. Among 222 patients with VL 50-999 and HIVDR, the most frequent antiretroviral drugs were EFV and NVP, both of which were NNRTI, and whose percentage both were 94.1% (209 cases). The most frequent mutations were M184V/I (NNRTI), and the percentage was 26.1% (58 cases). The second one was K103N (NNRTI), and the percentage was 22.5% (50 cases). The percentage of V32L/E (PI) and V82A (PI) were lower, they were 0.9% (2 cases) and 0.5% (1 case) respectively. Conclusion Decreased CD4⁺T cell counts were associated with HIV drug resistance at low viraemia. In the case of low viral load, the most vulnerable were the NNRTI antiviral drugs such as EFV and NVP.