Experience of treating severe cases of 2019 novel coronavirus pneumonia in Changde area / 中华危重病急救医学

Since the cluster of the 2019 novel coronavirus (2019-nCoV) pneumonia, a large number of patients gathered, the mortality of critical patients has remained high and the treatment was unclear. In this outbreak, Hunan Changde region immediately set up a hospital and intensive care unit. The patients relieved through respiratory support, hemodynamics management, nutritional support, the application of antiviral drugs, analgesic and sedation. The treatment experience in severe cases of 2019-nCov pneumonia patients were summarized as follows: in terms of respiratory support, we needed to pay attention to the advantages of high-flow nasal cannula oxygen therapy (HFNC) and the intervention of mechanical ventilation, pay attention to the ventilator parameters, and adopt prone position timely. In the aspects of fluid resuscitation and volume management, we should pay attention to the characteristics of severe patients' volume status, perform early evaluation, and clinicians should focused on hemodynamic management beside the bed. In the aspect of nutritional support and evaluation and maintenance of intestinal function, early enteral nutrition should be adopted in time. However, the trade-off between the risk of intestinal function and nutritional support in patients with mechanical ventilation and the antiviral benefits of Kaletra needed to be reevaluated, the optimized way of analgesia and sedation was adopted, at the same time, the usage and side effects of antiviral drugs should be paid attention to. We should grasp the opportunity of transportation for severe patients. It is suggested that some warning scores should be used to facilitate early recognition of patients with severe infection and then they should be earlier transferred to the designated hospital for intensive care.

Experience of treating severe cases of 2019 novel coronavirus pneumonia in Changde area / 中华危重病急救医学

Since the cluster of the 2019 novel coronavirus (2019-nCoV) pneumonia, a large number of patients gathered, the mortality of critical patients has remained high and the treatment was unclear. In this outbreak, Hunan Changde region immediately set up a hospital and intensive care unit. The patients relieved through respiratory support, hemodynamics management, nutritional support, the application of antiviral drugs, analgesic and sedation. The treatment experience in severe cases of 2019-nCov pneumonia patients were summarized as follows: in terms of respiratory support, we needed to pay attention to the advantages of high-flow nasal cannula oxygen therapy (HFNC) and the intervention of mechanical ventilation, pay attention to the ventilator parameters, and adopt prone position timely. In the aspects of fluid resuscitation and volume management, we should pay attention to the characteristics of severe patients' volume status, perform early evaluation, and clinicians should focused on hemodynamic management beside the bed. In the aspect of nutritional support and evaluation and maintenance of intestinal function, early enteral nutrition should be adopted in time. However, the trade-off between the risk of intestinal function and nutritional support in patients with mechanical ventilation and the antiviral benefits of Kaletra needed to be reevaluated, the optimized way of analgesia and sedation was adopted, at the same time, the usage and side effects of antiviral drugs should be paid attention to. We should grasp the opportunity of transportation for severe patients. It is suggested that some warning scores should be used to facilitate early recognition of patients with severe infection and then they should be earlier transferred to the designated hospital for intensive care.

Detection of peripheral CD14+CD277+monocyte-macrophage ratio with γδ TCR tetramer and analy-sis of its relationship with treatment outcome / 中华微生物学和免疫学杂志

Objective To investigate the role of peripheral CD14+monocyte-macrophages in the recognition of phosphorylated antigen by γδ T cells and its relationship with treatment outcome. Methods Three kinds of γδ TCR tetramers were used to stain PBMC collected from patients with tuberculosis ( TB) and neonatal umbilical cord blood samples. The proportions of various TB-specific antigen presenting cells (APC) in peripheral blood were analyzed, and their relationships with treatment outcome were assessed based upon clinical data. Results CD14+monocyte-macrophages both in tuberculosis patients′ peripheral blood and neonatal umbilical cord blood were the strongest binding cells to CD277 antibody and γδ TCR tet-ramers. The median (P50) of CD14+monocyte-macrophages reached the highest peak after taking anti-tu-berculosis treatment for about one month and patients′condition was improved obviously during this period. Conclusion This study elucidated that CD14+monocyte-macrophages accounted for the largest proportion of APC when γδ T cells recognized phosphorylated antigens, which provided reference data for further study on the mechanism of γδ T cells restrictively recognizing phosphorylated antigen and their significance in innate and adaptive immunity.

Alterations of CD4+CD8+T cells in peripheral blood of patients with tuberculosis and its clinical sig- nificance / 中华微生物学和免疫学杂志

Objective To characterize CD4+CD8+double-positive T ( DPT) cells in PBMCs from patients with tuberculosis(TB).Methods PBMCs were isolated from peripheral blood samples collected from patients with TB and healthy subjects.The subsets and percentages of CD4+T, CD8+T and DPT cells in PBMCs were determined by flow cytometry.Cell surface markers ( CD45RO, CCR7 and CD25 ) and intracellular cytokines ( IFN-γand TNF-α) were detected directly and after ESAT-6/PPD stimulation.Re-sults Patients with TB showed a significantly increased DPT cells as compared with the cured individuals and healthy subjects (P<0.005).The levels of DPT cells were gradually decreased down to normal upon the treatment of pharmacotherapy.DPT cells expressed higher levet of CD25 than CD4+T and CD8+T cells ( P<0.005 ) . DPT cells could express more IFN-γand TNF-αupon the stimulation of ESAT-6/PPD (P<0.005).The analysis of memory phenotype indicated that DPT cells were memory T cells.Conclusion DPT cells in peripheral blood of the patients with tuberculosis played a critical role in protective immunity against tuberculosis.The alterations of DPT cells in PBMCs during the period of pharmacotherapy might be a potential indicator for the prognosis of pulmonary tuberculosis.

Monitoring report of Oncomelania hupensis snails in Huizhou District in 2013 / 中国血吸虫病防治杂志

Objective To further master the Oncomelania hupensis snail situation in Huizhou District,so as to provide the ev-idence for improving the prevention and control work. Methods According to the prevalence of schistosomiasis in history and the characteristics of residual snail points in recent years,the snail surveys were carried out with the environmental sampling and sys-tematic sampling method in history snail environments and their surrounding suspicious environments. Results Totally 5 298 940 m2 in 12 administrative villages of 3 townships were investigated and there were 24 406 m2 snail areas at 5 remaining snail spots in 4 administrative villages. The highest snail density was 283 snails/0.1 m2,and the average density of living snails was 2.31 snails/0.1 m2. A total of 4 303 snails were captured,1 534 were checked by microscopy,and no infected snails were found. Conclu-sion The snail situation is still not stable in Huizhou District,and the monitoring of snail situation still need to be strengthened.

Detection of antigen-specific CD14+ monocytes in blood of tuberculosis patients by using CD4+ T-cell receptor tetramer-based flow cytometric analysis and cell climbing slice assay / 中国感染与化疗杂志

Objective To evaluate the utility of CD4+ TCR tetramers‐based flow cytometric analysis and cell climbing slice assay in detecting antigen‐specific CD14+ monocytes in the blood of tuberculosis (TB) patients .Methods CD4+ TCR tetramers were used to detect tetramer‐positive CD14+ monocytes in the peripheral blood (PBL ) samples of inpatients with advanced pulmonary TB (PTB) by flow cytometric analysis .The PBL samples obtained from non‐TB patients and umbilical cords were used as controls .These tetramers were also used to examine tetramer‐bound CD14+ monocytes and Mycobacterium tuberculosis (MTB) antigen‐specific and tetramer‐bound cells by cell climbing slice in situ staining .Results The median percentage of tetramer‐bound CD14+ monocytes in PBL samples from PTB patients ,non‐TB patients and umbilical cords were 1 .32% , 0 .50% and 0 .26% respectively by using CD4+ Vα21‐J39/Vβ29‐D1‐J2 tetramer , while the medians were 1 .05% , 0 .49% and 0 .19% respectively by using CD4+ Vα21‐J39/Vβ29‐D2‐J2 tetramer . The percentage of tetramer‐bound CD14+ monocytes in PTB patients group was significantly higher than the other two control groups .In cell climbing slice in situ staining ,tetramer‐bound CD14+ monocytes ,and MTB antigen‐specific and tetramer‐bound cells were positive in PTB tissue compared with negative in control tissues . Conclusions CD4+ TCR tetramers‐based flow cytometric analysis and cell climbing slice assay could be used to sensitively detect M TB antigen‐specific CD14+ monocytes in the blood of TB patients ,and more accurately evaluate the changing profile and clinical significance of these cells in TB patients .

The preliminary study of CD4+ Vα9-J27/Vβ29-D1-J2 tetramers in detecting Mycobacterium tuberculosis infections / 中华微生物学和免疫学杂志

ObjectiveTo investigate the specificity of CD4+ Vα9-J27/Vβ29-D1-J2 tetramer in detecting Mycobacterium tuberculosis(MTB) infections.MethodsThe above TCR tetramer by using biotinylated monomers expressed and purified from constructed stable Drosophila Schneider 2 cell( S2 cell) lines was prepared.The PE-labled TCR tetramer was used to costain with S2 cell lines expressing MTB prptide/HLA-DR complexes on the cell membrane,and also was used to detect tetramer-bound CD14+ monocytes and macrophages in the peripheral blood mononuclear cells (PBMC) of pulmonary tuberculosis (PTB) patients and three control groups by flow cytometric analysis.And the FITC-labled tetramer was used to examine tetramer-bound CD14+ monocytes and macrophages,and MTB antigen-specific and tetramer-bound cells by in situ staining.ResultsThe TCR tetramer was well binding with S2 cell lines expressing C14/HLA-DR *1504 on the cell membrane.By flow cytometric analysis,the percentage of tetramer-bound CD14+ monocytes and macrophages in PTB patients group was higher than the other three control groups( P＜0.001 ).By in situ staining,tetramer-bound CD14+ monocytes and macrophages,and MTB antigen-specific and tetramer-bound cells were positive in PTB tissue and negative in control pneumonia tissue.ConclusionThe spcificity of TCR tetramer in monitoring MTB infections by flow cytometric analysis and in situ staining could be seen,which laid a laboratory foundation in the diagnosis and immune mechanism research of TB by using TCR tetramers.

The correlation between nuclear factor kappa B expressed in peripheral blood mononuclear cells and the characteristics of coronary atherosclerosis plaque in patients with acute coronary syndrome / 中华老年医学杂志

Objective To explore the correlation between expression of nuclear factor kappa B (NF-kappa B) in peripheral blood monouclear cells(PBMC) and the severity of coronary artery lesion in patients with acute coronary syndrome(ACS). Methods The 81 patients were diagnosed with coronary heart disease, and all of them underwent immediate or selective coronary angiography(CAG) The nuclear protein level of activated NF-B was detected by Western blot and semi-quantity image analysis was done. Coronary angiograms were scored according to Gensini integration. The relationship between NF-κB and Gensini score was analyzed. Results The protein expression of NF-κB in PBMC in ACS group was significantly higher than that in stable angina group and control group (0.85±0.18 vs. O.75±0.21 and 0.71±0.23, F=3.72, P<0.05). The protein expression of NF-κB was not correlated with Gensini score(r=0.07, P>0.05). Conclusions The ACS patients have the activation of NF-κB in PBMC. The protein expression of NF-κB is not correlated with Gensini score, which does not suggest an implication of the severity of coronary artery.

Impact of mobile population on transmission of schistosomiasis in transmission-interrupted area / 中国血吸虫病防治杂志

The historical surveillance results showed, there were 10 schistosomiasis cases in Huangshan City from 1994 to 2006. The survey in 2007 showed, the positive rates of blood examination for schistosomiasis in migrant workers and immigrant workers were 0.49% and 0.47% , respectively, but no schistosome-infected patients were detected by using the stool examination. An area with snails of 3 000 m~2 was found in the residence of the immigrant workers, but no infected snails were found. It is indicated that the mobile population has some impact on the transmission of schistosomiasis in the transmission-interrupted area. The surveillance and health education for the mobile population should be strengthened, and the imported infectious source should be prevented.

Construction and application of cell fines screening Mycobacterium tuberculosis-specific tetramers of CD4+α/β T cell receptor / 中华微生物学和免疫学杂志

Objective To construct and apply a cell line screening Mycobacterium tuberculosis (Mtb)-specific tetramers of CD4+α/β T cell receptor(TCR). Methods The β chains of HLA class Ⅱ (DR) were amplified from tuberculosis patients by PCR. The pMT-HLA-DRB expression vectors that carries the HLA-DR 13 chain and pMT-HLA-DRA-P expression vectors which carries the genes of HLA-DR α chain loaded with Mtb antigen were transfected into S2 cells with the method of calcium phosphate transfection. The expressed Mtb peptide/HLA-DR complexes were primarily identified by the method of cell immunohistochemistry. The cell lines expressing Mtb peptide/HLA-DR complexes were used to screen tetramers of CD4+ TCR by flow cytometry. Results S2 cell lines expressing Mtb peptide/HLA-DR complexes on the cell surface were obtained, two kinds of Mtb specific tetramers of CD4+α/β TCR were screened. Conclusion S2 cell lines expressing Mtb peptide/HLA-DR complexes on the cell surface provide the solid basis of the further research on the TCR tetramers and are helpful for exploring new diagnostic study methods about tuberculosis and developing new vaccines.

Analyses for the ?/? T Cell Receptor Gene Rearrangement and CDR3 Repertoire in Active Pulmonary Tuberculosis Patients / 中国免疫学杂志

Objective:To establish a method of multi-PCR to amplify the complete DNA sequence (CDS) of TCR ? and ? chain of the antigen-specific T lymphocytes in local pathologic specimen of active pulmonary tuberculosis patients, and to analyze ?/? T cell receptor gene rearrangement and CDR3 repertoire.Methods:The lymphocytes in bronchoalveolar lavage (BAL) of active pulmonary tuberculosis patients were separated. Following total RNA extraction, cDNA synthesis, Multi-PCR, recombinant clones construction, and sequencing, the CDS of TCR ? and ? chains from these lymphocytes were analyzed by using software of DNAstar and internet TCR resources.Results:24 of ? chain CDS and 13 of ? chain CDS from 3 samples of BAL were obtained. As for TCR ? chain, AV1S2 (54%), AV12S3 (41%), and AV12S2(5%) appeared frequently. BV2(38%), BV29S1(46%), BV14(3%), and BV4S2(3%) in TCR ? chain appeared more often. There were CDR3 diversities between samples and even in the same sample by amino acid sequence analysis, but there were a few identical or similar amino acid sequences. There was the same amino acid sequence of SVGTGTLHQETQY in CDR3 region of ? chain of BAL sample No.1 and No.2; The sequence of AVRDWAGNMLT appeared in two ? chains of BAL sample No.2 and No.3; Moreover, the sequence of AV…DNN…RLM appeared in ? chains of BAL sample No.2 and No.3.Conclusion:A method of Multi-PCR is used to amplify TCR ? and ? chain CDS of tuberculosis patients. There are characteristic T cell clones to proliferate,with TCR ? and ? chain repertiore skewing in local infective focus. The sequences of CDR3 in different TCR clones are mostly different but there are a few identical or similar sequences in the same patient or even between different patients. The identical amino acid sequences of CDR3 are possibly specific for recognizing MTB polypeptide.