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Objective:To explore the dynamic changes of inflammatory cytokines and T lymphocyte activation in the peripheral blood of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients during anti-retroviral therapy (ART).Methods:Two hundred and six HIV/AIDS patients with ART at clinic of the Department of Infectious Diseases in Second Xiangya Hospital, Central-South University between January 2017 and December 2019 were selected as HIV infection group. They were followed up regularly and the blood samples before treatment and at month 6, month 12, month 24 of treatment were collected. Meanwhile, 52 healthy cases were enrolled in the healthy control group and their blood samples were collected. Enzyme-linked immunosorbent assay was used to detect the plasma concentrations of interleukin (IL)-6, hypersensitive C-reactive protein (hsCRP) and tumor necrosis factor (TNF)-α. Flow cytometry was used to detect the CD3 + CD4 + T lymphocytes count and the percentage of CD4 + CD38 + T lymphocytes and CD8 + CD38 + T lymphocytes in the peripheral blood mononuclear cells. Plasma HIV RNA viral load was determined using a quantitative real-time polymerase chain reaction technique. Statistical methods used paired t test and Pearson correlation analysis. Results:The concentrations of IL-6, hsCRP and TNF-α in HIV infection group were (13.42±2.35) pg/mL, (4 012.46±1 012.35) μg/L and (51.78±11.32) μg/L, respectively, which were higher than those in healthy control group ((6.14±0.78) pg/mL, (707.21±305.76) μg/L and (19.01±6.48) μg/L, respectively). The differences were all statistically significant ( t=12.56, 16.79 and 13.45, respectively, all P<0.001). They decreased gradually after initiation of ART in HIV infection group, and returned to normal levels at month 24 of ART. CD3 + CD4 + T cells count was (256.00±65.32)/μL and HIV RNA viral load was (4.467±4.244) lg copies/mL before ART in HIV infection group, which were negatively correlated ( r=-0.625, P=0.041). The percentages of CD8 + CD38 + T lymphocytes before treatment and at month 12 or month 24 of treatment in HIV infection group were higher than those in healthy control group. The differences were all statistically significant ( t=3.85, 6.84 and 2.57, respectively, all P<0.050). The percentage of CD8 + CD38 + T lymphocytes was positively correlated with HIV RNA viral load before ART ( r=0.768, P=0.026). The percentages of CD4 + CD38 + T lymphocytes before treatment and at month 12 or month 24 of treatment in the HIV infection group were lower than those in the healthy control group, and the differences were all statistically significant ( t=6.80, 1.10, and 2.11, respectively, all P<0.050). Conclusions:HIV infection could not only cause insufficiency in immune system, but also abnormal activation of immune system, which could get better gradually with ART.
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Objective:To explore independent risk factors and risk stratification for diagnosis of clinically significant prostate cancer (CsPCa) in biopsy-naive patients with nonsuspicious multiparametric magnetic resonance imaging (mpMRI).Methods:The data of 549 patients who underwent initial systematic biopsy (SB) in the First Affiliated Hospital of Soochow University, the Second Affiliated Hospital of Soochow University and Traditional Chinese Medicine Hospital of Kunshan between October 2015 and January 2021 were retrospectively reviewed. Nonsuspicious mpMRI was defined as Prostate Imaging-Reporting and Data System (PI-RADS)≤2. All patients received systematic 12 core prostate biopsy, 278 of them by transperineal and 271 by transrectal biopsies. The median age of the patients was 67 (62, 73) years, the median prostate specific antigen (PSA) was 9.01 (6.15, 13.64) ng/ml, the median prostate volume was 48.41 (35.85, 64.28) ml, and 54 patients were positive in digital rectal examination (DRE). Taking CsPCa as the outcome index, receiver operating characteristic (ROC) analysis was performed on age, tPSA, f/tPSA and PSA density (PSAD) to obtain the optimal cut-off value, and logistics regression was used to explore the independent risk factor of CsPCa in mpMRI negative patients. The optimal cut-off value when the negative predictive value (NPV) of mpMRI diagnosis of CsPCa was 100%, was taken as the protective factor, and the risk stratification model was finally proposed.Results:Of all 549 cases, 44 were CsPCa, 35 were clinically insignificant prostate cancer and 470 were non-prostate cancer. There were significant differences in age (71 vs. 67 years old), tPSA (11.95 vs. 8.75 ng/ml), PSAD [0.31 vs. 0.18 ng/(ml·cm 3)], f/tPSA (0.12 vs. 0.16) and DRE positive rate (38.6% vs. 7.3%) between CsPCa group and non-CsPCa group ( P<0.01). Cut-off values were taken in ROC analysis when the Youden index was at its maximum. The optimal cut-off values of each continuous variable were: age=65 years, tPSA=10ng/ml, f/tPSA=0.2 and PSAD=0.15 ng/(ml·cm 3). Multivariate analysis showed that ages over 65 years ( OR=3.43, 95% CI 1.55-7.58, P=0.002), f/t PSA ratio<0.2 ( OR=3.84, 95% CI 1.28-11.56, P=0.016), PSAD>0.15 ng/(ml·cm 3) ( OR=3.60, 95% CI 1.13-11.51, P=0.03) and positive DRE ( OR=5.20, 95% CI 2.39-11.32, P<0.001) were independent risk factors of CsPCa. When NPV was 100%, the cut-off values were taken as the protective factors: age≤55 years, f/tPSA≥0.3, PSAD≤0.1 ng/(ml·cm 3). Combined with independent risk factors, preliminary risk stratification was conducted: those with ≥2 high risk factors were considered as high risk group, those with ≥2 protective factors were considered as low risk group, and the middle region was considered as medium risk group. Conclusions:Patients with age>65 years, f/tPSA<0.2, PSAD > 0.15 ng/(ml·cm 3) and DRE positive are independent risk factors of CsPCa in mpMRI negative patients. Patients in the high-risk group were recommended to undergo prostate biopsy, while patients in the low-risk group could be considered to avoid biopsy.
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Malignant peripheral nerve sheath tumors(MPNST) of the bladder is a very rare malignant tumor, usually secondary to neurofibromatosis type 1 (NF-1), with a few sporadic cases. This paper reports a case of 70-year-old man with bladder MPNST who underwent transurethral resection. Adjuvant intravesical instillation with gemcitabine was given after surgery, and there was no local recurrence and distant metastasis after 12-month follow-up. This paper also made a corresponding literature review.
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Objective To investigate the effect of high active antiretroviral therapy ( HAART) on growth and development of infants born to pregnant women infected with human immunodeficiency virus (HIV) and the effect on blocking mother to children transmission.Methods Totally 165 pregnant women diagnosed with HIV infection from May 2006 to May 2017 and their 169 infants, including four pairs of twins were enrolled, and 82 infants born to HIV negative pregnant women in the same period were enrolled as control .All of the pregnant women in the experimental group were administrated with HAART when HIV antibody test was positive.The delivery intervention and artificial feeding were carried out as well.The weight, height, hemoglobin (Hb), serum iron and serum calcium level of infants at birth , 12 months and six years old were monitored and compared between the two groups.Apgar scores of newborns and intelligence tests at six-year-old were also recorded.Statistical analysis was performed by t test.Results Pregnant women were generally in good conditions and well tolerated to the drugs.There were no significant differences in neonatal Apgar scores , body weight, body length, Hb, serum iron, serum calcium and CD4+T lymphocyte count between HIV positive experimental group and control group (t ＝-1.27,-1.12,-3.41,-5.62,-0.89,-3.02 and-0.74, respectively, all P＞0.05).At the age of 12 months, there were no significant differences in body weight , length, Hb, serum iron, serum calcium and CD4+T lymphocyte count between the two groups ( t ＝1.02, 1.41, 1.32, 1.03, 0.89 and 1.06, respectively, all P ＞0.05).At the age of six years, there were no significant differences in all indexes between the two groups (t＝1.02, 0.87, 1.58, 1.03, 0.92 and 2.07, respectively, all P ＞0.05).Intelligence assessment was performed in 78 children of the experimental group and 45 children of the control group at the age of six years , and there was no significant difference between the two groups ((89.7 ±12.5) score vs (91.2 ±13.7) score, t＝1.67, P＝0.43).All the children in the experimental group were positive for HIV antibody at birth , and six cases were positive for HIV RNA who were diagnosed with neonatal HIV infection.HAART was initiated for the six cases , while HIV antibody tests were still positive until the age of 18 months after HAART.The rest of the children′s HIV antibody tests became negative with the mother to children tramsission rate of 3.55%(6／169).Conclusion HAART could not only block mother to children tramsission of HIV , but also has no effect on growth and intellectual development of children during the observation period.
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Objective To analyze the impact of secondary infection on prognosis of liver failure. Methods A total of 384 hospitalized patients who were diagnosed with liver failure from January 2015 to Decembet 2017 in the Department of Infectious Diseases of the Second Xiangya Hospital of Central South University were retrospectively analyzed.The patients were divided into infected group and non-infected group according to whether they were complicated with infection during hospitalization .The cause of liver failure, the area and source of infection were recorded.The infected group was divided into bacterial group and fungal group.The liver and kidney function , international normalized ratio ( INR).The model for end-stage liver disease ( MELD ) score, hospitalization days , medical expenditure , and mortality were calculated and evaluated.T test was used for normally distributed continuous variables , and chi-square test was used for classified variables.Results A total of 384 hospitalized patients with liver failure were enrolled , including 321 males and 63 females with age of (45.5 ±13.4) years.There were 240 patients (62.5%, infected group) who had secondary infection during the whole course , and 144 patients (37.5%, non-infected group ) were not infected.Among the 384 patients, 328 patients (85.4%) were infected with hepatitis B virus, 8(2.1%) with hepatitis C virus, and 10(2.6%) with alcoholic hepatitis.As for the clinical types of liver failure , 187 patients (48.7%) were diagnosed with acute-on-chronic (subacute) liver failure and 158 (41.1%) with chronic liver failure.Among the 240 patients in the infected group, 122 patients (50.8%) had abdominal infection, 84 (35%) had pulmonary infection, 8(3.3%) had urinary tract infection, 13(5.4%) had biliary tract infection , and 11 ( 4.6%) had bloodstream infection.The levels of total bilirubin , creatinine, MELD scores, hospitalization days and medical expenditure in the infected group and non -infected group were statistically significant (all P＜0.01) after 30 days in hospital.In the infected group, 362 various samples from 240 patients were submitted for bacterial culture , among which 87 samples were positive, including Candida in 15 samples, Aspergillus in 8 samples, Acinetobacter baumannii in 13 samples, Staphylococcus in 10 samples, Escherichia coli in 11 samples, Klebsiella pneumoniae in 14 samples, Bacillus faecalis in 4 samples, Bacillus pallid in 4 samples, Stenotrophomonas maltophilia in 4 samples and Aeromonas hydrophila in 4 samples.Among the 240 patients in the infected group , 182 patients were diagnosed with bacterial infection and 58 with fungal infection. There were significant differences in total bilirubin , serum creatinine, INR, MELD scores and mortality rate between the two groups ( all P＜0.05).Conclusions The rate of secondary infection in patients with liver failure is not related with age.The development of secondary infection , especially fungal infection , worsens the prognosis of patients with liver failure.
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Objective:To analyze the levels of immune cytokine in peripheral blood(PB) and the expressions of immune related transcription factors in placenta cytotrophoblast,which in patients with pregnancy-induced hypertension(PIH).And to explore the effect of fetal-maternal immune tolerance on pregnancy-induced hypertension.Methods:50 cases patients with PIH were selected as the observation group,and 40 healthy people were chosen as the control group.Enzyme-linked immunoassay(ELISA) was performed to detect the levels of IFN-γ,IL-4,IL-17 and TGF-β in peripheral blood.Quantitative Real-time PCR(RT-qPCR) and Western blot were used to analyze the mRNA expressions and protein levels of T-bet,GATA-3,RORC and Foxp3 in placenta cytotrophoblast,respectively.Results:①Compared with the control group,the IFN-γ and IL-17 levels in peripheral blood in the observation group were obviously higher and the TGF-β level was greatly lower(P0.05),but the ratios of IFN-γ/ IL-4 and IL-17/TGF-β in the observation group were larger than that in the control group(P<0.05).②Compared with the control group,the mRNA expressios and protein levels of T-bet and RORC in the observation group were increased significantly(P<0.05),but that of GATA-3 and Foxp3 were decreased greatly(P<0.05).Thus,the ratios of T-bet/GATA-3 and RORC/Foxp3 in the observation group were significantly larger than that in the control group(P<0.05).Conclusion:PIH is occurred with the imbalance of Th1/Th2 and Th17/Treg,and it might be associated with the mechanism of fetal-maternal immune tolerance disorder that induced by Th cells.
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OBJECTIVE:To observe the efficacy and safety of low-dose ropivacaine combined with sufentanil in the upper limb anesthesia. METHODS:100 patients with upper limb anesthesia were randomly divided into control group and test group. Control group was intravenously injected 20 ml 0.5% ropivacaine;test group was intravenously injected 20 ml 0.375% ropivacaine +10 μg sufentanil. The anesthesia effect,disappearance time of pain,duration of analgesia,and pain visual analogue (VAS) score before anesthesia(T0),5 min(T1),15 min(T2)and 30 min(T3)after anesthetic block,and 4 h(T4)and 8 h(T5)after surgery,and in-cidence of adverse reactions in 2 groups were observed. RESULTS:VAS scores at T1-T5 in test group and T2-T4 in control group were significantly lower than T0,test group was lower than control group at T1,T2 and T5,the differences were statistically signifi-cant(P<0.05). The total effective rate of anesthesia in test group was significantly higher than control group,disappearance time of pain was significantly shorter than control group,duration of analgesia was significantly longer than control group,incidence of adverse reactions was significantly lower than control group,the differences were statistically significant(P<0.05). CONCLU-SIONS:Both the efficacy and safety of low-dose ropivacaine combined with sufentanil in the upper limb anesthesia are good.
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OBJECTIVE:To compare therapeutic efficacy and safety of desflurane and sevoflurane for anesthesia of elderly pa-tients. METHODS:A randomized,parallel-controlled method was used,120 elderly patients undergoing anesthesia were random-ized into trial group and control group,with 60 cases in each group. Based on routine medication and disposal,control group was additionally given sevoflurane for anesthesia,and trial group given desflurane for anesthesia. The blood pressure and heart rate were recorded before anesthesia,2 min and 10 min after intubation,2 min and 30 min after the start of the operation;the extubation time,eye opening time,consciousness recovery time and postoperative complications were also recorded. RESULTS:10 min after intubation,the heart rate of trial group was significantly faster then that of control group,with statistical significance(P0.05). The extubation time and consciousness recovery time of trial group were significantly shorter than those of control group, with statistical significance(P<0.05). The postoperative complications mainly were hypopiesia,hypertension,bronchospasm,nau-sea and vomiting,and dysphoria;the incidence of postoperative complications in trial group and control group were 25.0% and 40.0%,with statistical significance (P<0.05). CONCLUSIONS:Desflurane is effective with less postoperative complications for the anesthesia of elderly patients.
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Objective The occurrence and progression of renal cell carcinoma ( RCC) is complicated process associated with DNA abnormal methylation , histone modification , and Wnt signaling pathway .This study aimed to investigate the expression of histone methylase SET8 in RCC, its relationship with the Wnt signaling pathway , its action mechanism in RCC , and its clinical significance . Methods We selected 50 cases of RCC treated by radical nephrectomy , detected the expression of SET 8 in the RCC and adjacent noncancerous kidney tissues by immunohistochemical EliVision two-step staining with β-catenin.We compared the expression levels of SET8 and β-catenin in the two types of tissue and analyzed their relationship with the patients′clinical information and the pathologic stage and grade of tumor as well as the correlation between the SET 8 andβ-catenin expressions . Results SET8 was mainly express in the cytoplasm of the RCC and noncancerous kidney tissues , partially in the cell membrane and nucleus , while theβ-catenin protein chiefly in the cell membrane of renal tubular epithelial cells in the normal kidney tissue .The expression levels of SET 8 and β-catenin in the RCC tissue were closely related to the TNM stage and tumor grade (P0.05), but that of β-catenin was remarkably higher in the former (68%[34/50]) than in the latter (4%[2/50]) (P<0.01).There was a positive correlation between the positive expression of SET 8 and the abnormal expression of β-catenin (r=0.219, P<0.05). Conclusion SET8-activated H4K20me-1 controls the activation and abnormal activities of the Wnt signaling pathway , affects the gene transcription and cell activity , and participates in the occurrence , progression, and distant metastasis of RCC .
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Objective:To assess the survival-predictive value of TNM and Lugano staging systems in patients with primary gastro-intestinal lymphoma (PGL). Methods:A total of 73 patients with PGL were recruited from February 2001 to August 2013. All patients were diagnosed according to the TNM and Lugano staging systems. Five-year survival rate was used as the major clinical outcome. Sur-vival curves were plotted using the Kaplan–Meier method and analyzed with the log-rank test. The prognostic value of different vari-ables for clinical outcomes was assessed using the Cox multiple regression model. Results:The median follow-up time of surviving pa-tients was 42.4 months (range:1.3-158.6 months). The estimated 5-year overall survival rate was 77.82%. When diagnosed with the TNM system, the 5-year survival rates in stagesⅠ,Ⅱ,Ⅲ, andⅣwere 100%, 90.0%, 67.4%, and 22.2%, respectively (χ2=17.7956, P=0.0005). When staged by the Lugano system, the 5-year survival rates in stagesⅠ,Ⅱ,ⅡE , andⅣwere 100%, 100%, 70.7%, and 46.2%, respectively (χ2=15.6776, P=0.0013). Cox analysis showed that the invasion depth (T) (P=0.0181) and metastasis (M) (P=0.0031) were covariates that were prognostically significant for the overall survival. Conclusion:The TNM staging system is more ac-curate than the Lugano system in predicting the 5-year survival rate of patients with PGL.
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Objective Studies on the application of fast track surgery ( FTS) are comparatively limited in urologic proce-dures.This randomized controlled study was to evaluate the impact of FTS on recovery after retroperitoneal laparoscopic adrenalectomy . Methods Eighty patients undergoing retroperitoneal laparoscopic adrenalectomy were randomly assigned to an FTS and a control group of equal number to receive an FTS recovery program and conventional perioperative care , respectively .Comparisons were made between the two groups in the time of the first flatus , first oral nutrition , and first mobilization , the incidence of gastrointestinal tract complica-tions, the time of drainage and transurethral catheterization , the length of postoperative hospital stay , hospitalization expenses , visual analogue scale (VAS) pain scores, and general state of the patients . Results The FTS group, in comparison with the control, showed significantly earlier time of first flatus ([20.6 ±8.3] vs [39.8 ±18.3]h, P0.05), nor in the incidence of gastrointesti-nal tract complications between the FTS and control groups ( P >0.05). Conclusion By improving the general state and accelera-ting the recovery of the patients , FTS can be applied safely and effectively in retroperitoneal laparoscopic adrenalectomy .
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Some issues about the rationality of subject selection are identified in the registration applications of chemical generic drugs. It should be the sponsor's responsibility to follow the latest information about safety, efficacy and quality control of the proposed drug, and provide a sound basis for subject selection. In this article, issues about the basis of the subject selection of chemical generic drugs are discussed from the aspects of compound, formulation and strength.
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Objective To investigate the biosecurity and biocompatibility of small intestinal submucosa (SIS) as scaffold for tissue engineering and to explore the possibility to induce synovial mesenchymal stem cells (SMSCs) differentiate into cartilage with SIS as the scaffold and SMSCs as the seed cells. Methods The SMSCs were isolated and cultured from the synovial mem-brane of knee joints of rabbits by a conventional method. The SIS was harvested from pigs according to the physical method and Abraham's method. 4 rabbits are divided into the experimental group and control group. The biosecurity of SIS as scaf-folds were investigated in pyrogen test, skin sensitization test and systemic toxicity test. The SMSCs and SIS were co-cultured in vitro and induced to differentiate into cartilage to explore the biocompatibility of SMSCs and SIS, the proliferation and differ-entiation ability of SMSCs on the scaffold of SIS. The varietyies were identified by the microscope. Results The SIS isolated with the physical method and Abraham's method is a milky and translucent membrane with a smooth surface. Under the electron microscope, SIS presented a porous Stereoscopic three-dimensional network structure, which is formed by fibrous tissues' intertex-ture. Its' porosity was about 80%and its aperture was 100-200μm. Meanwhile, the biosecurity and biocompatibility of SIS were also fine. In the trial that the SMSCs and SIS were co-cultured in vitro, the SMSCs can grow, adhere to and differentiate on the sur-face of SIS and into the hollows very well. It can also secrete extracellular matrix. Through scanning microscope observation, cells contact with each other by their neuritis, or adhered to the wall of hole by cellular protrution. On the surface of SIS, the SMSCs maintain the property that it can easily differentiate into the chondrogenic lineage in the chondrogenic medium. Immunochemistry staining showed positive expression of type II collagen post 21 days of co-cultrue. Conclusion SIS can be used as the scaffold to construct tissue engineering meniscus as it has good biosecurity and biocompatibility with SMSCs without disturbing the cell form or inhibiting the growth and function of SMSCs.
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Some specific markers are useful of separating and identifying gastric cancer stem cells.They are including gastric stem cells,general tumor stem cells and mesenchymal tissue stem cells.At present,more and more new biomarkers are discovered besides familiar CD133 and CD44.Combined detection helps to separate pure gastric cancer stem cells and promote the therapy of gastric cancer.
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Objective: To establish a rabbit unstable bladder and Partial Bladder Outlet Obstruction (BOO) model, and to study on urodynamic changes. Methods: 30 male New Zealand rabbits were divided into control group and operative group. After 8 weeks, urodynamic changes were determined after they were anaesthetized by ketamine and droperidol. Results: Prominent changes of Main urodynamic parameters were found between the operative group and control group. The incidence rate of unstable bladder was 60%. Conclusion: The method of establishing rabbit model of Partial BOO is successful. It provides a platform for the study on the changes of pathology and pathophysiology of human chronic partial BOO and treatment of this kind of diseases.
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Objective:To investigate the role of RECK gene in the progression and invasion of prostate carcinoma by evaluating the expression of RECK,MMP-2 and MMP-9 genes in prostate cancer cell strains: BPH-1,DU-145,LNCap and PC-3.Methods: The mRNA levels of RECK,MMP-2 and MMP-9 were measured by RT-PCR and the protein level of RECK by Western blot analysis in the above 4 prostate cell lines.Results: The mRNA levels of RECK in DU-145,LNCap and PC-3 cells were obviously lower than those in the benign prostate hyperplasia cell strain BPH-1(P