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Objective:To investigate the relationship between serum fibroblast growth factor 21 (FGF21) and sarcopenia in hemodialysis (HD) patients, and to explore the relationship between FGF21 and signal pathways related to skeletal muscle metabolism in uremic state at the cellular level.Methods:The data of the HD patients from the blood purification center of the Third Affiliated Hospital of Soochow University were collected in this prospective observational study between January 2018 and December 2019. Serum FGF21 concentration was detected by enzyme-linked immunosorbent assay (ELISA). Meanwhile, the skeletal muscle indexes (SMI) at the fourth thoracic vertebra (T4) and the first lumbar vertebra (L1) were assessed by chest CT. According to the T4 SMI and L1 SMI, the patients were divided into sarcopenia group and non-sarcopenia group. The relationship between serum FGF21 and sarcopenia was analyzed. The C2C12 mouse myoblasts were cultured in vitro, which were intervened with healthy human serum, healthy human serum+different concentrations of FGF21, uremic serum, uremic serum+different concentrations of FGF21. The expressions of muscle ring finger protein-1 (MURF1), muscle atrophy F-box (Atrogin-1), myogenic differentiation (MyoD) and myogenin (MyoG) were detected by Western blotting. Results:A total of 118 HD patients with age of (52.64±15.29) years were enrolled in the study, including 64 males (54.2%) and 54 females (45.8%). The images at T4 and L1 level assessed by chest CT could be acquired from 118 patients and 82 patients, respectively. According to the lowest sex-specific quartile ( P25) of T4 SMI (male < 59.92 cm 2/m 2, female < 46.75 cm 2/m 2) and the lowest sex-specific quartile ( P25) of L1 SMI (male < 29.02 cm 2/m 2, female < 24.50 cm 2/m 2), patients were divided into sarcopenia group and non-sarcopenia group, and there were 29(24.58%) and 20(24.39%) patients in the sarcopenia group, respectively. When the patients were divided into two groups according to the sex-specific lowest quartile of T4 SMI, although the serum FGF21 level in the sarcopenia group was higher than that in the non-sarcopenia group, there was no statistical significance between the two groups [448.52(183.96, 1 684.08) ng/L vs. 273.65 (152.83, 535.54) ng/L, Z=-1.741, P=0.082]. When the patients were divided into two groups according to the sex-specific lowest quartile of L1 SMI, the serum FGF21 level in the sarcopenia group was significantly higher than that in the non-sarcopenia group [460.95(188.91, 1 276.38) ng/L vs. 239.10(133.25, 466.36) ng/L, Z=-2.170, P=0.030]. Binary logistic regression analysis showed that higher serum FGF21 was an independent influencing factor for sarcopenia in HD patients regardless of whether the patients were divided into two groups according to the sex-specific lowest quartile of T4 SMI or the sex-specific lowest quartile of L1 SMI (T4 SMI grouping: OR=4.085, 95% CI 1.778-9.388, P=0.001; L1 SMI grouping: OR=7.327, 95% CI 1.841-29.160, P=0.005). At T4 and L1 levels, the area under the receiver operating characteristic curve of FGF21 in predicting sarcopenia in HD patients was 0.636(95% CI 0.494-0.779, P=0.036) and 0.684(95% CI 0.535-0.833, P=0.018), respectively. Cell experiment showed that compared with the uremic serum group, the expressions of MURF1 and Atrogin-1 in myotube cells were increased, while the expressions of MyoD and MyoG were significantly decreased in uremic serum+FGF21 group (both P < 0.05). Conclusions:Higher serum FGF21 is associated with an increased risk of sarcopenia in HD patients. FGF21 may increase the expression of ubiquitin proteasome system, reduce the synthesis and differentiation of skeletal muscle protein, and promote the occurrence of muscle atrophy in uremic patients
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Achalasia is a primary esophageal motility disorder manifested by dysphagia and chest pain that impair patients’ quality of life, and it also leads to chronic esophageal inflammation by food retention and increases the risk of esophageal cancer. Although achalasia has long been reported, the epidemiology, diagnosis and treatment of achalasia are not fully understood. The current clinical dilemma of achalasia is mainly due to its unclear pathogenesis. In this paper, epidemiology, diagnosis treatment, as well as possible pathogenesis of achalasia will be reviewed and summarized. The proposed hypothesis on the pathogenesis of achalasia is that genetically susceptible populations potentially have a higher risk of infection with viruses, triggering autoimmune and inflammation responses to inhibitory neurons in lower esophageal sphincter.
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Myeloid-derived suppressor cells (MDSCs) play an important immunosuppressive role in the tumor microenvironment. Tumor cells can regulate the immunosuppressive function of MDSCs in the tumor microenvironment through exosomes, thereby affecting the development of tumors. Tumor-derived exosomes (TEXs) promote the development of MDSCs and improve their immunosuppressive function in the tumor microenvironment mainly by participating in the processes such as intercellular information exchange and information transmission. Moreover, the miRNAs in TEXs will also be transferred to recipient cells to inhibit the immunosuppressive function of MDSCs by inducing the negative regulation of target genes. This review summarized the progress in the mechanism of TEXs on MDSCs.
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Objective:To assess the significance of counting the number of caudal vertebral ossification centers (OCN) below fetal terminal conus medullaris in the screening for closed spina bifida and tethered cord syndrome (TCS).Methods:The OCN was counted in 961 normal fetuses(normal group) between 17 and 41 gestational weeks and in 140 fetuses with closed spina bifida or tethered cord syndrome(abnormal group) from Jan.2013 to Dec.2020 in Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Women and Children′s Hospital, School of Medicine, Xiamen University and Maternity and Child Health Care of Guangxi Zhuang Autonomous Region. The OCN was counted in the dorsal mid-sagittal section of fetal caudal spine.The reliability and agreement test were evaluated by intraclass correlation coefficients in another 50 normal fetuses. The OCN was compared between two groups. ROC curve and the cut-off value were constructed and calculated.Results:In normal group, the N increased with the growing of gestational age.In the subgroup of 17-20 weeks, the OCN ranged from 5 to 7 in most fetuses. In the others subgroups, the OCN was equal to or greater than 6 in 99.9% cases and more than 6 in 97.1% cases. In abnormal group, OCN was less than 7 in 93.0% fetuses and less than 6 in 82.8% cases. There were statistical differences between the two groups except for the subgroup of 17-20 gestational weeks( P<0.05). With the cut-off value of 6.5, the specificity and sensitivity were 93.0% and 94.3% respectively for predicting the presence of closed spinal dysraphism or TCS. Conclusions:OCN is a simple way to evaluate the position of conus medullaris and to screen for the skin-covered spine dysraphism or TSC. OCN is more than 6 in most normal fetuses. Further evaluation of spine is required in fetuses with N less than or equal to 6.
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Objective:To observe the morphological changes of the sylvian fissure on the transthalamic section of fetal brain at 20-32 weeks, and grade the fetal sylvian fissure development by means of a simple scoring system and explore its clinical feasibility.Methods:From September 2018 to June 2020, 487 normal single fetuses of 20-32 weeks were examined in Shenzhen Maternal and Child Health Hospital Affiliated to Southern Medical University. The sylvian fissure maturation was analyzed on the transthalamic section of fetal brain at 20-32 weeks and was graded from 0 to 5: un-visualized (grade 0), shallow arc (grade 1), obtuse-angled platform (grade 2), right-angled platform (grade 3), acute-angled platform (grade 4), and closed operculum (grade 5). The pregnancy outcomes and gestational age were recorded.Statistical analysis was performed by SPSS 20.0 software using box plot, Mann-Whitney U test, Weighted Kappa coefficient. Results:Left sylvian fissuer grades were obtained in 280 fetuses and right sylvian fissure grades were obtained in 247 fetuses. The fetal sylvian fissure maturation at 20-32 weeks was graded from 0 to 5, which increased with advancing gestation. Grade 0 only appeared in 3 fetuses at 20 weeks, and 99.4% fetuses at 20 weeks had grade ≥1. Grade 1 appeared in 20-22 weeks, grade 2 in 20-25 weeks, grade 3 in 22-26 weeks, grade 4 in 25-32 weeks, and grade 5 in 27-32 weeks. Box-plot and Mann-Whitney U test showed that gestational week distribution of sylvian fissure at all grades was symmetric on both sides ( P>0.05). The Weighted Kappa coefficients were 0.857(95% CI=0.750-0.957) and 0.939 (95% CI=0.859-1.000), respectively, with strong consistency regarding inter- and intra-observer agreements. Conclusions:Fetal sylvian fissure maturation at 20-32 weeks can be evaluated by means of a simple scoring system with symmetrical grading of both sides.
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Background/Aims@#There is less acid burden in Chinese gastroesophageal reflux disease (GERD) patients. However, the Lyon consensus proposed a higher threshold of acid exposure time (AET > 6%) for GERD. The aims are to apply the updated criteria in Chinese GERD patients and clarify its influence on clinical outcome. @*Methods@#Patients who were referred for both esophageal high-resolution manometry and 24-hour esophageal pH monitoring due to reflux symptoms were retrospectively screened. Those patients with AET > 4% was included and grouped into either AET 4-6% or AET > 6%. Their manometric profile, reflux profile, and response to proton pump inhibitors (PPIs) were evaluated. Adjunctive evidence proposed in the Lyon consensus was added in patients with AET 4-6% for therapeutic gain. Another group of patients (n = 144) with AET 6% (74.9%). GERD patients with AET > 4% were with more male, older patients, and higher body mass index compared with non-GERD patients. Meanwhile, GERD patients were less competent in esophagogastric junction pressure. However, the manometric and reflux profile were similar between patients with AET > 6% and 4-6%. The response rate of PPI therapy was 64.6% and 63.2%, respectively, in groups of AET > 6% and 4-6% (P > 0.05). When adjunctive evidence was added in patients with AET 4-6%, no therapeutic gain was obtained. @*Conclusions@#The efficacy of PPI therapy was similar in patients with AET > 6% and 4-6%. The increase of the AET threshold did not influence the clinical outcome of Chinese GERD patients.
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Background/Aims@#Esophagogastric junction outflow obstruction (EGJOO) is characterized by elevated integrated relaxation pressure (IRP) and preserved esophageal peristalsis. The clinical significance of EGJOO is uncertain. This study aim to describe the clinical characteristics of these patients and to find out potential parameters to predict patients’ symptom outcome. @*Methods@#Consecutive patients who received high-resolution manometry examination in our hospital in 2013-2019 and met the diagnostic criteria of EGJOO were retrospectively included. Motility and reflux parameters as well as endoscopy and barium esophagogram results were studied and compared. Patients were also followed up to record their treatment methods and symptom outcomes. @*Results@#A total of 138 EGJOO (accounting for 5.2% of total patients taking high-resolution manometry examination in our hospital) patients were included. Only 2.9% of these patients had persistent dysphagia. A total of 81.8% of EGJOO patients had symptom resolution during follow-up. Patients with persistent dysphagia had significantly higher upright IRP (16.6 [10.3, 19.8] vs 7.8 [3.2, 11.5]; P = 0.026) than those without. Upright IRP can effectively distinguished patients with persistent dysphagia (area under curve: 0.826; P = 0.026) using optimal cut-off value of 9.05 mmHg. @*Conclusion@#EGJOO patients with persistent dysphagia and higher upright IRP (median > 9.05 mmHg) needs further evaluation and aggressive management.
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Background/Aims@#Esophagogastric junction outflow obstruction (EGJOO) is characterized by elevated integrated relaxation pressure (IRP) and preserved esophageal peristalsis. The clinical significance of EGJOO is uncertain. This study aim to describe the clinical characteristics of these patients and to find out potential parameters to predict patients’ symptom outcome. @*Methods@#Consecutive patients who received high-resolution manometry examination in our hospital in 2013-2019 and met the diagnostic criteria of EGJOO were retrospectively included. Motility and reflux parameters as well as endoscopy and barium esophagogram results were studied and compared. Patients were also followed up to record their treatment methods and symptom outcomes. @*Results@#A total of 138 EGJOO (accounting for 5.2% of total patients taking high-resolution manometry examination in our hospital) patients were included. Only 2.9% of these patients had persistent dysphagia. A total of 81.8% of EGJOO patients had symptom resolution during follow-up. Patients with persistent dysphagia had significantly higher upright IRP (16.6 [10.3, 19.8] vs 7.8 [3.2, 11.5]; P = 0.026) than those without. Upright IRP can effectively distinguished patients with persistent dysphagia (area under curve: 0.826; P = 0.026) using optimal cut-off value of 9.05 mmHg. @*Conclusion@#EGJOO patients with persistent dysphagia and higher upright IRP (median > 9.05 mmHg) needs further evaluation and aggressive management.
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Objective:To systematically evaluate the clinical effect of biliary stent combined with intra-biliary radiofrequency ablation and stent alone in the treatment of malignant obstructive jaundice.Methods:The PubMed, Cochrane library, Embase, HowNet, Wanfang, Weipu were systematically searched, the search time was up to February 2021. To collect and compare the clinical efficacy studies of combined intra-biliary radiofrequency ablation in the treatment of patients with malignant obstructive jaundice before biliary stent placement. After literature screening, data extraction and quality assessment conducted by two independent reviewers. Meta-analysis was performed with the patients' 1-year survival rate, 6-month patency rate after biliary stent operation, and comparative changes in postoperative complications as the main outcome indicators.Results:Finally, 9 studies were included, comprising 2 randomized controlled studies (RCT) and 7 retrospective studies, involving a total of 443 patients, with 211 cases in the biliary stent combined with intra-biliary radiofrequency ablation group and 232 cases in the stent alone group. The results of meta-analysis showed that in two joint groups compared with the stent alone group, in overall analysis, the rate of re-obstruction of the biliary tract decreased 6 months after stenting ( OR=0.24, 95% CI: 0.13-0.42) and 1-year survival rate increased ( OR=3.79, 95% CI: 2.08-6.90), the differences are statistically significant ( P<0.001), there was no statistical difference in the complications ( P=0.13). In ERCP group, the rate of re-obstruction of the biliary tract decreased 6 months after stenting ( OR=0.21, 95% CI: 0.08-0.55), and the 1-year survival rate significant increase ( OR=3.63, 95% CI: 1.76-7.48), the differences are statistically significant ( P<0.01). In PTCD group, the rate of re-obstruction of the biliary tract decreased 6 months after stenting ( OR=0.25, 95% CI: 0.12-0.51), and the 1-year survival rate significant increase ( OR=4.13, 95% CI: 1.42-12.03), the differences are statistically significant ( P<0.01). Conclusion:Compared with the stent-only group, the combined group is safe and effective in treating malignant obstructive jaundice.
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Objective@#To evaluate the value of cerebrospinal fluid markers expecially total-tau protein (T-tau), phosphorylated-tau protein (P-tau) in diagnosis and differentiation of sporadic Creutzfeldt-Jakob disease (sCJD).@*Methods@#sCJD (according to 2009 Brain criteria, 2018 Neurology amended criteria), Alzheimer's disease (AD; the National Institute on Aging at National Institutes of Health and the Alzheimer's Association revised guidelines 2011 criteria) and other patients without cognitive impairment, matched for sex and age, in the Department of Neurology, Peking Union Medical College Hospital from 2018 to 2019 were enrolled. Twelve sCJD patients, 49 AD patients and 14 normal controls were enrolled. Cerebrospinal fluid (CSF) specimens were collected through gravity dropping directly, and further stored in -80 ℃ and disposed according to widely used standards. The levels of T-tau and P-tau were measured by ELISA. The data on electroencephalogram and neuroimaging findings of sCJD patients were recorded. Moreover, specimens of sCJD patients were sent to the Chinese Center for Disease Control and Prevention to test 14-3-3 protein and PRNP genotype.@*Results@#Using Mann-Whitney U test, T-tau concentrations were found higher in patients with sCJD (1 211(448, 2 227) pg/ml) than in AD patients (549(314, 1 078) pg/ml; U=178, P=0.034 9), and both groups had higher T-tau than the control group (127(79, 192) pg/ml; U=20, 73, P<0.01). The level of P-tau was significantly increased in AD patients (72(58,109) pg/ml) compared to the control group (27(15, 42) pg/ml; U=82, P<0.01), but not in sCJD patients (32(24, 47) pg/ml). The T-tau/P-tau ratio was higher in sCJD patients (29.77(20.01, 54.53)) than in AD patients (7.45(4.79, 10.43); U=87, P<0.01). Twelve sCJD patients had cotical hyperintensity on diffusion weighted imaging and five had periodic three-phase waves on electroencephalogram. Nine sCJD patients, whose CSF samples were tested in the Chinese Center for Disease Control and Prevention, carried an M/M genotype at codon 129 and E/E at codon 219.@*Conclusion@#The CSF tau level and T-tau/P-tau ratio are significantly increased in sCJD, which may promote the diagnosis and differentiation of sCJD in routine clinical setting.
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Objective:To evaluate the effects of modified peroral endoscopic myotomy (POEM) on esophageal dynamics and clinical efficacy in achalasia (AC) patients.Methods:From January 2013 to December 2014, 51 patients diagnosed with AC and received modified POEM at The First Affiliated Hospital of Sun Yat-sen University were retrospectively enrolled. AC patients were classified as type Ⅰ, type Ⅱ and type Ⅲ according to Chicago classification. The changes of esophageal dynamics before and after the modified POEM were compared by high resolution manometry (HRM). The reflux after the operation was evaluated by 24-hour esophageal impedance-pH monitoring. The clinical symptoms and the quality of life of AC patients were assessed by impaction dysphagia questionnaire (IDQ), Eckardt scale and short-form 36 item health survey (SF-36). Paired t test, independent sample t test, Wilcoxon rank sum test and Pearson correlation analysis were used for statistical analysis. Results:At three months and one year after operation, lower esophageal sphincter pressure (LESP) and integrated relaxation pressure (IRP) were all lower than those before operation ((23.89±12.68) and (23.44±12.56) mmHg (1 mmHg=0.133 kPa) vs. (39.29±16.14) mmHg; (16.13±9.43) and (15.37±8.36) mmHg vs. (30.57±11.31) mmHg), and the differences were statistically significant ( t=7.520, 7.866, 7.641 and 8.909, all P<0.05). There were no statistically significant differences in LESP and IRP during the same period between patients with type Ⅰ AC and type Ⅱ AC (all P>0.05). The LESP of patients with partial esophageal peristalsis function recovered one year after operation was lower than that of patients with unrecovered esophageal peristalsis function ((15.38±4.54) mmHg vs. (25.65±13.19) mmHg), and the difference was statistically significant ( t=0.039, P<0.05). The proportions of pathologic acid reflux of AC patients at three months and one year after operation were 7.8%(4/51) and 2.0%(1/51), respectively. The IDQ and Eckardt scores of patients with AC at three months and one year after operation were both lower than those before operation (4 points, 0 points to 10 points and 4 points, 0 points to 11 points vs. 23 points, 18 points to 30 points; 2 points, 1 points to 3 points and 1 points, 0 points to 1 points vs. 5 points, 4 points to 5 points), and the differences were statistically significant ( Z=-6.036, -6.104, -5.971 and -6.209, all P<0.01). According to Eckardt score, the proportions of clinical remission at three months and one year after operation were higher than that before operation (98.0%, 50/51 and 100.0%, 51/51 vs. 19.6%, 10/51), and the differences were statistically significant ( χ2=64.76 and 68.56, both P<0.05). The SF-36 general health and social function scores at three months and one year after operation were both higher than those before operation (0.55 points, 0.45 points to 0.70 points and 0.55 points, 0.45 points to 0.70 points vs. 0.45 points, 0.30 points to 0.55 points; 0.88 points, 0.75 points to 1.00 points and 0.88 points, 0.75 points to 1.12 points vs. 0.75 points, 0.75 points to 1.00 points); and the differences were statistically significant ( Z=-4.439, -4.225, -2.123 and -2.320, all P<0.05); and the health change scores were lower than those before operation (3.00 points, 2.00 points to 3.00 points and 2.00 points, 1.00 points to 3.00 points vs. 4.00 points, 3.00 points to 4.00 points), and the differences were statistically significant ( Z=-4.827 and -4.841, both P<0.05). Before and after modified POEM, the changes of LESP were positively correlated with the changes of IRP ( r=0.624 and 0.592, both P<0.01). Conclusion:Modified POEM can significantly improve the symptoms and LES relaxation function of AC patients, with a low incidence of post-operative reflux.
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protein (T-tau),phosphorylated-tau protein (P-tau) in diagnosis and differentiation of sporadic Creutzfeldt-Jakob disease (sCJD).Methods sCJD (according to 2009 Brain criteria,2018 Neurology amended criteria),Alzheimer's disease (AD;the National Institute on Aging at National Institutes of Health and the Alzheimer's Association revised guidelines 2011 criteria) and other patients without cognitive impairment,matched for sex and age,in the Department of Neurology,Peking Union Medical College Hospital from 2018 to 2019 were enrolled.Twelve sCJD patients,49 AD patients and 14 normal controls were enrolled.Cerebrospinal fluid (CSF) specimens were collected through gravity dropping directly,and further stored in-80℃ and disposed according to widely used standards.The levels of T-tau and P-tau were measured by ELISA.The data on electroencephalogram and neuroimaging findings of sCJD patients were recorded.Moreover,specimens of sCJD patients were sent to the Chinese Center for Disease Control and Prevention to test 14-3-3 protein and PRNP genotype.Results Using Mann-Whitney U test,T-tau concentrations were found higher in patients with sCJD (1 211(448,2 227) pg/ml) than in AD patients (549(314,1 078) pg/ml;U=178,P=0.0349),and both groups had higher T-tau than the control group (127(79,192) pg/ml;U=20,73,P＜0.01).The level of P-tau was significantly increased in AD patients (72(58,109) pg/ml) compared to the control group (27(15,42) pg/ml;U=82,P＜0.01),but not in sCJD patients (32(24,47) pg/ml).The T-tau/P-tau ratio was higher in sCJD patients (29.77(20.01,54.53)) than in AD patients (7.45(4.79,10.43);U=87,P＜0.01).Twelve sCJD patients had cotical hyperintensity on diffusion weighted imaging and five had periodic three-phase waves on electroencephalogram.Nine sCJD patients,whose CSF samples were tested in the Chinese Center for Disease Control and Prevention,carried an M/M genotype at codon 129 and E/E at codon 219.Conclusion The CSF tau level and T-tau/P-tau ratio are significantly increased in sCJD,which may promote the diagnosis and differentiation of sCJD in routine clinical setting.
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Objective To analyze changes in serum levels of inflammatory factors,galectin-3 (Gal-3),fractalkine(FKN) and interleukin-6 (IL-6),in patients with dilated cardiomyopathy (DCM) or ischemic cardiomyopathy (ICM),and to explore their clinical significance.Methods Seventy-six hospitalized patients with DCM were selected to serve as a DCM group,and 78 patients with ischemic cardiomyopathy were selected into an ICM group from October 2016 to December 2017 at the Department of Cardiology,and patients in the two groups received cardiac function classification.Meanwhile,82 healthy people were included as a control group.Fasting venous blood was collected,and serum levels of Gal-3,FKN,IL-6,and BNP were measured.The correlations of Gal-3,FKN,and IL-6 with DCM or ICM were analyzed.Results Levels of plasma BNP and serum Gal-3,FKN,and IL-6 in the DCM and ICM groups were higher than those in the control group,and their levels in the DCM group were significantly higher than in the ICM group.Levels of plasma BNP and serum Gal-3,FKN,and IL-6 increased as their New York Heart Association(NYHA)classification went higher in both the DCM and ICM groups.For patients classified at the same level,serum levels of Gal-3,FKN,and IL-6 of the DCM group were significantly higher than those of the ICM group(P ＜ 0.05).BNP levels showed no difference between the two groups(P ＞0.05).Spearman correlation analysis indicated positive correlations of NYHA classification with levels of BNP(r =0.30,0.19),Gal-3(r=0.24,0.19),FKN(r =0.63,0.51),and IL-6(r =0.28,0.15)in both the DCM and ICM groups(P ＜ 0.05),and the correlation was stronger in the DCM group.Conclusions Increased expression of plasma BNP,Gal-3,FKN,and IL-6 in patients with DCM and ICM are closely related to the severity of cardiac function impairment.Monitoring changes in levels of plasma BNP and serum inflammatory factors Gal-3,FKN and IL-6 provides important clues for the differential diagnosis between DCM and ICM,the assessment of clinical conditions and treatment-related decisions.
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Objective To analyze of internal strength in patients with chronic disease,make clear the concept development,property,prerequisites,outcome and evaluation index of internal force.Methods To retrieve the relevant research literature in the knowledge service platform of Pubmed,PsycINFO and Chinese CNKI,Wanfang data,using the Rodgers analysis method to analyze the evolution of the concept of internal force.Results The molding process of internal strength of patients with chronic diseases included 4 defining characteristics:self concept,support,development and transcendence.Conclusions Rodgers evolution concept analysis method can help medical workers make clear concept essence of internal strength,deepening their cognition and understanding,so as to provide the basis for the implementation of the related research and clinical interventions.
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Objective To determine the expression of CD4+ CD25+ FOXP3+ regulatory T cells(Treg cells) in peripheral blood of patients with hepatocellular carcinoma (HCC) and investigate the clinical significance of Treg cells determination in clinical practice. Methods Flow cytometry was employed to measure the levels of CD4+ CD25+ T cells and CD4+ CD25+ FOXP3+ T cells in peripheral blood of 18 HCC patients, 26 hospitalized patients without HCC (clinical control) as well as 24 healthy persons (healthy control). Results The percentage of CD4+ CD25+ T cells in total CD4+T cells isolated from the HCC patients(4.25% ± 3.98 % ) was elevated significantly compared to that in the clinical control group (1.34% ± 1.14%) or healthy control group (1.29% ±0.95%) (both P＜0.01). There was no difference in the percentage between the clinical control group and the healthy control group (P＞0.05). Meanwhile, the ratio between CD4+ CD25+ FOXP3+ T cells and CD4+ T cells in HCC patients (2.94%0.91%) also increased significantly compared to that in the clinical control group (0.76% ± 0.34%) or healthy control group (0.81% ± 0.29%) ( both P＜0. 001), which showed a more obvious increasing tendency than the ratio of CD4+ CD25+ T cells and CD4+ T cells. No difference in percentage of CD4+ CD25+ FOXP3+ T cells in CD4+ T cells was found between the clinical control group and the healthy control group (P＞0.05). Conclusion As the more accurate regulatory T cells, CD4+ CD25+ FOXP3+ T cells are able to detect the increase of population in HCC patients. Therefore, it is important to determine the levels of CD4+ CD25+FOXP3+ T cells in HCC patients for prevention and treatment of malignancy.