Objective: To analyze the variation characteristics of HIV-1 Gp120 sequences in men who have sex with men (MSM) in Guangzhou. Methods: Plasma samples were collected from HIV-1 infected MSM before antiretroviral treatment. Viral RNA was extracted from plasma. Gp120 gene sequences were amplified by reverse transcription and nested-PCR using specific primers. Phylogenetic tree, length polymorphism, amino acid characteristics of V3 loop, co-receptors and signature amino acids were analyzed. Results: The phylogenetic tree were divided into 4 clusters, and the most prevalent subtypes were CRF07_BC (34/61, 55.74%) and CRF01_AE (24/61, 39.34%). Majority of HIV-1 Gp120 sequences had 496-515 amino acids. Among five hypervariable regions, the V1 region had the highest levels of length polymorphism and V3 region had the lowest. The top four peptide of V3 loop were GPGQ (56/58, 96.55%). Most of the co-receptors HIV-1 strains used was CCR5(50/58, 86.21%)according to four methods of comprehensive prediction. There are four signature amino acids in CRF01_AE subtype strains, and the frequency of occurrence was 0.75-0.83; there are eight signature amino acids in CRF07_BC subtype strains, and the frequency was 0.74-0.94. Conclusions The length of Gp120 sequences in MSM in Guangzhou has a high polymorphism. The top four peptide of V3 loop, co-receptor and signature amino acid of V3 ring have formed unique patterns.

Objective To evaluate the efficacy and safety of transurethral thulium-Yag laser(Tm-Yag Laser) resection of bladder tumor in the treatment of non-muscle invasive bladder cancer(NMIBC).Methods The clinical data of 186 patients who underwent transurethral resection with pathologically identified of NMIBC were retrospectively analyzed.76 cases and 110 cases were in the transurethral resection of bladder cancer Tm-Yag Laser group and TURBT group,respectively.The operative time,intraoperative blood loss,incidence of obturator nerve reflex,days for urethral catheterization,duration of hospitalization after surgery,detection rate of muscle layer in postoperative pathologic examination and recurrence between the two groups were compared.All patients were followed up for 24 months.Regularly gemcitabine intravesical instillation chemotherapy and cystoscopy were performed postoperation.Results The operative time [(27.08±5.56) min vs.(25.55±5.37) min,P>0.05]and intraoperative blood loss [(14.23±4.05) mL vs.(15.10±3.24) mL,P>0.05]showed no differences between the two groups.The incidence of obturator nerve reflex in Tm-Yag laser group was lower than that in TURBT group (0.0% vs.5.5 %,x2=4.28,P=0.038).The days for urethral catheterization [(3.48±1.05) d vs.(4.02±1.14) d,t=3.328,P=0.001]and the duration of hospitalization after surgery [(4.47±1.08) d vs.(5.02±1.13) d,t=3.350,P=0.001]in Tm-Yag laser group were significantly shorter than those in TURBT group.In Tm-Yag laser group,the detection rate of muscle layer in postoperative pathologic examination was higher than that in TURBT group(x2=14.96,P=0.001).The total rate of tumor recurrence in Tm-Yag laser group was significantly lower than that in TURBT group(13.2 % vs.25.5%,x2=4.18,P=0.041).Conclusion Transurethral Tm-Yag laser is safe and effective in the treatment of NMIBC.It can avoid the incidence of complications and reduce tumor recurrence rate,which is worthy of promotion.

Objective To compare the perioperative safety and curative effects oflaparoscopic adrenal sparing surgery (ASS) with laparoscopic total adrenalectomy (TA) for aldosterone producing adenoma (APA).Methods An online systematical retrieval was performed with Pubmed,ScienceDirect,Springerlink,the Cochrane library,CNKI and China Biology Medicine disc for clinical comparative studies published before May 2016,these studies reported the treatment of ASS/partial adrenalectomy (PA) versus TA for APA.The selected studies were applied to Revman 5.3 software for meta-analysis.The main contents were perioperative outcomes (operative time,intra-operative blood loss,and length of hospital stay) and postoperative efficacy (cure rate,partial response rate,inefficiency rate).Results A total of 9 clinical studies (3 English documents and 6 Chinese documents) with 1036 patients were included into the final analysis,among which 544 patients were assigned to ASS group and 492 in TA group.The analyzed results demonstrated no statistical significance between ASS group and TA group on operative time (WMD:-2.09min,95％CI:-9.86-5.67,P=0.60),length of hospital stay (WMD:-0.10d,95％CI:-0.32-0.12,P=0.36),intra-operative blood loss (WMD:1.13ml,95％CI:-8.86-11.12,P=0.82),cure rate (OR=l.07,95％CI:0.73-1.58,P=0.72),partial response rate (OR=0.85,95％CI:0.57-1.27,P=0.43) and inefficiency rate (OR=2.15,95％CI:0.32-14.34,P=0.43).Conclusion For surgical treatment of APA,ASS is technically safe,can achieve reliable postoperative efficacy and a similar therapeutic effect compared with TA,so deserves further application in clinical practice.

Objective:To examine the inhibitory effect and mechanism of niclosamide combined with low-dose cisplatin on adrenocor-tical carcinoma xenografts in nude mice. Methods:A SW-13 cell transplanted tumor model was first established in nude mice. The nude mice were then divided into the control group, niclosamide group, cisplatin group, and combined drug group. The groups were compared in terms of tumor body volume, tumor weight, and biochemical index. The cell apoptosis rate of the transplanted tumor tis-sue was detected by TUNEL assay, while Bcl-2 and caspase-3 protein expression in the transplanted tumor tissue was detected by im-munohistochemistry and Western blot. Results:The terminal tumor volume and weight of the combined drug group were lower than those of the niclosamide and cisplatin groups (all P<0.001). The white blood cell count of the cisplatin and combined drug groups were lower than that of the control group (all P<0.001). Meanwhile, no difference was observed between the cisplatin and combined drug groups (P=0.29). The creatinine and glutamic pyruvic transaminase of the cisplatin and combined drug groups were higher than those of the control group (all P<0.001), whereas no significant difference was observed in the levels of creatinine and alanine aminotransfer-ase between cisplatin and combined drug groups (all P>0.05). TUNEL test results showed that the cell apoptotic rate of the combined drug group was higher than that of the niclosamide group (P=0.004) and cisplatin group (P=0.005). Immunohistochemistry and West-ern blot test results showed that Bcl-2 expression in the combined drug group was lower than those of the niclosamide and cisplatin groups (all P<0.001), while caspase-3 expression in the combined drug group was the highest among those of other groups (all P<0.001). Conclusion:Niclosamide can enhance the inhibitory effect of low-dose cisplatin on the growth of adrenocortical carcinoma and has no additional side effects. This enhancement is probably related to the influence of niclosamide on Bcl-2 and caspase-3 expres-sion levels. Niclosamide promotes the apoptosis of the tumor cells by influencing Bcl-2 and caspase-3 expression.

Objective To investigate the prevalence and characteristics of non-nucleoside reverse transcriptase inhibitors (NNRTIs)resistance-related gene mutations among the AIDS patients with virological suppression failure in Guangdong Province 2015.Methods Plasma samples from AIDS patients receiving highly active antiretroviral therapy for more than one year with viral loads > 1000 copies/mL from Guangdong province (except Shenzhen)were collected from January to December 2015.Total 612 HIV-1 gene fragments were amplified from plasma samples using self-developed lab method.Sub-genotypes were determined by phylogenetic tree according to the sequences,NNRTIs resistance-related mutations were determined in Stanford University HIV-1 Drug Resistance Database. The NNRTIs-resistance, the relationships of NNRTIs resistance-related mutations with baseline CD4 +T lymphocyte counts,transmission routes,antiviral regimens and HIV-1 genotypes were analyzed.SPSS 17.0 software was used to analyze the data.Results In 612 patients with virological suppression failure,the main NNRTIs resistance-related mutations were K103 (26.80%),Y181 (14.71 %),V179 (13.73%),G190 (11 .44%) and V106 (10.62%).The susceptibility rate of 310 patients (50.65%)to NNRTIs had changed,the highly resistant rate to nevirapine was 49.51 %,which was higher than that of efavirenz (43.14%),etravirine (5.56%) and rilpivirine (12.25%),respectively,and the differences were statistically significant (χ2 =5.00,296.3 and 198.0,all P <0.05).The incidence rate of drug resistance in patients with baseline CD4 +T lymphocyte counts >200 cells/μL was lower than that in those with baseline CD4 +T lymphocyte counts <200 cells/μL (χ2 =17.93,P <0.01 );the incidence rate of drug resistance was lower in intravenous drug abusers than that of sexually transmitted patients (χ2 =44.21 ,P <0.01 );while the incidence of drug resistance in patients receiving NVP-containing regimens was higher than that in those receiving EFV-containing regimens (χ2 =8.93,P <0.01 ),and the incidence rate was higher in patients with CRF01 _AE than that in those with CRF07_BC and CRF08 _BC (χ2 =8.46 and 8.47,P <0.01 ).Conclusions The results suggest that compliance education and follow-up should be strengthened in patients with high baseline CD4 +T lymphocyte counts and intravenous drug users,and patients with liver diseases should avoid using drugs containing NVP regimens.

Objective: To investigate the effects of modified three-step procedure for anatrophic nephrolithotomy in the treatment of complex staghorn renal calculi. Methods: A total of 22 patients with complex staghorn renal calculi between June 2013 and June 2016 at Department of Urology in Guangzhou General Hospital of Guangzhou Military Command were retrospective analyzed. There were 13 males and 9 females, ranging from 35 to 62 years old with mean age of 47 years. There were 17 patients with dull pain, and 5 patients who were found through physical examinations. Kidney calculi located in left kidney in 15 patients, right kidney in 7 patients. All patients were treated with modified three-step procedure for anatrophic nephrolithotomy. The operation time, blood loss, time of intraoperative renal ischemia, and postoperative complications were recorded. Serum creatinine (Scr), blood urea nitrogen(BUN), β₂-microglobulin(β₂-MG), diseased side glomerular filtration rate(GFR) , and renal cortical thickness of the diseased kidney in preoperative and postoperative were compared. The clinical data were compared by paired sample t test between pre-operation and post-operation. Results: The calculi were completely removed in 22 patients, the mean operation time was 84 minutes (50 to 126 minutes), the mean time of intraoperative renal ischemia was 31 minutes (20 to 56 minutes), the mean blood loss was 246 ml (150 to 360 ml). There were no secondary bleeding or urinary fistula happened, the perinephric drainage tub was removed in 3 to 7 days postoperative, the mean hospitalization time was 7 days.Compared with the preoperative, the Scr ((172.7±21.3)μmol/L vs. (146.4±22.8)μmol/L, t=7.197, P=0.000), BUN ((9.2±1.8)mmol/L vs. (8.0±0.5)mmol/L, t=3.798, P=0.001) and β₂-MG ((203.0±32.0)μg/L vs. (175.6±23.8)μg/L, t=5.009, P=0.000) in postoperative decreased, the diseased side GFR increased ((28.6±4.0) ml/min比(31.8±3.3) ml/min, t=-3.521, P=0.002). There were no significant difference of diseased renal cortical thickness between preoperative and postoperative(t=-1.323, P=0.200). There were 12 patients with postoperative pain, 2 patients with vomiting, 3 patients with fever, and 2 patients with wound infection. The follow-up time was 6 months, no residual stones in 22 patients. Conclusion The modified three-step procedure for anatrophic nephrolithotomy has high stone free rates with less effects on renal function and fewer complications, the method could be widely applied.

Objective To detect the change of hepatitis C virus (HCV)RNA in the peripheral blood mononuclear cells (PBMC)and serum of patients with chronic hepatitis C (CHC)during treatment with peg-interferon α-2a (Peg IFNα-2a)plus ribavirin (RBV),and to analyze the clinical significance of HCV RNA detection in PBMC.Methods The peripheral blood samples of 20 CHC patients who visited Department of Infectious Diseases in Guangzhou No.8 People′s Hospital from June 2013 to December 2014,were collected during treatment with Peg IFNα-2a+RBV at different time points (week 0,2,4, 12,24,36 and 48).Serum and PBMC were separated.Accurate fluorescence quantification assay (Cobas TaqMan real time polymerase chain reaction[PCR])was used to detect HCV RNA level in serum,while real-time PCR and nest-PCR were applied to detect HCV RNA in PBMC.Categorical data were analyzed byχ2 test.Results Accurate fluorescence quantification of serum HCV RNA showed that HCV RNA level decline rapidly after treatment (F = 148.06,P < 0.01 ),and 18 patients achieved HCV RNA undetectable at week 12 of treatment.The positive rate of nest-PCR was higher than real-time PCR (all P <0.01).Comparison of HCV RNA levels in serum and PBMC from 20 cases found that,the clearance rate of HCV RNA in PBMC was postponed.Two patients whose HCV RNA in PBMC kept detectable relapsed at week 24 after end of treatment.Conclusions HCV RNA can be detected in PBMC of CHC patients and the positive rate of nest-PCR is higher than real-time PCR.Antiviral therapy is effective on HCV both inside and outside PBMC,but the clearance rate of HCV RNA in PBMC is postponed compared with that in serum.Slow clearance of HCV in PBMC may be a risk factor for relapse after end of treatment.

Objective The clinical effect and prognosis of greenlight photoselective laser vaporization combined with intraoperative submucosa multi-point injection of gemcitabin for the treatment of non muscle-invasive bladder tumors(NMIBC).Methods Selected 105 cases of NMIBC Confirmed by pathology from Mar.2012 to Nov.2013 in Guangzhou General Hosptial of Guangzhou Military Command of PLA urology.Put the patients into three groups randomly.Greenlight photoselective laser vaporization for bladder tumors (PVBT) combined with intraoperative submucosal injection of gemcitabine (PVBT group) 38 cases,Transurethral resection of bladder tumor(TURBT) combined with intraoperative submucosal injection of gemcitabine 25 cases (TURBT group),TURBT combined with immediate postoperative bladder perfusion chemotherapy (Control group)42 cases.Maintain the bladder perfusion chemotherapy after surgery,follow-up of 2 years.To compare and analysis the effect and the prognosis of three ways of operation method,And evaluate the quality of life of three groups of patients after treatment.Results The operation of 105 cases were successful,a total of 31 cases of recurrence,included PVBT group 7 cases (18.4％),TURBT group 6 cases (24％),contrlol group 18 cases (42.9％).Tumor progression of time were 12、10、6 month for the first time.The body function,psychological function,social function and material life of four dimensions scores have no obvious difference Three groups (P ＞ 0.05).Conclusions PVBT combined with intraoperative submucosal multi-point injection of gemcitabine is a kind of simple operation,and reduce the complications and the recurrence of the operation,especially suitable for the lateral wall of superficial tumor and intolerance to TURBT surgery for high-risk patients.It is a new better method of expansion clinical application.

Objective To explore the diagnosis and treatment of adrenal black adenoma . Methods From June 2002 to July 2014, 7 patients with adrenal tumors were treated with retroperitoneal laparoscopic partial adrenalectomy in our hospital .During the operation all the patients were placed in healthy lateral decubitus position .Three trocars were introduced into the lumbar region:below the 12th rib along the anterior and posterior axillary lines , and 2 cm beyond superior iliac spine on the middle axillary line .The retroperitoneal space was established with homemade balloon-expanding devices .Afterwards , the tumors were removed by using a harmonic scalpel. Results All the tumors were resected completely .The average operation time was 60 min (range, 34-90 min) and the average blood loss in the operation was 70 ml (range, 20 -200 ml) without blood transfusion.The drainage tubes were removed on the 3rd or 4th postoperative day and the patients were discharged on the 6th or 7th postoperative day .They were pathologically diagnosed as adrenal black adenoma . Two patients manifested the Cushing ’ s syndrome and 3 patients showed hypertension , all of which were recovered to normal postoperatively .No recurrence or metastasis was noted during a follow-up for 12-24 months (mean, 18 months). Conclusions Adrenal black adenoma, without specific clinical features, is a rare kind of adrenocortical adenoma .The confirmative diagnosis depends on pathological results .Retroperitoneal laparoscopic surgery is a minimally invasive, safe and effective technique for adrenal black adenoma , which provides favorable prognosis .

OBJECTIVETo investigate the correlation between CT image presentations and biochemical indexes in adrenal adenomas and pheochromocytomas.

METHODSWe retrospectively analyzed the CT features, cortisol rhythm, supine and orthostatic hypertension and 24-h urine methoxy in 209 patients with benign adrenal tumors. The relationship between CT findings and the biochemical indexes were analyzed in patients with different benign adrenal tumors.

RESULTSThe 209 cases analyzed included 53 cases of cortisol adenoma, 65 cases of aldosterone adenoma, 45 cases of non-functional adenoma and 46 cases of pheochromocytomas. The plain CT scan values of the 4 groups were 17.25 ± 1.81, 14.52 ± 1.57, 12.20 ± 2.05, 42.42 ± 0.97 HU, enhanced CT values (arterial phase) were 47.82 ± 3.07, 39.23 ± 2.37, 45.35 ± 6.46, and 104.93 ± 5.84 HU, respectively, and the differences between CT scan and enhanced CT values were 30.58 ± 2.29, 24.71 ± 1.55, 33.15 ± 5.18, and 62.51 ± 5.73 HU, respectively. In cortisol adenoma group, cortisol levels measured at 16:00 and 24:00 were positively correlated with plain CT scan value (r=0.506, P=0.0001; r=0.504, P=0.0001) and enhanced CT value (r=0.514, P=0.0001; r=0.554, P=0.0001). In pheochromocytoma group, plain scan CT value and the difference between plain and enhanced CT scan value were correlated with 24-h urine methoxy adrenaline (Rho;=0.342, 0.350; P=0.020, 0.017, respectively) and norepinephrine (Rho;=0.419, 0.412; P=0.004, 0.004, respectively).

CONCLUSIONPlain and enhanced CT scan values and their combination have important value in differential diagnosis of adenoma and pheochromocytoma tumor, CT values combine with biochemical indexes can reduce misdiagnosis and missed diagnosis of pheochromocytoma.

Adenoma ; chemistry ; diagnosis ; Adrenal Gland Neoplasms ; chemistry ; diagnosis ; Diagnosis, Differential ; Diagnostic Errors ; Humans ; Hydrocortisone ; Hypertension ; Pheochromocytoma ; chemistry ; diagnosis ; Retrospective Studies ; Tomography, X-Ray Computed