Clinical features and risk factors of acute hepatitis E with severe jaundice / 临床肝胆病杂志

ObjectiveTo investigate the clinical features of acute hepatitis E (AHE) patients with or without severe jaundice and the risk factors for severe jaundice. MethodsA retrospective analysis was performed for the clinical data of 179 AHE patients who were admitted to Shanghai Public Health Clinical Center Affiliated to Fudan University from January 1, 2018 to March 26, 2020. According to whether total bilirubin (TBil) was ＞171 μmol/L, the patients were divided into AHE-mild jaundice (AHE-M) group and AHE-severe jaundice (AHE-S) group, and the two groups were compared in terms of clinical data and laboratory markers. The t test or the Mann-Whitney U test or the chi-squared test was used for comparison, and a binary logistic regression analysis was used to identify independent risk factors. ResultsOf all 179 patients, 101 (56.42%) were found to have severe jaundice. Compared with the AHE-M group, the AHE-S group had a significantly higher proportion of male patients (80.20% vs 61.54%, χ2=7.612, P=0.006), a significantly longer length of hospital stay ［29 (19-45) days vs 18 (14-22) days, Z=-6.035, P＜0.001］, a significantly higher number of patients with liver failure (23 vs 0, χ2=18.373, P＜0.001), and a significantly poorer prognosis (P＜0.001). Compared with the AHE-M group, the AHE-S group had significantly higher baseline anti-HEV-IgM, alpha-fetoprotein, and liver elasticity (Z=-3.534, -3.588, and -4.496, all P＜0.001), significantly lower baseline CD4 (Z=-2.015, P＜0.05), significantly higher peak values of TBil, direct bilirubin, creatinine, prothrombin time, international normalized ratio, and absolute neutrophil count (Z=-11.016, -10.926, -2.726, -4.787, -4.989, and -6.016, all P＜0.01), a significantly lower peak value of gamma-glutamyl transpeptidase (GGT) (Z=-4.55, P＜0001), and significantly lower valley values of albumin, prealbumin (PA), and absolute lymphocyte count (Z=-4.685, -5.087, and -4.818, all P＜0.001). The logistic regression analysis showed that anti-HEV-IgM (odds ratio ［OR］=1.022, 95% confidence interval ［CI］: 1005-1.039, P=0.012), GGT (OR=0.995, 95%CI: 0.993-0.998, P=0.001), PA (OR=0.991, 95%CI: 0.983-0.999, P=0.02), and neutrophils (OR=1.486, 95%CI: 1.169-1.889, P=0.001) were independent risk factors for severe jaundice in AHE patients. ConclusionThere is a relatively high proportion of male patients among the AHE patients with severe jaundice, with a long length of hospital stay, a large number of patients with liver failure, and poor prognosis. Anti-HEV-IgM, GGT, PA, and neutrophils are independent risk factors for severe jaundice in AHE patients.

Association between intestinal microecology and spontaneous bacterial peritonitis / 临床肝胆病杂志

Spontaneous bacterial peritonitis (SBP) is a common serious complication of end-stage liver disease. Intestinal microecology is closely associated with the development, progression, and prognosis of SBP, and bacterial translocation is the key pathogenesis of SBP. This article summarizes the intestinal microecology in patients with liver cirrhosis and briefly describes the mechanism of action of intestinal flora in the development and progression of SBP, thus providing a theoretical basis for the clinical regulation of intestinal microecology and treatment of SBP.

Rational medication in clinical practice for COVID-19 guided by Shanghai expert consensus / 中华临床感染病杂志

The outbreak of COVID-19 occurred in January 2020, the epidemic is still rampant around the world. The Shanghai Expert Consensus on Comprehensive Treatment and Management of Corona Virus Disease 2019 was issued in early March 2020, which provided the guidance of the standardized treatment and rational medication for COVID-19. The administration of " four agents (glucocorticoids, heparin, high-dose vitamin C, Interferon-κ) and one peptide (thymic peptide)" recommended by the consensus is the key to successfully block and treat critical illness.

Effects of angiotensin converting enzyme inhibitor/angiotensin receptor blocker on clinical characteristics of coronavirus disease 2019 patients with hypertension / 中华内科杂志

Objective:To analyze the effects of angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) on coronavirus disease 2019 (COVID-19) patients with hypertension, and to provide an evidence for selecting antihypertensive drugs in those patients.Methods:Clinical data were retrospectively analyzed in 58 COVID-19 patients with hypertension admitted to Shanghai Public Health Clinical Center from January 20 to February 22, 2020, including epidemiological history, clinical manifestations, laboratory findings, chest CT and outcome. Patients were divided into ACEI/ARB group and non-ACEI/ARB group.Results:Twenty-six patients were in ACEI/ARB group and the other 32 patients in non-ACEI/ARB group, with median age 64.0 (49.5, 72.0) years and 64.0 (57.0, 68.8) years respectively. The median time to onset was 5(3, 8) days in ACEI/ARB group and 4 (3, 7) days in non-ACEI/ARB group, the proportion of patients with severe or critical illness was 19.2% and 15.6% respectively. The main clinical symptoms in two groups were fever (80.8% vs. 84.4%) and cough (23.1% vs. 31.3%). The following parameters were comparable including lymphocyte counts, C-reactive protein, lactate dehydrogenase, D-dimer, bilateral involvement in chest CT (76.9% vs. 71.9%), worsening of COVID-19 (15.4% vs. 9.4%), favorable outcome (92.3% vs. 96.9%) between ACEI/ARB group and non-ACEI/ARB group respectively (all P>0.05). However, compared with non-ACEI/ARB group, serum creatinine [80.49 (68.72, 95.30) μmol/L vs. 71.29 (50.98, 76.98) μmol/L, P=0.007] was higher significantly in ACEI/ARB group. Conclusions:ACEI/ARB drugs have no significant effects on baseline clinical parameters (serum creatine and myoglobin excluded) , outcome, and prognosis of COVID-19 patients with hypertension. Antihypertensive drugs are not suggested to adjust in those patients, but the potential impairment of renal function as elevation of serum creatinine should be paid attention in patients administrating ACEI/ARB drugs.

Value of FDG PET/CT in the differential diagnosis of benign and malignant hilar mediastinal lymph nodes in patients with non-small cell lung cancer / 中华核医学与分子影像杂志

Objective:To investigate the diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/CT in detecting N 1 or N 2 metastasis of lymph node (LN) with different densities in patients with non-small cell lung cancer (NSCLC). Methods:A total of 118 patients (68 males, 50 females, age range: 27-87 (65.4±10.8) years) with N 0-N 2 M 0 NSCLC in Beijing Hospital between October 2007 and December 2017 were included in this study. All patients underwent 18F-FDG PET/CT, followed by surgery within 1 month. The pathological findings of the resected hilar mediastinal LN were taken as the gold standard, and ratios of LN metastasis were calculated for different density groups (calcification, partial calcification, hyper density, hypodensity/isodensity). The cut-off values of LN size (short diameter) and the maximum standardized uptake value (SUV max) in the detection of N 1 and N 2 metastases was determined by the receiver operating characteristic (ROC) curve, and the diagnostic efficiencies were calculated. Independent-sample t test, Mann-Whitney U test and χ2 test (partition of χ2) were used for data analysis. Results:A total of 433 LN has the histopathologic results: 365 LN was in stage N 0, 68 LN was in stage N 1-N 2. There were no metastases in calcification group (0/8). The metastatic LN proportions in partial calcification group (28.6%, 8/28), hypodensity/isodensity group (20.3%, 44/217) were significantly higher than that in the hyper density group (8.9%, 16/180; χ2 values: 7.369, 9.945, both P<0.017 (threshold for partition of χ2)). There was no significant difference between the partial group and hypodensity/isodensity group ( χ2=1.021, P>0.017). The SUV max of N 1+ N 2 group was significantly higher than that in N 0 group (6.94 (4.51, 11.36) vs 2.45 (1.93, 3.42); z=-10.388, P<0.01). According to the ROC curve, the cut-off value of SUV max in detecting hilar and mediastinal LN was 3.66. The diagnostic sensitivity, specificity and accuracy for N 1+ N 2 metastasis was 85.3%, 78.9%, 80.0% respectively. The cut-off values of SUV max for hypodensity/isodensity group and hyper density group were 3.66 and 2.79 respectively, and the corresponding sensitivities, specificities, accuracies and positive predictive values (PPV) were 93.2%, 86.7%, 88.0%, 64.1% vs 93.8%, 57.9% ( χ2=10.724), 61.1% ( χ2=7.326, P<0.01), 17.9%( χ2=32.971, P<0.01). The specificity of LN size (1.0 cm)+ SUV max was significantly higher that of LN size or SUV max alone (94.2% vs 80.9%, 86.7%; χ2 values: 14.048, 5.661, both P<0.05) in hypodensity/isodensity group. The specificity and accuracy of LN size (1.0 cm)+ SUV max were significantly higher those of SUV max alone ( χ2 values: 58.043, 37.037, both P<0.01) in hyper density group. Conclusions:18F-FDG PET/CT is useful in diagnosing the N 1+ N 2 metastases in hypodensity/isodensity LN, but has limitation in diagnosing the partial calcification LN. Combination of lymph node short diameter and SUV max cut-off value can improve the diagnostic specificity or accuracy of 18F-FDG PET/CT for hypodensity/isodensity and high density LN.

Mid-long-term prognostic value of preoperative 18F-FDG PET/CT imaging on patients with resectable non-small cell lung cancer / 中华核医学与分子影像杂志

Objective:To investigate the role of preoperative 18F-fluorodeoxyglucose (FDG) PET/CT imaging in mid-long-term prognosis of patients with resectable non-small cell lung cancer (NSCLC). Methods:Seventy resectable NSCLC patients (35 males, 35 females, median age 64 years) in Beijing Hospital between April 2010 and August 2016 were enrolled into this retrospectively study. All patients underwent 18F-FDG PET/CT imaging followed by pulmonary resection with mediastinal or hilar lymph nodes dissection within 1 month. The findings of PET/CT imaging including characteristics of primary lesions and mediastinal or hilar lymph nodes (size and maximum standardized uptake value (SUV max) of primary lesion, SUV max and distribution of high metabolic lymph nodes (HML)) were analyzed, and patients were followed up. Survival outcome indicators were defined as overall survival (OS) and progression-free survival (PFS). Survival analysis was conducted by Kaplan-Meier method, log-rank method and Cox proportional hazard models to assess the predictive factors. Results:Patients were followed up for 0.9-8.2 years. Among 70 patients, 31.4% (22/70) had disease progression and 24.3% (17/70) died. As for OS, there were significantly differences between patients with SUV max of primary lesion≥10 and <10 (4.6 vs 7.6 years), with size of primary lesion >3 cm and ≤3 cm (4.8 vs 7.4 years), with unilateral mediastinal or hilar HML and bilateral sides or without HML (4.4 vs 7.4 years), with SUV max of mediastinal or hilar lymph nodes ≥5.0 and <5.0 (3.8 vs 7.3 years) ( χ2 values: 10.135-15.238, all P<0.01), as well as PFS (3.9 vs 6.7, 3.8 vs 6.6, 3.8 vs 6.4, 3.3 vs 6.3 years; χ2 values: 8.410-14.600, all P<0.01). Cox multivariate analysis demonstrated that the size and SUV max of primary lesion were independent predictive factors of OS and PFS (all P<0.01). Moreover, the distribution of mediastinal or hilar HML had marginal significance in predicting OS ( P=0.051). Conclusions:Size and SUV max of primary lesion in preoperative 18F-FDG PET/CT imaging are predictive factors for the survival of postoperative NSCLC. The distribution of the mediastinal or hilar HML may have significance for the survival prediction of postoperative NSCLC.

Predictive value of phase analysis of gated myocardial perfusion imaging for major adverse cardiac events in patients with coronary artery disease / 中华核医学与分子影像杂志

Objective:To evaluate the value of phase analysis of gated myocardial perfusion imaging (GMPI) in predicting major adverse cardiac events (MACE) in patients with coronary atherosclerotic heart disease.Methods:Patients who underwent two-day rest-stress GMPI in the Department of Nuclear Medicine of Beijing Hospital from September 2012 to January 2014 were selected as observed subjects and analyzed retrospectively. The general clinical information, GMPI images and related parameters including phase standard deviation (PSD), phase histogram bandwidth (PBW), entropy, left ventricular ejection fraction (LVEF), summed stress score (SSS), peak ejection rate (PER), peak filling rate (PFR) were noted. Patients were followed up until the onset of MACE (cardiac death, nonfatal myocardial infarction, and late revascularization within 60 d after GMPI). χ2 test, independent-sample t test or Wilcoxon rank sum test were used to compare data between different groups. The independent risk factors of MACE were obtained by Cox proportional risk regression model. Kaplan-Meier survival curve analysis was used to analyze the cumulative survival rate without MACE. Results:A total of 505 patients (235 males, 270 females, median age: 73 years) were followed up successfully, with a median follow-up period of 55.6(52.0, 60.5) months. There were 54 cases (10.7%) with MACE: 6 patients with cardiac death, 27 patients with non-fatal myocardial infarction, and 21 patients with late revascularization. The incidence of hypertension and hyperlipidemia in patients with MACE was significantly higher than that in patients without MACE ( χ2 values: 4.126, 6.021, both P<0.05); LVEF, PFR and absolute value of PER of patients with MACE were significantly lower ( t/ z values: 6.261, 5.683, -4.246, all P<0.05), while SSS, PSD, PBW and entropy were significantly higher ( t/ z values: 5.024, 5.874, 7.119, -6.405, all P<0.05). Cox proportional risk regression model showed that abnormal PBW(>80°), abnormal entropy(>58 J·mol -1·K -1) and SSS≥12 were independent risk factors for MACE (odds ratio( OR) values: 2.795(95% CI: 1.259-6.201), 3.213(95% CI: 1.468-7.029), 3.640 (95% CI: 1.999-6.628), all P<0.05). The 5-year cumulative MACE-free survival rates of abnormal PSD group(>26.7°), abnormal PBW group and abnormal entropy group were 51.2%, 63.2% and 46.7%, which were significantly lower than those of normal PSD group (92.3%; χ2=77.768, P<0.05), normal PBW group (94.2%; χ2=77.741, P<0.05) and normal entropy group (92.8%; χ2=117.437, P<0.05). The 5-year cumulative MACE-free survival rate (31.7%) of patients with abnormal PBW and SSS≥12 was significantly lower than that of patients with normal PBW or patients with abnormal PBW and SSS<12 (80.1%-94.4%; χ2=185.4, P<0.01). The combination analysis of entropy and SSS showed similar results. Conclusions:PBW and entropy obtained by GMPI phase analysis are independent risk factors for predicting MACE in coronary artery disease. GMPI phase analysis is useful for coronary artery disease risk stratification.

Clinical analysis of risk factors for severe patients with corona virus disease 2019 / 中华传染病杂志

Objective:To analyze the clinical features of patients with corona virus disease 2019 (COVID-19) in Shanghai and the risk factors for disease progression to severe cases.Methods:The clinical data of 292 adult patients with COVID-19 hospitalized in Shanghai Public Health Clinical Center from January 20 to February 10, 2020 were retrospectively analyzed, including 21 severe patients and 271 mild patients. The demographic characteristics, epidemiological history, history of underlying diseases and laboratory tests were compared between the two groups. Measurement data were compared using t test or Mann-Whitney U test. The count data were compared using chi-square test. The binary logistic regression equation was used to analyze the risk factors for the progression of patients to severe cases. Results:Among the 292 patients, there were 21 severe cases with the rate of 7.2%. One patient died, and the mortality rate was 4.8% in severe patients. The severe patients aged (65.5±15.7) years old, and 19 (90.5%) were male, 11 (52.4%) had underlying diseases, seven (33.3%) had close relatives diagnosed with COVID-19. The mild patients aged (48.7±15.7) years old, and 135 (49.8%) were male, 74 (27.3%) had underlying diseases, 36 (13.3%) had close relatives diagnosed with COVID-19. The differences between two groups were all significant statistically ( t=-4.730, χ2=12.930, 5.938 and 4.744, respectively, all P<0.05). Compared with the mild patients, the levels of absolute numbers of neutrophils, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatinine, serum cystatin C, C reactive protein (CRP), procalcitonin, D-dimer, pro-B-type natriuretic peptide (proBNP), serum myoglobin, creatine kinase (CK), creatine kinase isoenzyme (CK-MB), serum cardiactroponin I (cTn I) in severe patients were all significantly higher ( U=2 091.5, 1 928.0, 1 215.5, 729.0, 1 580.5, 1 375.5, 947.5, 789.5, 1 209.0, 1 434.0, 638.0, 964.5, 1 747.5 and 1 258.0, respectively, all P<0.05), while the levels of lymphocyte count, albumin, transferrin, CD3 + T lymphocyte count, CD8 + T lymphocyte count and CD4 + T lymphocyte count in severe patients were all significantly lower ( U=1 263.5, t=4.716, U=1 214.0, 962.0, 1 167.5 and 988.0, respectively, all P<0.05). Further logistic regression analysis showed that the albumin (odds ratio ( OR)=0.806, 95% confiderce interval ( CI)0.675-0.961), serum myoglobin ( OR=1.010, 95% CI 1.004-1.016), CRP ( OR=1.016, 95% CI 1.000-1.032), CD3 + T lymphocyte count ( OR=0.996, 95% CI 0.991-1.000) and CD8 + T lymphocyte count ( OR=1.006, 95% CI 1.001-1.010) at admission were independent risk factors for the progression of COVID-19 patients to severe illness (all P<0.05). Conclusions:Severe patients with COVID-19 in Shanghai are predominantly elderly men with underlying diseases. Albumin, CRP, serum myoglobin, CD3 + T lymphocyte count and CD8 + T lymphocyte count could be used as early warning indicators for severe cases, which deserve more clinical attention.

Clinical analysis of risk factors for severe patients with novel coronavirus pneumonia / 中华传染病杂志

Objective To analyze the clinical features of patients with coronavirus disease 2019 (COVID-19) in Shanghai and to investigate the risk factors for disease progression to severe cases. Methods The clinical data of 292 adult patients with COVID-19 hospitalized in Shanghai Public Health Clinical Center from January 20, 2020 to February 10, 2020 were retrospectively analyzed, including 21 severe patients and 271 mild patients. The demographic characteristics, epidemiological history, history of underlying diseases and laboratory examinations were compared between the two groups. Measurement data were compared using t test or Mann-Whitney U test. The count data were compared using hi-square test. The binary logistic regression equation was used to analyze the risk factors for the progression of patients to severe cases. Results Among the 292 patients, 21 were severe cases with the rate of 7.2% (21/292). One patient died, and the mortality rate was 4.8% in severe patients. The severe patients aged (65.0±15.7) years old, 19 (90.5%) were male, 11 (52.4%) had underlying diseases, 7 (33.3%) had close relatives diagnosed with COVID-19. The mild patients aged (48.7±15.7) years old, 135 (49.8%) were male, 74 (27.3%) had underlying diseases, 36 (13.3%) had close relatives diagnosed with COVID-19. The differences between two groups were all significant statistically ( t =-4.730, χ 2 =12.930, 5.938 and 4.744, respectively, all P <0.05). Compared with the mild patients, the levels of absolute numbers of neutrophils, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatinine, serum cystatin C, C reactive protein (CRP), procalcitonin , D -dimer, pro-B-type natriuretic peptide (proBNP), serum myoglobin, creatine kinase (CK), creatine kinase isoenzyme (CK-MB), serum troponin I (cTnI) in severe patients were all significantly higher ( U =2 091.5, 1 928.0, 1 215.5, 729.0, 1 580.5, 1 375.5, 917.5, 789.5, 1 209.0, 1 434.0, 638.0, 964.5, 1 258.0 and 1 747.5, respectively, all P <0.05), while the levels of lymphocyte count, albumin, transferrin, CD3 + T lymphocyte count, CD8 + T lymphocyte count and CD4 + T lymphocyte count in severe patients were all significantly lower ( U =1 263.5, t =4.716, U =1 214.0, 962.0, 1 167.5 and 988.0, respectively, all P <0.05). Further logistic regression analysis showed that the albumin (odds ratio ( OR )=0.806, 95% CI 0.675-0.961), CRP ( OR =1.016, 95% CI 1.000-1.032), serum myoglobin ( OR =1.010, 95% CI 1.004-1.016), CD3 + T lymphocyte count ( OR =0.996, 95% CI 0.991-1.000) and CD8 + T lymphocyte count ( OR =1.006, 95% CI 1.001-1.010) at admission were independent risk factors for the progression of COVID-19 patients to severe illness (all P <0.05). Conclusions Severe cases of patients with COVID-19 in Shanghai are predominantly elderly men with underlying diseases. Albumin, CRP, serum myoglobin, CD3 + T lymphocyte count and CD8 + T lymphocyte count could be used as early warning indicators for severe cases, which deserve more clinical attention.

Experimental research on the treatment of mouse endometriosis model with nanoparticles loaded with CCR5?antibody / 中华妇产科杂志

Objective To investigate whether poly (lactic?co?glycolic acid) (PLGA) as protein delivery vehicles that encapsulate CC chemokine receptor 5 antibody (anti?CCR5) has more suppressive function on macrophages than single anti?CCR5 in mouse endometriosis model. Methods The PLGA/anti?CCR5 nanoparticles were synthesized. The cumulative release of anti?CCR5 from PLGA/anti?CCR5 nanoparticles was evaluated. The mouse endometriosis model was established and divided into control group, anti?CCR5 group and PLGA/anti?CCR5 group. Meanwhile, ectopic endometrial cells (EEC) and macrophages isolated from peritoneal fluid were cultured in vitro. Flow cytometry was used to detect the proportion of macrophages in the peritoneal fluid of each group. The secretion of interleukin 10 (IL?10) and transforming growth factor β (TGF?β) in each group were determined by ELISA. The proliferation and infiltration of EEC were detected by 5?bromodeoxyuridine proliferation kit and matrigel invasion kit. Results The PLGA/anti?CCR5 nanoparticles were successfully synthesized. The mouse endometriosis model was established and the EEC and macrophages were cultured. Compared with the anti?CCR5 without nanoparticles, the bioconjugate PLGA/anti?CCR5 nanoparticles could control the release of anti?CCR5 from day 3 to day 24. The proportion of macrophages in PLGA/anti?CCR5 group were gradually reduced compared with those in anti?CCR5 group (P<0.01), the ratios of day 7 [(4.5±1.5)%] and day 3 [(6.3±0.6)%], day 14 [(2.6±0.7)%] and day 7 were significantly different (P<0.01 and P<0.05). PLGA/anti?CCR5 reduced IL?10 and TGF?β levels relative to anti?CCR5 (P<0.01),and decreased gradually on day 3, day 7, and day 14 (P<0.01). Anti?IL?10+anti?TGF?β could reduce the proliferation [(70.8 ± 7.6)% ] and invasion ability [(50.2 ± 9.1)% ] of EEC (P<0.05). Conclusions In mouse endometriosis model, PLGA/anti?CCR5 may inhibit the proliferation and invasion of EEC by inhibiting the secretion of IL?10 and TGF?β by macrophages, suggesting that it provide a new idea for the treatment of clinical endometriosis.

Experimental research on the treatment of mouse endometriosis model with nanoparticles loaded with CCR5-antibody / 中华妇产科杂志

Objective@#To investigate whether poly (lactic-co-glycolic acid) (PLGA) as protein delivery vehicles that encapsulate CC chemokine receptor 5 antibody (anti-CCR5) has more suppressive function on macrophages than single anti-CCR5 in mouse endometriosis model.@*Methods@#The PLGA/anti-CCR5 nanoparticles were synthesized. The cumulative release of anti-CCR5 from PLGA/anti-CCR5 nanoparticles was evaluated. The mouse endometriosis model was established and divided into control group, anti-CCR5 group and PLGA/anti-CCR5 group. Meanwhile, ectopic endometrial cells (EEC) and macrophages isolated from peritoneal fluid were cultured in vitro. Flow cytometry was used to detect the proportion of macrophages in the peritoneal fluid of each group. The secretion of interleukin 10 (IL-10) and transforming growth factor β (TGF-β) in each group were determined by ELISA. The proliferation and infiltration of EEC were detected by 5-bromodeoxyuridine proliferation kit and matrigel invasion kit.@*Results@#The PLGA/anti-CCR5 nanoparticles were successfully synthesized. The mouse endometriosis model was established and the EEC and macrophages were cultured. Compared with the anti-CCR5 without nanoparticles, the bioconjugate PLGA/anti-CCR5 nanoparticles could control the release of anti-CCR5 from day 3 to day 24. The proportion of macrophages in PLGA/anti-CCR5 group were gradually reduced compared with those in anti-CCR5 group (P<0.01), the ratios of day 7 [(4.5±1.5)%] and day 3 [(6.3±0.6)%], day 14 [(2.6±0.7)%] and day 7 were significantly different (P<0.01 and P<0.05). PLGA/anti-CCR5 reduced IL-10 and TGF-β levels relative to anti-CCR5 (P<0.01),and decreased gradually on day 3, day 7, and day 14 (P<0.01). Anti-IL-10+anti-TGF-β could reduce the proliferation [(70.8±7.6)%] and invasion ability [(50.2±9.1)%] of EEC (P<0.05).@*Conclusions@#In mouse endometriosis model, PLGA/anti-CCR5 may inhibit the proliferation and invasion of EEC by inhibiting the secretion of IL-10 and TGF-β by macrophages, suggesting that it provide a new idea for the treatment of clinical endometriosis.

PDL1 Ig gene-modified BMSCs induce immune tolerance in rat liver trans-plantation / 中国病理生理杂志

[ ABSTRACT] AIM: To investigate the effects of bone marrow mesenchymal stem cells ( BMSCs) modified by programed death ligand-1 immunoglobulin ( PDL1 Ig) gene on immune rejection of orthotopic liver transplantation in rats. METHODS:Rat BMSCs were cultured and identified.The protein expression of PDL1 Ig in the BMSCs 72 h after infection with pAdEasy-1/PDL1 Ig was detected by Western blot.Mixed lymphocyte reaction was used to detect the inhibitory effect of BMSCs on the viability of T-lymphocytes in peripheral blood.The male Wistar rats were used as donors (n=40), and the male SD rats were used as recipients ( n=40 ) .The rat model of orthotopic liver transplantation was established by im-proved cuff method for observing acute rejection.The rats were randomly divided into control group, BMSCs treatment group, BMSCs/GFP treatment group and BMSCs/PDL1 Ig treatment group with 10 pairs each.Five rats were executed at the 7th day and the remains were used for measuring the survival time.RESULTS:The expression of PDL1 Ig in the BM-SCs was detected after pAdEasy-1/PDL1 Ig infection.The effect of BMSCs/PDL1 Ig on the viability of the lymphocytes was stronger than that of BMSCs/GFP.The level of IL-4 in BMSCs/PDL1 Ig group was significantly higher than that in the other 3 groups, while the levels of IFN-γand IL-2 were significantly decreased.The liver function in BMSCs/PDL1 Ig group was significantly improved and the levels of ALT, AST and TBil were almost recovered to normal at the 7th day after transplan- tation.Severe rejection reaction was observed in control group, and rejection reactions were decreased with different degrees in BMSCs treatment group and BMSCs/GFP treatment group.Much slighter rejection reaction and significantly longer sur-vival time were showed in BMSCs/PDL1 Ig group than those in the other 3 groups.CONCLUSION:PDL1 Ig-modified BM-SCs inhibit the rejection of liver transplantation in rats and induce the immune tolerance, and the effect is better than that of BMSCs alone.

Clinical characteristics and management of liver failure patients complicated with infection / 中国医师杂志

Infection is one of the most frequent complications in liver failure and results in high mortality rates.Patients with liver failure have altered and impaired immunity,which favors bacterial translocation.The most common infections in liver failure are pneumonia,spontaneous bacterial peritonitis (SBP),urinary tract infections (UTI),and bloodstream infection.Risk factors associated with the development of infections are variceal bleeding,low ascitic protein level,using of hormones,using of antibiotics,and application of invasive operation,etc.The prognosis of these patients is closely related to a prompt and accurate diagnosis.An appropriate treatment decreases the mortality rates.Preventive strategies are the mainstay of the management of these patients.

Meta-analysis on treatment of lower respiratory tract infection of azatreonam or ceftazidime / 药学实践杂志

Objective The aim of the study is to evaluate clinical efficacy and safety of azatreonam or ceftazidime on treatment of lower respiratory tract infection .Methods Four English databases (MEDLINE、EMBASE、Pubmed、Cochrane li‐brary) and three Chinese databases (CNKI、VIP、WANFANG) were searched .Meta‐analysis was performed using Review Manager 5 .2 .Results The Meta‐analysis revealed azatreonam was superior to ceftazidime in total efficiency (RR=1 .15 ,95%CI is 1 .09‐1 .21) .No significant differences are seen between azatreonam and ceftazidime (RR=1 .03 ,95% CI is 0 .98‐1 .09) on the bacterial eradication rates or the incidence of adverse reactions (RR=0 .66 ,95% CI is 0 .39‐1 .12) .Conclusion Azatreonam is more effective than ceftazidime on the treatment of lower respiratory tract infection in the clinical practice .

Determination of the localization of rupture aneurysms in patients with multiple cerebral aneurysms and spontaneous subarachnoid hemorrhage / 中国综合临床

Objective To discuss the reasons of false judgments of localization of the rupture aneurysms and find the way to fix this problem in patients with multiple intracranial aneurysms. Methods The clinical data of 25 consecutive patients, who presented with their first spontaneous subarachnoid hemorrhage and had multiple intracranial aneurysms from 2003 to 2009 in our hospital, were analyzed retrospectively. The rupture aneurysms were determined according to Nehls' method that reported before, and the supposed responsible rupture aneurysms w0ere clipped within 48 hours after hemorrhage in all patients. More aneurysms that could not be accessed in the same surgical session were surgically terated later. Results The location of the rupture aneurysm was verified at the time of surgery in all 25 patients. The concordance rate of the prediction and the reality of the rupture aneurysm was 80% (20/25). Four patients ( 16% ) ,in whom the ruptured aneurysm was not correctly identified,rebled after surgery,and 2 patients died as a result of the rebleeding One patients had no clear diagnosis at the end. Conclusion In the reported cases, about 80% rupture aneurysms could be correctly diagnosed before treatment according to the CT and DSA examinations. If clear diagnosis couldn't be made,additional examinations should be considered, such as CTA or MRI. Rupture aneurysms must be confirmed during the operation and the other aneurysms should be checked to exclude additional responsible aneurysms in all cases.

Clinical application of computer-aided design of composite materials with epoxide acrylate maleic and hydroxyapatite in cranioplasty / 中华创伤杂志

Objective To evaluate the effect of computer-aided design of composite materials with epoxide acrylate maleic (E) and hydroxyapatite (H) in cranioplasty. Methods A total of 45 patients with cranium defects were treated with cranioplasty by using skull bone flaps made of composite materials including epoxide acrylate maleic (E) and hydroxyapatite (H) ,which was designed with computer aid according to individual requirements. The patients were followed up for 6-36 months. Results After cranioplasty with composite EH, there occurred subcutaneous fluid in one patient and mild bone collapse in one. The composite EH showed good histocompatibility, with no infection or rejection. Conclusion During cranioplasty, use of computer-aided design of composite EH takes advantages of good accuracy, short operation time, good biocompatibility and good clinical efficiency.