Objective To investigate the expression of IgG4 in liver tissues of patients with type Ⅰ autoimmune hepatitis (AIH) and to analyze the clinical manifestation,biochemical indexes,immunological genetic features,pathological characteristics and the effects of immunosuppressive therapy.Methods From March 2012 to July 2013,45 patients diagnosed as type Ⅰ AIH were enrolled.Immunostaining of CD38,IgG and IgG4 in liver tissue slices was performed,inflammation grade G and fibrosis stage S were determined.At the same time,serological indexes (alanine aminotransferase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),IgG,antinuclear antibody (ANA) titer,antibodies to asialoglycoprotein receptor (ASGPRAb)) of the patients were collected,serum IgG4 was tested and the response to immunosuppressive therapy was observed.Wilcoxon rank sum test and t test were performed for quantitative data comparison.Spearman correlation coefficient was used for correlation analysis.Results Among 45 patients with type Ⅰ AIH,five patients (11.1％) were IgG4 associated AIH (IgG4-AIH group).There were no significant differences in age,gender,biochemical indexes (serum levels of ALT,AST,ALP),immunity indexes (serum levels of IgG,ANA titer,ASGPRAb) and degree of liver fibrosis between patients with IgG4-associated AIH and classical AIH (40 cases) (all P＞ 0.05).Compared with classical AIH group (18.3(6.7) mg/L).The serum level of IgG4 of IgG4 AIH group was 25.8(9.2) mg/L,which significantly increased (Z=-2.041,P＜0.05).However,there was no significant difference in serum level of IgG4 between the two groups (P＞0.05).There was no correlation between the number of infiltrated IgG4 positive plasma cells and the serum level of IgG4 (r=0.311,P=0.279).The inflammation in the liver tissues of IgG4-AIH group was more significant compared with that of classic AIH group (H=4.120,P＜0.05).The number of CD38' or IgG+ plasma cells was larger compared with that of classical AIH (CD38(39.3(13.5)/high power field (HPF) vs (21.3(8.8))/HPF,IgG(39.3 (14.0))/HPFvs (18.5(8.9))/HPF;Z ＝-3.561 and-3.584,both P＜0.01).The number of IgG4+ plasma cells in liver tissues was positively correlated with the number of CD38+ or IgG+ plasma cells (r=0.884 and 0.791,both P＜0.01).Conclusions Among patients with type Ⅰ AIH,the incidence of IgG4-associated AIH was not high.The serum level of IgG4 did not significantly increase in these patients.However,the histological inflammation activity was significant along with many CD38+ or IgG+ plasma cells infiltration.

Background and purpose:Promoter methylation ofPCDH10, a gene encoding protocadherin 10, has been found to be correlated to poor prognosis in gastric cancer (GC) patients. However, the relationship between the expression of PCDH10 and prognosis in GC remained unknown. This study aimed to explore the relationship be-tween the expression of PCDH10 and clinicopathological features and prognosis of GC, and to identify biomarker for predictions of recurrence and survival of GC.Methods:mRNA expressions of PCDH10 in 115 pairs of GC tissues and adjacent normal tissues were detected by real-time lfuorescence quantitative polymerase chain reaction (RTFQ-PCR). The correlation between PCDH10 expression level and clinicopathological features and prognosis of GC was analyzed. Prediction models for 5-year recurrence and 5-year survival were established using logistic regression method.Results:Progression-free survival (PFS) and overall survival (OS) were signiifcantly prolonged in patients with PCDH10 low expression compared to patients without PCDH10 low expression (P=0.046 andP=0.033 respectively). PCDH10 low expression signiifcantly correlated with less lymph node metastasis (P=0.001) and earlier TNM staging (P=0.001), and was more common in female than in male (P=0.040). The mRNA expression of PCDH10 did not correlate with age, Lauren classiifcation, T stage, neural invasion or vascular invasion. Univariate Cox analysis showed Lauren classiifca-tion, T stage, N stage, M stage and PCDH10 expression signiifcantly correlated with PFS and OS. Logistic regression models for the prediction of 5-year recurrence or 5-year survival based on clinicopathological features included Lauren classiifcation, T stage, N stage and M stage as variables. Logistic regression models for the prediction of 5-year recur-rence or 5-year survival based on PCDH10 expression included Lauren classiifcation, T stage, M stage and PCDH10 expression level but not N stage as variables. The models based on PCDH10 expression had the same effciencies as models based on clinical parameters in predicting 5-year recurrence or 5-year survival for GC patients.Conclusion:PCDH10 low expression correlated with better prognosis, less lymph node metastasis and earlier TNM stage in GC patients. Low expression of PCDH10 may be a biomarker of better survival for GC patients. Logistic regression model based on PCDH10 mRNA expression may serve as a prediction model when patients have unknown lymph node metas-tasis status.

Background and purpose: L-asparaginase (L-Asp) is an important drug in the treatment of childhood lymphoid neoplasms at present, but a lot of adverse reactions of L-Asp were observed. Pegasparaginase (PEG-Asp) is available in China in recent years. This study aimed to explore efifcacy and side-effect of PEG-Asp as ifrst-line treatment in childhood acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL). Methods:A total number of 211 ALL or LBL patients were treated with CCLG 2008 or BFM-90 protocol with PEG-Asp or L-Asp between Apr. 2008 and Mar. 2013;42 patients, among whom, were 35 ALL patients and 7 LBL patients, were treated with PEG-Asp as ifrst-line treatment;169 patients were treated with L-Asp as ifrst-line treatment (including 53 patients treated with L-Asp during induction protocol; with PEG-Asp during consolidate protocol). The clinical outcome and adverse reaction of PEG-Asp with L-Asp were observe and compared. Results: There were 35 ALL patients in PEG-Asp ifrst-line treatment group and the complete remission rate after 1 course of PEG-Asp was 97.1%,however, which was 83.3%of high risk ALL patients. The complete remission rate of 7 LBL patients of PEG-Asp ifrst-line treatment group was 57.1%. There was no signiifcant difference between 2 groups (P>0.05). Thirty-four patients relapsed including 5 patients of PEG-Asp ifrst-line treatment group, 16 patients of L-Asp ifrst-line treatment group and 13 patients treated with L-Asp during induction protocol and with PEG-Asp during consolidate protocol. Thirty-one patients died including 3, 18, 10 patients in 3 groups respectively. Twenty-two patients died of relapse, 4 died without remission, 5 died of complications. There was also no signiifcant difference between 2 groups (P>0.05). The incidence rates of adverse reactions were 47.6% and 63.3% respectively. Anaphylaxis, liver functions abnormalities, blood coagulation abnormalities, gastrointestinal reaction, hyperglycemia and pancreatitis were common in our patients. The incidence rate of anaphylaxis in PEG-Asp as ifrst-line treatment group was lower than other groups (P=0.03). But there was no signiifcant difference been observed in the incidence of other adverse reaction. Conclusion: The short-term efifcacy of PEG-Asp as the ifrst-line treatment in childhood leukemia and lymphoma was satisfactory and the incidence rate of anaphylaxis was lower. However, we will still pay much attention to adverse reaction monitoring of PEG-Asp.

Objective To investigate the influence of tissue-specific growth hormone receptor (GHR)deficiency in type 1 diabetes in the mice at the gene level using pancreaticβcells combined with streptozotocin (STZ)-induced type 1 diabetes model.Methods The experiment was divided into four groups:knockout mice group (LLc knockout group), using the homozygotes (LLc:LL+Cre) producted by pancreaticβ cell-specific expressed recombinant enzyme mice (RIP-Cre)and Cre-LoxP system modified GHR mice (Floxed,LL);LL control group, containing Floxed GHR allele homozygous mice (LL);LLc STZ group and LL STZ group (STZ was used for inducing type 1 diabetes model mice). The mice with feeding glucose≥25 mmol · L-1 were considered to be successful models.The Glucose Tolerance Test (GTT),pancreas tissue HE staining and immunohistochemistry were performed in the mice.Results The blood glucose of the mice in LL STZ group and LLc STZ group and LLc STZ group were increased after inj ection of STZ and the models achieved the diagnostic criteria for diabetes 1 6 d later.The results of GTT showed that compared with LLc control group and LLc knockout group, the blood glucose levels of the mice in LL STZ and LLc STZ groups were increased (P<0.05).There was no significant change of morphology and structure of islets between LL control group and LLc knockout group detected by HE staining. The immunohistochemistry results showed that the insulin level of the mice in LL STZ group was significantly reduced compared with LL control group;the insulin level of the mice in LLc STZ group was reduced compared with LLc control group.Conclusion Pancreaticβcell GHR gene knockout has no effect on the blood glucose and the function ofβcells in the mice with STZ-induced type 1 diabetes.

Objective:To observe factors influencing the risk of urinary tract infection (UTI) after cerebral hemorrhage (ICH).Methods:A total of 77 ICH patients undergoing rehabilitation between August 2015 and August 2017 were studied. Among them, 24 were diagnosed with a UTI according to clinical manifestations and urine routine tests and urine culture. They formed the UTI group. The other 53 were the non-UTI group. Complete clinical evaluations were available for all 77, and those data were used to identify risk factors for UTI using univariate and multivariate logistic regression analysis.Results:The univariate analysis showed that age, side of paralysis, consciousness dysfunction, Brunnstrom staging of the lower extremity, tracheotomy, indwelling catheter, lung infection, white blood cell count, neutrophil percentage, serum natrium, uric acid, D-dimer level and fibrinogen were all significant predictors of UTI. The multivariate analysis identified age, right side hemiplegia and D-dimer level as useful predictors.Conclusions:Advanced age and a high D-dimer level are independent risk factors for UTI after ICH, while hemiplegia on the right side is a protective factor.

Objective To approach the changes of cytosol phospholipase A2α(cPLA2α)and nitric oxide (NO)in patients with chronic obstructive pulmonary disease(COPD)and its significance. Methods One hundred patients with COPD admitted into Department of Critical Care Medicine of Affiliated Wuqing Traditional Chinese Medicine(TCM)Hospital of Tianjin University of TCM were enrolled,and according to the COPD severity grading standards,they were divided into mild group(25 cases),moderate group(25 cases),severe group(26 cases) and extremely severe group(24 cases);simultaneously,90 cases with normal pulmonary function who had taken health examination were chosen and assigned to the healthy control group. The cPLA2α level was detected by enzyme linked immunosorbent assay(ELISA),the level of uric acid(UA),total cholesterol(TC),triacylglycerol (TG)were detected by enzymatic method,and serum NO metabolites(NOx)level was detected by nitrate reductase method. Results Compared with the healthy control group,the serum levels of cPLA2α and UA in patients with different severity of COPD were significantly increased;along with the increase of patient's COPD grade of severity,the cPLA2α,UA levels were gradually increased,while NOx level was gradually decreased in mild, moderate, severe, extremely severe groups〔cPLA2α(ng/L):125.60±8.17, 155.20±6.42, 190.20±9.32, 255.80±11.28 vs. 88.50±7.99;UA(μmol/L):381.23±32.22,434.95±87.71,464.81±52.65,487.45±82.61 vs. 241.95±52.33;NOx(μmol/L):59.90±17.52,45.60±6.17,38.20±4.08,25.70±3.04 vs. 74.90±18.31,all P<0.05〕. The differences in blood cPLA2αand serum NOx level among groups with different severity of COPD were of statistical significance(P<0.05). The levels of TC,TG among these different severity groups had no statistical significance(all P>0.05). The cPLA2αand NOx levels presented significant negative correlation(rs=-0.798,P=0.013). Conclusion The combined examination of blood cPLA2αand serum NOx levels can evaluate the severity degree of COPD patients,and cPLA2αcan be used as a new target index for COPD grading.

Objective To be good for the different working age midwives to carry out the same evaluation of the pregnant woman,we build and use the Episiotomy Evaluation Form for reducing the rate of episiotomy with ensuring the safety of mother and baby.Methods Consult relevant literature,combine clinical practice,discuss,report to the hospital ethics committee many times and at last it was made after approval.The details included:perineal lesions,perineum elasticity,perineal length,maternal coordination,gestational age,age,fetal distress degree,amniotic fluid situation,the weight of fetus estimated,the second time of labor and so on,to score by 0,1,3,5,20.A total of 600 patients with low risk of natural childbirth were randomly divided into observation group and control group according to method of random number table with 300 cases each.The observation group was graded according to the perineal incision evaluation and we operated according to its use method.The control group was judged according to the experience of midwife and subjective cognition.At last compared the effects on the mother and baby.Results The rates of lateral episiotomy and Ⅰ degree laceration were 15.00％ (45/300) and 63.00％ (189/300) in the observation group and 48.33％ (145/300) and 21.67％ (65/300) in the control group,respectively.The difference between the two groups was statistically significant (x2=16.238,21.507,P ＜ 0.05).There was no statistical difference in the perineal intact rate,median perineal incision rate,perineal Ⅱ degree laceration rate,severe perineal laceration,second stage of labor,postpartum hemorrhage 2 hours,neonatal asphyxia rate,incidence of neonatal birth injury (brachial plexus injury,clavicle fracture,etc.) and pelvic floor muscle strength of 42 days after delivery between the two groups (P ＞ 0.05).Conclusions By using the episiotomy evaluation form,we can improve the accuracy and homogeneity of the midwife's assessment about the episiotomy which is benefit to reduce rate of episiotomy.It is worth promoting in clinical practice but we should ensure the safety of maternal and child.

Objective To investigate the expression of MPZL1 in gastric cancer tissues, its relation with the prognosis, and its effects on proliferation and colony formation of gastric cancer. Methods GEPIA and UALCAN databases were used to analyze the expression of MPZL1 in various malignant tumors. The KM Plotter database and UALCAN database were used to analyze the effect of MPZL1 on the overall survival of gastric cancer patients. The expression of MPZL1 protein and the changes of apoptosis-related proteins in gastric cancer cells were detected by Western blot, and the effects of MPZL1 expression on cell proliferation and colony formation were detected by CCK-8 and colony formation assay, respectively. Results MPZL1 was found to be highly expressed in various malignant tumors by GEPIA database. The results of UALCAN and KM Plotter databases analysis showed that MPZL1 was highly expressed in gastric cancer tissues, and might be correlated with the overall survival of gastric cancer patients. The results of CCK-8 and colony formation assay showed that the overexpression of MPZL1 promoted the proliferation and colony formation ability of gastric cancer cells (P < 0.05). Western blot results showed that compared with control group, the expression levels of pro-apoptotic proteins Bad and Caspase-7 in the overexpression group were significantly lower while those in knockdown group were higher. Conclusion MPZL is highly expressed in gastric cancer tissues and promotes the proliferation and colony formation of gastric cancer cells, which may be related to the inhibition of apoptosis.

Objective To study the regulation of Withaferin A on apoptosis-related proteins in lung squamous cell carcinoma and its effect on cell epithelial-mesenchymal transition.Methods Lung squamous cell carcinoma cell line SK-MES-1 were cultured in vitro.The SK-MES-1 cells were treated with the final mass concentration of 0 (control),5,10,20,and 40 μg/ml for 28 h,and the general morphology and shedding of the cells were observed under phase contrast microscope;MTT assay was used for detection of cell viability;flow cytometry was used for detection of apoptosis;immunofluorescence and real-time fluorescent polymerase chain reaction (RT-PCR) was used for detection of apoptosis-related proteins and genes bcl-2 and bax,and expression of the epithelial marker E-cadherin and the interstitial marker Vimentin.Results Different concentrations (0,5,10,20,40 μg/ml) of Withaferin A inhibited the activity of SK-MES-1 cells with cell viability of 0.62±0.05,0.42±0.04,and 0.33±0.06,0.21±0.03,0.17±0.04,respectively,which suggesting that this inhibition was related to the concentration of Withaferin A (F =386.505,P =0.005).After treatment with SK-MES-1 cells for 24 h at different concentrations (0,5,10,20,40 μg/ml) of Withaferin A,the apoptosis rates of each group were (0.180±0.011) ％,(0.310±0.013) ％,(0.500±0.021) ％,(0.540±0.018) ％,and (0.410± 0.027) ％,which suggesting that Withaferin A rarely caused apoptosis,mostly necrotic cells (F =1 065.78,P =0.124).In SK-MES-1 cells treated with different concentrations of Withaferin A for 24 h,the results of immunofluorescence showed that the expression of Vimentin was decreased in the experimental group at a concentration of 20 μg/ml compared with the control group,and the fluorescence intensity was lower than that of the control group,but the fluorescence intensity of E-cadherin was higher than that of the control group;the intensity did not change significantly in the experimental group with the other concentrations.While the expression levels of bax and bcl-2 proteins in the control group and the experimental group did not change significantly.RT-PCR results showed that the mRNA expression of E-cadherin (6.7±0.6 and 6.4±0.9) in the experimental group at a concentration of 20 and 40 μg/ml was significandy higher than that in the control group (4.2±1.0),and the difference was statistically significant (both P ＜ 0.05),and the mRNA expression of Vimentin (4.7±0.5 and 4.7±0.5) was significantly lower than that in the control group (7.2±0.7),and the difference was statistically significant (both P ＜ 0.05).Conclusion Withaferin A can inhibit the growth of lung squamous cell carcinoma cells and inhibit the process of epithelial-mesenchymal transition,but it has no obvious relationship with apoptosis and apoptosis-related proteins.

Retinitis pigmentosa (RP) is a group of hereditary blinding fundus diseases caused by abnormalities in photoreceptors of the retina.RP is highly heterogeneous in hereditary and cdinical phenotypes.It can be divided into simple type RP and syndrome type RP.The main inheritance patterns are autosomal dominant,autosomal recessive inheritance and X-linked inheritance.With the popularization and clinical application of gene sequencing technology,more and more disease-causing genes have been discovered,and these genes are mainly expressed in photoreceptor cells and retinal pigment epithelial cell.ln-depth understanding of RP pathogenic genes not only provides a theoretical basis for RP diagnosis and genetic counseling,but also provides guidance for RP gene therapy.