Objective To investigate the expression of Toll-like receptors 2 (TLR2) mRNA,p38 mitogen activated protein kinase(p38 MAPK) mRNA and cytokine in peripheral blood of children with measles and to study the effect and possible mechanism for TLR2-p38 MAPK signal pathway defects on immune suppression in the children with measles during acute phase.Methods Thirty children with measles hospitalized in the department of infectious diseases from June 2012 to July 2013 were enrolled into the measles group,and 30 healthy children were chosen as the healthy control group.The mRNA expressions of TLR and p38 MAPK in peripheral blood mononuclear cells (PBMC) were detected by reverse transcription-polymerase chain reaction (RT-PCR).The protein levels of interferon-γ (IFN-γ),tumor necrosis factor-β (TNF-β),interleukin (IL)-12,IL-6 and IL-10 in plasma were measured by using enzyme linked immunosorbent assay (ELISA),and flow cytometry (FCM)was applied to detect the percentage of lymphocyte subpopulation.The serum IgG,IgA and IgM levels were detected by velocity scatter turbidimetry.Results (1) The expressions of TLR2 mRNA and p38 MAPK mRNA in the measles group were both significantly lower than those in the healthy control group (all P ＜ 0.05).(2) Compared with the healthy control group,the protein levels of IFN-γ,TNF-β and IL-12 in the plasma of the measles group decreased significantly (all P ＜ 0.05),and the levels of IL-6 and IL-10 increased significantly(all P ＜ 0.05).(3)Compared with the healthy control group,the percentage of CD3 +,CD4 +,CD4 +/CD8 + ratio and the level of IgG and IgA in the measles group decreased significantly(all P ＜ 0.05),and the percentage of CD19 + increased significantly(P ＜ 0.05),but there was no any significant change in the percentage of CD8 + and the level of IgM (all P ＞ 0.05).Conclusions The mRNA expressions of TLR2 and p38 MAPK are low in PBMC in the measles children during acute phase.There are different degrees of suppression of cell immunity,humoral immune and cytokines disorder in children with measles.Defects of TLR2-p38 MAPK signal pathway may cause the formation of measles immune suppression.

Objective To study the diagnostic value of Sox2 mRNA transcription level in bronchoscopic biopsy specimens from lung cancer patients. Methods The expression of Sox2 mRNA was detected using RT-PCR from 100 hu-man lung cancer biopsy and 18 non-cancer lung biopsy through bronchoscopy. The expression of Sox2 protein was examined by immunohistochemistry from 50 cases of lung cancer biopsy, 32 cases of benign lung lesions and 18 cases of pericarcino-matous normal lung tissues. Then the relationships between Sox2 mRNA transcription level and lung cancer clinical patho-logical parameters were analyzed to test the diagnostic value of Sox2 transcription level. Results The transcription of Sox2 mRNA and its protein expression level were significantly higher in lung cancer than that in benign pulmonary disease tissues (P＜0.05). The transcription of Sox2 mRNA was not correlated with age, gender, histology, lymph node metastasis, TNM stage and differentiation of lung cancer patients (P>0.05). The Sox2 mRNA yielded an area of 0.748 under the ROC curve with the sensitivity of 85.0%and the specificity of 61.1%, taking the cut-off value of 0.513. Conclusion The Sox2 mRNA might be a useful diagnostic marker for lung cancer.

Objective To explore the effect of quality control circle (QCC) in reducing the health examination report errors. Methods QCC was founded, activity themes were selected, activity schedule was planned, the reasons of health examination report errors were analyzed, goal setting, countermeasures were planned and implemented jointly by circle members. Totally 11 738 reports of health checkup were selected and analyzed the errors were analyzed during the activity, 6 892 were male, 4 846 were female, their average age was(38.01 ± 11.31)years, 5 000 reports were made before improvement, 5 120 reports during improvement, 1 618 reports after improvement and compared the report error rates were compared. Evaluation of QCC activity results and tracking effect were evaluated. Results Error rate of health checkup report from 17.80‰ decreased to 7.23‰ during improvement, dropped to 2.48‰ after improvement. The rate of standard was 141.9%, progress rate was 86.1%. Tracking results for 8 months, error rate remained below the target value of 3.40‰although error rate roise to 5.25‰in August 2016, the effect was good. The additional benefit, working efficiency of the doctors was improved; Average time for each written report was reduced to 4 minutes from 5 minutes;Saved about 1 hours per person a day to review the accuracy of the report and learning; Formed“communication model between clinical departments”;Established the error registration system for the report has been distributed;Similar error of ECG department has been avoided. Conclusions Application of QCC not only reduced the error rate of the health checkup report, but also ensured quality, objective, and accurate physical examination report; activities not merely help to improve the work efficiency of physician, team's mutual cooperation, and is beneficial to optimize the system of medical institution and avoid the error.

Objective To detect the expressions and clinical significance of Nanog and CD44 protein in lung cancer. Methods The expressions of Nanog and CD44 were detected by immunohistochemistry in 50 cases of lung cancer, 32 cases of benign lesion lung tissue and 18 cases of paraneoplastic normal lung tissue. Then their relationships with clinicopathological factors were analyzed. Results The expression of Nanog in lung cancer was significantly higher than those in benign lesion lung tissue and paraneoplastic normal lung tissue (P < 0.05). There was no significant difference of the expression of CD44 among the three groups (P > 0.05). The expressions of Nanog and CD44 in squamous cell carcinomas were higher than those in adenocarcinomas and small cell lung carcinomas (P < 0.05). The expressions of Nanog and CD44 were significantly correlated with lymph node metastasis (P < 0.05), but were not correlated with age, gender, tumour size, TNM stage and differentiation of lung cancer (P>0.05). The positive correlation was also noted between the expressions of Nanog and CD44 in lung cancer (r = 0.564, P < 0.05). Conclusion Nanog and CD44 proteins may participate in the genesis and progression of lung cancer. Nanog protein is a potential diagnostic marker and therapeutic target for lung cancer.

Objective:To analyze the clinical distribution characteristics and drug resistance of Staphylococcus aureus infection and provide clinical basis for rational use of antibacterial drugs.Methods:From 2016 to 2019, 462 strains of Staphylococcus aureus were collected from sputum specimens of hospitalized children in Jingzhou Central Hospital.The clinical distribution characteristics of Staphylococcus aureus infection and drug resistance of various antibacterial drugs were analyzed.Results:Among 462 strains of Staphylococcus aureus infection, 285 strains were male, accounting for 61.7%, 177 strains were female, accounting for 38.3%.There was no statisticall significant difference between male and female children with Staphylococcus aureus pneumonia(χ 2=0.762, P=0.383). Staphylococcus aureus mainly infected children under 1 year old(χ 2=73.163, P<0.001), and the seasonal distribution was mainly in winter and spring(χ 2=27.656, P<0.001). A total of 462 strains of Staphylococcus aureus were detected, of which 363 strains(78.6%) were methicillin-sensitive Staphylococcus aureus(MSSA), and 99 strains(21.4%) were methicillin-resistant Staphylococcus aureus(MRSA). MSSA and MRSA were 100% sensitive to vancomycin, tigecycline, teicoplanin, rifampicin, linezolid, quinoprotein-daffodil and nitrofurantoin.The sensitivity of MSSA to levofloxacin, gentamicin, compound sulfamethoxazole, oxacillin, moxifloxacin, ciprofloxacin and tetracycline were 100.0%, 95.9%, 91.7%, 72.2%, 96.7%, 92.6% and 90.0%, respectively.The sensitivity of MRSA to levofloxacin, gentamicin, compound sulfamethoxazole, oxacillin, rifampicin, moxifloxacin, ciprofloxacin and tetracycline were 91.9%, 82.8%, 80.8%, 57.6%, 90.9%, 77.8% and 76.8%, respectively, and it suggested that the drug resistance rate of MRSA was higher than MSSA, and there was statistically significant difference.The antibiotics with high MSSA resistance rate were penicillin G(91.2%), erythromycin(61.7%), clindamycin(50.1%), MRSA was 100.0% resistant to penicillin G, erythromycin and clindamycin. Conclusion:The situation of clinical infection of Staphylococcus aureus in children is grim, and the Staphylococcus aureus detected in the specimens of respiratory tract infection in children is mainly MSSA, which has good sensitivity to most antibacterial drugs.MRSA and MSSA have obvious differences in drug resistance to various antibacterial drugs.Antibiotics should be used rationally, and nosocomial infection control should be strengthened to prevent and reduce the occurrence of MRSA.

Objective To observe the effect of bone morphogenetic protein 4(BMP4) on the infil-tration of macrophages and the expression of nuclear factor-κB in mice model of unilateral ureteral obstruc-tion(UUO).Methods C57BL/6 mice were randomly divided into four groups:injected intra-abdominally with saline-sham-operated group(saline-sham group,n =8),injection intra-abdominally with saline-UUO-operated group(saline-UUO group,n=8),injection intra-abdominally with anti-BMP4-sham-operated group (anti-BMP4-sham group,n=8),and injection intra-abdominally with anti-BMP4-UUO-operated group(anti-BMP4-UUO group,n=8).Either saline or anti-BMP4(group 200 μl/gram of body weight per day) were injected intra-abdominally for 7 days after surgery.Mice were sacrificed at 7th day to evaluate the expression of CD68 and p-P65 by immunohistochemical staining in each group.Besides,the p-P65 protein level was also analyzed by Western blotting in four groups.Results Immunohistochemical staining showed that the expres-sions of CD68 and p-P65 were significantly reduced in the kidney cortices in anti-BMP4-UUO group than in saline-UUO group(P<0.05,respectively).Similar to that,the p-P65 protein level was significantly reduced in the kidney cortices in anti-BMP4-UUO group than in saline-UUO group(P < 0.05,respectively). Conclusion BMP4 participates in the process of renal interstitial inflammation in obstructive nephropathy, and may play a role through the activation of nuclear factor-κB signaling pathway.

Objective To investigate the CT and MRI manifestations of intra-abdominal aggressive fibromatosis and correlation with pathology.Methods The CT and MRI manifestations of 26 cases with intra-abdominal aggressive fibromatosis confirmed by pathological examination were analyzed retrospectively.Results 26 cases showed single solid mass,13 cases showed well-circumscribed and round-like,9 cases wrapped around the common bile duct,intestine or ureter,4 cases were lobulated which had unclear margin with surrounding tissues in pelvic.All the lesions displayed isodensity or slightly low density non-enhanced CT appearance,heterogenous high intensity FS T2WI,some larger tumors showed mixed signal.CT/MRI enhanced scan showed gradual enhancement in 26 cases.Conclusion Intra-abdominal aggressive fibromatosis have some certain imaging features,MRI can offer the histo logical features of tumors and have some correlation with pathology.

Objective To investigate the correlation between lipid-related index and diabetic kidney disease(DKD)by observing the expression levels of lipid-related index in different stages of DKD.Methods A total of 265 patients with type 2 diabetes mellitus(T2DM)were divided into the T2DM group(n=106)and the DKD group(n=159).According to estimated glomerular filtration rate(eGFR)level,the DKD group was sub-divided into the DKD-G2 group(n=59),the DKD-G3 group(n=59)and the DKD-G4 group(n=41).Data of triglycerides(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),apolipoprotein A(Apo A),Apo B and urinary albumin/urinary creatinine ratio(UACR)were collected.Gomerular filtration rate(eGFR),triglyceride-glucose index(TyG),visceral adiposity index(VAI)and atherogenic index of plasma(AIP)were calculated.The differences of TyG,VAI and AIP between different groups and their correlation with eGFR and UACR were analyzed.Multiple linear regression analysis of DKD renal injury factors was conducted.Receiver operating characteristic(ROC)curves were drawn to evaluate the predictive efficiency of TyG,VAI,and AIP.Results The levels of TyG,VAI and AIP were significantly higher in the DKD group compared to the T2DM group,and these indices exhibited an increasing trend with disease progression(P＜0.05).Furthermore,there was a negative correlation between TyG,VAI,AIP and eGFR(r=-0.396,-0.425,-0.519,P＜0.01),and a positive correlation between UACR and eGFR(r=0.482,0.479 and 0.583,P＜0.01)in DKD patients.Multiple linear regression results showed that VAI and AIP were independent risk factors for eGFR,and TG,HDL-C,LDL-C,Apo B and VAI were influencing factors of UACR(P＜0.05).The ROC curve analysis revealed that the areas under the curves for TyG,VAI and AIP were 0.902(0.866-0.937),0.969(0.953-0.986)and 0.958(0.937-0.979)respectively.Conclusion The levels of TyG,VAI and AIP are correlated with the progression of DKD,and have predictive value for the occurrence and development of DKD.These biomarkers can be used as a biological indicator to evaluate the occurrence and development of DKD.

Objective:To determine the motion detection uncertainty of the real-time CybeRay ? imaging system and patient intrafractional motion with thermoplastic mask-based immobilization. Methods:Real-time CybeRay ? imaging system was used for irradiation and treatment for head phantom and patients with brain tumors. All patients were immobilized with thermoplastic masks. Real-time imaging was delivered using kilovoltage projection images during radiotherapy. The detected patient motion data was collected from 5 head phantom measurements and 27 treatment fractions of 9 brain tumor patients admitted to Kaifeng Cancer Hospital. The accuracy and uncertainty of the motion monitoring system were determined. Results:The mean and standard deviation (SD) of the detected motion in the X, Y, and Z directions for phantom were (-0.02±0.41) mm, (-0.05±0.22) mm and (0.01±0.35) mm, respectively. The detected motion in the X, Y and Z directions for patents were (-0.13±0.48) mm, (-0.05±0.48) mm and (0.11±0.36) mm, respectively. After removing the motion detection uncertainty, the actual intrafractional motion of patients were (-0.11±0.25) mm, (0±0.43) mm and (0.10±0.08) mm in three directions, respectively. Conclusions:The uncertainty of real-time imaging-based motion monitoring system of CybeRay ? is less than 0.5 mm. It is feasible to apply thermoplastic masks for brain tumor patients in clinical practice, which can provide steady immobilization and limit the SD of patient intrafractional motion within 0.5 mm. Real-time imaging-based motion monitoring system of CybeRay ? is accurate for patient motion monitoring during frameless stereotactic radiosurgery/radiotherapy.

ObjectiveTo investigate the characteristics of intrahepatic and extrahepatic organ failure at the onset of acute－on－chronic liver failure（ACLF）， to explore the features of a new clinical classification system of ACLF， and to provide a basis for the diagnosis， treatment， prognostic analysis of the disease. MethodsA retrospective analysis was performed for the clinical data of the patients who were hospitalized Beijing YouAn Hospital， Capital Medical University， from January 2015 to October 2022 and were diagnosed with ACLF for the first time. According to the conditions of intrahepatic and extrahepatic organ failure at disease onset， they were classified into type Ⅰ ACLF and type Ⅱ ACLF. Type Ⅰ ACLF referred to liver failure on the basis of chronic liver diseases， and type Ⅱ ACLF referred to acute decompensation of chronic liver diseases combined with multiple organ failure. The clinical features of patients with type Ⅰ or type Ⅱ ACLF were analyzed， and the receiver operating characteristic （ROC） curve was used to assess the value of MELD， MELD－Na， and CLIF－C ACLF scoring system in predicting the 90－day prognosis of ACLF patients with type Ⅰ or type Ⅱ ACLF. The independent－samples t test was used for comparison of normally distributed continuous data between two groups， and the Wilcoxon rank－sum test was used for comparison of non－normally distributed continuous data between two groups； the chi－square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsA total of 582 patients with ACLF were enrolled， among whom there were 535 patients with type Ⅰ ACLF and 47 patients with type Ⅱ ACLF. Hepatitis B and alcoholic liver disease were the main causes in both groups， with no significant difference between the two groups （P>0.05）. Chronic non－cirrhotic liver disease （28.2%） and compensated liver cirrhosis （56.8%） were the main underlying liver diseases in type Ⅰ ACLF， while compensated liver cirrhosis （34.0%） and decompensated liver cirrhosis （61.7%） were the main underlying liver diseases in type Ⅱ ACLF， and there was no significant difference in underlying liver diseases between the patients with type Ⅰ ACLF and those with type Ⅱ ACLF （P<0.001）. The patients with type Ⅱ ACLF had significantly higher median MELD score， MELD－Na score， and CLIF－C ACLF score than those with type Ⅰ ACLF （all P<0.001）. The patients with type Ⅱ ACLF had significantly higher 28－ and 90－day mortality rates than those with type Ⅰ ACLF （38.3%/53.2% vs 15.5%/27.5%， P<0.001）. For the patients with type Ⅰ ACLF who did not progress to multiple organ failure， the patients with an increase in MELD score accounted for 63.7% in the death group and 10.1% in the survival group （P<0.001）， while for the patients with type Ⅰ ACLF who progressed to multiple organ failure， there was no significant difference in the change in MELD score between the survival group and the death group （P>0.05）. In the patients with type Ⅰ ACLF， MELD score， MELD－Na score， and CLIF－C ACLF score had an area under the ROC curve （AUC） of 0.735， 0.737， and 0.740， respectively， with no significant difference between any two scores （all P>0.05）. In the patients with type Ⅱ ACLF， CLIF－C ACLF score had a significantly higher AUC than MELD score （0.880 vs 0.560， P<0.01） and MELD－Na score （0.880 vs 0.513， P<0.01）. ConclusionThere are differences in underlying liver diseases， clinical features， and prognosis between type Ⅰ and type Ⅱ ACLF， and different prognosis scoring systems have different emphases， which provide a basis for the new clinical classification system of ACLF from the perspective of evidence－based medicine.