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Objective:To explore the application value of different methods of segmented latissimus dorsi myocutaneous flap in repairing chest wall defects after local advanced breast cancer surgery.Methods:The clinical data of 64 patients with unilateral locally advanced breast cancer admitted to Shanxi Cancer Hospital from Feb. 2019 to Jan. 2020 were selected. All patients underwent modified radical mastectomy for breast cancer. The patients were divided into two groups according to the random number table method. Antegrade (group A, n=32 cases) and retrograde (group B, n=32 cases) were used to design and cut the segmented latissimus dorsi myocutaneous flap to repair the defects. The range of skin island cut was 14 cm×6 cm-19 cm×7 cm; The donor area of the flap was closed directly. The application effects of the two groups of methods were compared. Results:In group A, one antegrade flap was partially necrotic, while in group B, six retrograde flaps were partially necrotic ( P>0.05). The delayed healing rate of donor site incision in group A was 6.25%, significantly lower than that in group B (25.00%) ( χ2=4.267, P=0.039). All the patients in both groups were followed up for 12 to 24 months, and the appearance and texture of the flaps were satisfactory; Only linear scar was left in the donor area, and the shoulder joint activity was not affected. The mean survival time was 20.8 months. Conclusion:The antegrade latissimus dorsi myocutaneous flap can repair the large area defect of chest wall after LABC, which can ensure the blood supply of the flap to the greatest extent, reduce the closing tension of the donor area, the incidence of postoperative complications, and promote the healing of the incision.
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Objective To observe the effect of two different chemotherapy regimens, including irinotecan, folinic acid and FU chemotherapy regimen (FOLFIRI) versus folinic acid, FU and oxaliplatin chemotherapy regimen (mFOLFOX6) on nutritional status in patients with advanced colon cancer. Methods A total of 110 patients with advanced colon cancer in Shanxi Cancer Hospital were divided into FOLFIRI (group A) and mFOLFOX6 (group B). To investigate the effect of two different regimens on the patients with advanced colon cancer by toxicity, the traditional methods of nutritional assessment, scored patient-generated subjective global assessment (PG-SGA), nutrition risk screening-2002 (NRS-2002). Shapiro-Wilk was used to detect the normality of small samples, t test was used to analyze measurement data conformed to the normal distribution, Wilcoxon non-parametric test was used to analyze the abnormal distribution data, and enumeration data was detected by using chi-square test. Results The incidence of vomiting, diarrhea and alopecia in group A and group B was respectively 53.8 % (28/52) vs. 29.3 % (17/58), 65.4 % (34/52) vs. 43.1 %(25/58),46.2 %(24/52)vs.20.7 %(12/58)respectively,and there was a significant difference(all P <0.05). The albumin, body mass index, NRS-2002 score, PG-SGA score after chemotherapy were significantly lower than those before chemotherapy in both groups (all P < 0.05). PG-SGA scores after chemotherapy in group A and group B were respectively 7.0 and 5.5 (Z= -2.026, P< 0.05). There were no statistically significant differences between the two groups in the albumin, body mass index, triceps skin fold (TSF), arm muscle weeks diameter(MAMC)and NRS-2002 score(all P >0.05).Conclusions FOLFIRI and mFOLFOX6 scheme can reduce the patient's nutritional status. The probability of gastrointestinal adverse reaction of FOLFIRI regimen is high, which may have an obvious impact on nutritional status of patients compared with mFOLFOX6 scheme.
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Objective To describe the expressions of programmed death-1 (PD-1) and its ligand PD-L1 on the surface of peripheral blood lymphocytes in patients with tuberculosis.Methods A total of 77 cases of pulmonary tuberculosis were recruited,of which 27 were single infection,41 were coincident with bacterial or fungal infection and 9 patients with diabetes mellitus.Twenty-nine healthy donors were also enrolled as control group.The expressions of PD-1/PD-L1 on the peripheral blood lymphocytes and mononuclear cells were detected using immunostaining and flow cytometry.Collected data were analyzed with t-test statistics.Results Among the three groups of tuberculosis including pulmonary tuberculosis,pulmonary tuberculosis coincident with infection and pulmonary tuberculosis with diabetes mellitus,the percentages of CD4+ CD25+ T cells as well as CD4+ CD25high T cell subsets were both significantly higher than those in healthy controls (t=4.892,4.635,4.974,5.407,4.660,5.279,all P＜0.01).The expression of PD-1 was up regulated on the surface of CD8+ T cells in the groups of tuberculosis as compared with the control group (t=6.392,8.249,7.072,all P＜0.01).The proportions of PD-L1 expressed on the monocytes in each group were (42.51 ± 7.54) ％,(49.42± 6.29) ％ and (48.46 ± 14.58)％,respectively.The difference was significant in contrast to the control group,which was (17.91 ±3.03)％ (t=5.168,6.854,5.665,all P＜0.01).PD-L1 expression was also up-regulated on B cells in each group and much higher than that of the control group (51.51±7.32)％,(50.85±7.09)％,(55.66±14.29)％ vs (40.11±4.25)％ (t=2.562,2.046,2.766,all P＜0.05).Conclusion PD-1/ PD-L1 co-inhibitory pathway could be closely related to the development of tuberculosis and its complications,which is involved in the attenuation of anti-tuberculosis and anti infection immune responses.
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The proliferation of MG63 cells under high glucose intervened with metformin was measured by CCK-8 assay.The activity of intracellular alkaline phosphatase (ALP) was detected by SFBC assay.The expression of related genes was detected by RT-PCR.Metformin promoted the proliferation of MG63 cells (P＜0.01),the activity of ALP was increased (P＜0.05).The expressions of collagen Ⅰ and osteocalcin were up-regulated while the expressions of matrix metalloproteinase (MMP)-1,MMP-2,MMP-3,and MMP-8 were down-regulated (P＜0.05).The results indicate that metformin may protect osteoblast,via promoting osteoblast proliferation,differentiation and mineralization,as well as by inhibiting degradation of osteoblast extracellular collagen matrix.
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ObjectiveTo explore the relationship between the negative co-inhibitor programmed death-1 ( PD-1 ) and the pathogenesis of myasthenia gravis ( MG), by detecting the expression of PD-1 and programmed death ligand-1 ( PD-L1 ) on peripheral blood mononuclear cells (PBMCs) and soluble PD-1 (sPD-1) in plasma from myasthenia gravis patients. MethodsPeripheral blood samples were collected from 45 MG patients and 33 healthy persons without prednisone or other immunodepressant treatment during the half year ahead of withdrawal.The expression of PD-1 and PD-L1 on PBMCs were detected using immuno-fluorescence labeling and flow cytometry, and the concentrations of sPD-1 in plasma were measured using an ELISA kit. Results(1) The proportion of CD4+ PD-1 + T cells, as well as CD14+ PD-L1 +monocytes of the MG group was higher than that of the control group. There were no significant differences in the proportion of CD4+ PD-1 + T cells or CD14+ PD-L1 + monocytes in the MG sub-groups between different genders or MG types. While the proportion of CD4+ PD-1 + T cells of the late-onset MG (age ≥40) group was higher than that of the early-onset MG group (age ＜40). And it was higher in the MG patients with thymoma or thymus hyperplasia than that from the MG patients with normal thymus. The proportion of CD14+ PD-L1 +monocytes from the MG patients with thymoma or thymus hyperplasia group decreased obviously compared with that of the patients with normal thymus group; but no difference could be found between the late-onset group and early-onset group. (2)The concentration of sPD-1 in the plasma from the group of MG patients was(6. 92 ±0. 72) ng/ml,which was higher than that of the healthy control group ( (3.28 ±0. 42) ng/ml),even more, it was significantly higher in the early-onset MG group than that of the late-onset MG group,there was a negative correlation( r =-0. 526, P =0. 000) between the age of onset and the concentration of sPD-1. ConclusionsThe increased expressions of PD-1 on CD4+ T cells and PD-L1 on CD14+ monocytes in MG patients suggested the involvement of the couple of molecules in the pathogenesis of MG.Higher concentration of soluble PD-1 in the plasma of patients with MG suggested that it might disturb the ligation of PD-1 and PD-L1 on T cells and antigen presenting cells, which might result in the abnormal transportation of the negative modulating signal, and accelerate the pathological progress of MG.
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Objective To determine the concentration of soluble PD-1 (sPD-1) in the sera of patients with recurrent genital herpes (RCH), and to explore the significance of abnormal expression of sPD-1 in RCH. Methods Serum samples were obtained from 88 healthy blood donors, 74 patients with RCH including 34 cases of outbreak-stage RCH and 40 cases of stable-stage RCH. The serum level of sPD-1 was measured by monoclonal antibody labeling and enzyme linked immunosorbent assay (ELISA). Results A significant difference was observed in the serum level of sPD-1 between the patients with RGH and the blood donors (33.06 ± 17.5 μg/L vs. 53.07 ± 26.3μg/L, P < 0.01) and between the patients with outbreak-stage RGH and those with stable-stage RGH (27.47 ± 12.9 μg/L vs. 37.71 ± 19.6 μg/L, P< 0.01). Conclusions There is a low expression of sPD-1 in patients with RGH, which may be one of the mechanisms underlying the escape of HSV- Ⅱ from immunologic surveillance and development of immunological tolerance.
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Objective:This study was to analyze the changes of CD4~+ T lymphocytes and their subtypes,Th1 and Th2 cells,in the peripheral blood of patients with pulmonary tuberculosis disease and to investigate their clinical significance in the pathologic process of pulmonary tuberculosis.Methods:For polarization measurement of T-helper cells,1∶100 diluted Ionomycin and 1∶10 diluted Monensin were added in sequence into the equivalent volume mixture of heparin anti-coagulated whole blood and RPMI-1640 culture liquid.After being well mixed,the mixture was incubated at 5% CO_2,37℃ for 4 hours or overnight.To 100 μl of the mixture and in sequence,the antibodies of CD3-PerCP,CD8-APC,mIgG1-FITC,Rat IgG1-PE,IL-4-PE or IFN-γ-FITC were added.The stained CD4~+ IL-4~+ (Th2) and CD4~+ IFN-γ~+ (Th1) were analyzed by flow cytometry.Results:Compared with those from healthy controls,the peripheral blood of pulmonary tuberculosis patients contained significantly fewer Th1 (P＜0.01) but significantly more Th2 cells (P＜0.05).Th1 cells in the peripheral blood of the patients with miliary pulmonary tuberculosis were obviously fewer (P＜0.05) than in infiltrative pulmonary tuberculosis patients.The amount of Th2 cells in the peripheral blood of the patients with miliary pulmonary tuberculosis was significantly more (P＜0.05) than in either infiltrative pulmonary tuberculosis or tuberculous pleurisy patients.The ratio of CD4~+/CD3~+ tended to decrease in all these patients,and it was much lower (P＜0.05) in the patients of miliary pulmonary tuberculosis than in infiltrative pulmonary tuberculosis patients.Patients suffering from both pulmonary tuberculosis and diabetes had significantly lower levels of Th1 cells and CD4~+/CD3~+ (P＜0.05) and more Th2 cells,compared with those of pulmonary tuberculosis patients without diabetes.Levels of Th1 and Th2 cells restored significantly (P＜0.05) in 15 severe pulmonary tuberculosis patients after receiving tuberculosis chemotherapy and microcalorie theropy for three months.Patients with positive sputum examination tended to have decreased Th1 and CD4~+/CD3~+ (P＞0.05) and significantly increased Th2 (P＜0.05).Conclusion:Immunosuppression existed,in different extents,in patients of infiltrative pulmonary tuberculosis,tuberculous pleurisy,miliary pulmonary tuberculosis as well as patients with both pulmonary tuberculosis and diabetes.Analysis of Th1,Th2 and CD4~+/CD3~+ may be benefit for the judgments of disease conditions and therapeutic effects.
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ObjectiveTo study the clinical features of stercoral bowel obstruction and perforation of colon in elderly patients MethodsThe data of 22 cases of stercoral bowel obstruction and 6 cases of stercoral perforation of colon in elderly patients in our hosital from January 1994 to December 2003 were analyzed retrospectively ResultsIn the 22 cases with stercoral bowel obstruction, 6 cases were recovered after operation, 6 cases suffered from stercoral perforation in which all cases were misdiagnosed before operation,and 2 cases were dead.ConclusionsThe prevalence of stercoral bowel obstruction and perforation of colon in elderly patients are increasing with population being aged. The cases without perforation are often recovered by non-operative therapy. The perforation case of stercoral bowel obstruction is relatively rare, easy to be misdiagnosed, and in high mortality. The Hartmanns ostomy should be the choice for the perforation.