Objective To affirm the expression of Toll like receptor 4 (TLR4) on the surface membrane of platelet and to explore the immunomodulatory factors[(interlukine-8(IL-8),β-thromboglobulin(β-TG), soluble CD40 ligand(sCD40L)] released by platelets after platelets stimulated by TLR4 ligand.Methods TLR4 expressed on the platelet was detected by flow cytometry. Monoclonal anti-human FcγRⅡantibody(Ⅳ.3)-treated human platelets were cultured with LPS in the presence or absence of blocking monoclonal antibody to human TLR4. The release of IL-8, β-TG, sCD40L were measured by specific enzymelinked immunosorbent assay. Results Human platelets could express functional TLR4. The detection rate of TLR4 on platelets were decreased after LPS involvement(P<0.01). It was noted that sCD40L and β-TG were present in large concentration in the release of platelets stimulated by TLR4 ligand but the release of IL-8 was independent of platelet activation after TLR4 engagement. The concentration of sCD40L and β-TG had no statistical difference between 1-5 μg/ml LPS. The effects of LPS on the modulation of secretory factors were attenuated by preincubation of platelets with an anti-TLR4 monoclonal antibody. Conclusion The TLR4 on platelet could recognize and link LPS, induce the release of sCD40L, β-TG by platelet, but could not influence IL-8.

Objective:To investigate the diagnostic value of metagenomic next-generation sequencing (mNGS) in AIDS patients complicated with Pneumocystis jirovecii ( P. jirovecii) infection. Methods:This is a retrospective study. From January 2019 to June 2021, the respiratory tract and other body fluid samples of 236 cases of AIDS co-infected patients diagnosed in the AIDS Department of Changsha First Hospital were collected, along with corresponding medical histories. Traditional etiological hexamine silver staining and serum 1,3-β-D glucan (BDG) were performed simultaneously with mNGS detection, and Fisher′s exact test was used to analyze the results and compare the diagnostic performances of mNGS with those of hexamine silver staining and serum G test.Results:A total of 236 cases of AIDS patients with pulmonary infection were collected and tested. Seventy-seven cases were clinically diagnosed with Pneumocystis jiroveci pneumonia and 159 cases with non- Pneumocystis jiroveci pneumonia. Among the 236 AIDS patients with pulmonary infection, mNGS detected 77 [32.63%(77/236)] positive cases of Pneumocystis jiroveci, while hexamine silver staining detected 10[4.24%(10/236)] and serum BDG detected 146 [61.86% (146/236). Based on these clinical diagnostic results, the sensitivity of mNGS detection was 100% (77/77) for the 77 patients with Pneumocystis pneumoniae, significantly higher than that of silver hexamine staining [12.99% (10/77), P=0.046] and serum BDG [58.44% (45/77), P=0.038]. The mNGS showed good specificity, which was the same as that of hexamine silver staining [100% (159/159)] and significantly higher than that of serum BDG [36.48% (58/159), P=0.026]. With therapeutic clinical diagnosis as the reference method, the accuracy of mNGS detection was 100% (236/236). Conclusions:This study evaluated the diagnostic value of mNGS detection in AIDS patients with Pneumocystis jirovecii infection. The results showed that the sensitivity and specificity of mNGS detection were high, and it had exceptional clinical application value in the pathogenic detection of infectious diseases.

Objective To evaluate the performance of MRI in predicting pathological response of different breast cancer subtypes after neoadjuvant chemotherapy(NAC).Methods The MRI images and postoperative pathological results of 91 patients with breast cancer after NAC were analyzed retrospectively.The correlation between the imaging features of different molecular subtypes of breast cancer and postoperative pathological results was studied,and the diagnostic performance of MRI in predicting pathological response after NAC was evaluated,with postoperative pathological results referred as the diagnostic standard.Results Of 91 patients,27(29.7％)and 35(38.5％)cases were diagnosed as imaging complete response(iCR)and pathological complete response(pCR),respectively.The accuracy of MRI in predicting pathological response after NAC was 84.62％,with 94.64％sensitivity,68.57％specificity,and positive predictive value(PPV)and negative predictive value(NPV)of 82.81％and 88.89％,respectively.Conclusion MRI can accurately predict the pathological response of the human epidermal growth factor receptor-2(HER-2)+and triple-negative breast cancer after NAC.

OBJECTIVETo observe the early reperfusion therapy status for patients with ST elevation acute myocardial infarction (STEMI) hospitalized in tertiary and secondary hospitals in Henan province.

METHODSBaseline data, early reperfusion treatment and in-hospital mortality of STEMI patients hospitalized in 17 hospitals in Henan province (8 tertiary hospitals, 9 secondary hospitals) from June 2011 to June 2012 were obtained using a uniformed questionnaire.

RESULTSOne thousand six hundred and eighty six patients were enrolled, of which 886 patients were hospitalized in tertiary hospitals and 880 patients were early hospitalized in secondary hospitals. Six hundred and fifty four patients (38.8%, 654/1 686) underwent early reperfusion therapy (543 with thrombolysis and 111 with primary percutaneous coronary intervention (PCI)). There was no difference in the proportion of early reperfusion therapy between tertiary and secondary hospitals (40.1% (355/886) vs. 37.4% (299/800), P = 0.257). The median time from symptom onset to first medical contact, door-to-needle and door-to-balloon was 132 min, 18 min and 60 min, respectively. The median time from symptom onset to first medical contact (150 min vs. 120 min, P = 0.001), door-to-needle (30 min vs. 18 min, P = 0.003) and symptom onset-to-thrombolysis (3.5 h vs. 2.7 h, P = 0.001) were significantly longer in tertiary hospitals than in secondary hospitals. No difference was found in median time of door-to-balloon, symptom onset-to-primary PCI or symptom onset-to-elected PCI between tertiary and secondary hospitals (all P > 0.05). The proportion of door-to-needle ≤ 30 min was lower in tertiary hospitals than in secondary hospitals (46.4% (84/181) vs. 62.2% (153/246), P = 0.001). However, there was no difference in the proportion of door-to-balloon ≤ 90 min between tertiary and secondary hospitals (58.8% (60/102) vs. 57.1% (4/7), P = 1.000). In-hospital mortality was also similar between tertiary and secondary hospitals (5.8% (51/886) vs. 5.5% (44/800), P = 0.820).

CONCLUSIONSEarly reperfusion rate is low, and thrombolysis is the main early reperfusion therapy in both tertiary and secondary hospitals in Henan province. Tertiary hospitals did not take advantage of their primary PCI capability. There is great room for improvement in early reperfusion therapy in tertiary and secondary hospitals.

Hospital Mortality ; Hospitals ; Humans ; Myocardial Infarction ; Myocardial Reperfusion ; Percutaneous Coronary Intervention ; Secondary Prevention ; Surveys and Questionnaires

Objective To explore the incidence and risk factors of gout in Jinchang cohort and provide scientific evidence for the prevention and control of gout.Methods People without gout detected by baseline survey in Jinchang cohort were selected as study subjects.All the subjects were followed up through questionnaire interview,physical examination as well as laboratory test from January 24,2013 to November 24,2015.Cox regression model was used to analyze the risk factors for gout in Jinchang cohort.In addition,log-linear model was used to analyze the interaction between risk factors.Results A total of 33 153 subjects were followed up,and there were 277 newly diagnosed gout cases in the cohort.The overall incidence of gout was 0.8％.The incidence of gout in males was higher than that in the females,but the incidence of gout in males and females was similar after the age of 60 years.Cox regression analysis showed that age ＞40 years (at age 40 to 59 years:HR=2.982,95％CI:1.503-5.981;at age 60 to 91 years:HR=2.588,95％CI:1.107-6.049),alcohol abuse (HR=2.234,95％CI:1.128-4.427),obesity (HR=2.204,95％CI:1.216-3.997),diabetes (HR=2.725,95％CI:1.500-4.950) and high uric acid (HR=5.963,95％CI:3.577-9.943) were risk factors for gout,while weekly beans intake ≥0.25 kg (HR=0.528,95％CI:0.345-0.808) and regular physical exercise (HR=0.499,95％ CI:0.286-0.869) were protective factors for gout.The analysis with log-linear model showed that there were two order effects between the risk factors.Conclusions Age,beans intake,alcohol abuse,physical exercises,obesity,diabetes and high uric acid were important factors influencing the incidence of gout.It is important to have healthy lifestyle and dietary habits,receive regular health examination to prevent and control the incidence of gout in this cohort.

Atherosclerosis (AS) is an invisible killer among cardiovascular diseases (CVD), which has seriously threatened the life of quality. The complex pathogenesis of AS involves multiple interrelated events and cell types, such as macrophages, endothelial cells, vascular smooth muscle cells and immune cells. Currently, the efficacy of recommended statin treatment is not satisfactory. Natural products (NPs) have attracted increasing attention with regard to their broad structural diversity and biodiversity, which makes them a promising library in the demand for lead compounds with cardiovascular protective bio-activity. NPs can preclude the development of AS by regulating lipid metabolism, ameliorating inflammation, stabilizing plaques, and remodeling the gut microbiota, which lays a foundation for the application of NPs in clinical therapeutics.
Humans ; Biological Products/metabolism* ; Endothelial Cells/metabolism* ; Atherosclerosis/metabolism* ; Macrophages/metabolism* ; Inflammation/metabolism*