Toll-like receptor (TLR) plays a crucial role in innate immune response and the subsequent induction of adaptive immunity. TLR is expressed on immune cells as well as epithelial cells and tumor cells. When endogenous and exogenous ligands bind with TLR, TLR signaling pathways are activated and a large number of inflammatory cytokines are released, creating an inflammatory microenvironment and leading to tumor formation, invasion and metastasis.

Objective To investigate the therapeutic effect and advantage of laparoscopic appendectomy by concealed three-ports technique. Methods The clinical data of 283 patients received concealed three-ports laparoscopic appendectomy were retrospectively reviewed. Results All the patients were cured after appendectomy,including 5 patients required conversion to operation(because of adhesions around the appendix and difficult to dissect). The surgical time ranged from 25 min to 110 min and the mean time was 38 min. After 8 ～ 12h the patients could move and the average length of postoperative stay was 5d (range 4 ～ 6d). 3 cases had postoperative wound infection. None occurred complications such as postoperative bleeding, abdominal abscess, intestinal fistula, adhesion ileus and incision hernia in 6 months on average (range 1 ～ 18 months)after operation. Conclusion Laparoscopic appendectomy by concealed three-ports technique was a safe and available method and had advantages such as convenience and safety,good cosmetic results,less injury,rapid recovery,less complications,cheap and easy.

This article was aimed to study the optimum extraction process of paeonol. The extraction yield of paeonol was taken as investigation index. And the best extraction process was screened by orthogonal experimental design. The results showed that the optimum condition of extraction process was to soak coarse powder of Paeonia suffruti-cosa into 15-fold water for 0.5 h, and then the distillation lasted for 2.5 h. The distillate was collected and cooled to room temperature. The crystallization lasted for 24 h at 4℃, and then filtered and dried for 48 h at room tempera-ture. It was concluded that the selected technology was stable, reasonable and feasible. The extraction yield of paeonol is over 80%.

Objective To establish a quantitative analysis method for the anatomic structure of aortic root by real-time three-dimensional transesophageal echocardiography,and to explore the reliability and repeatability of this method.Methods Ninety five adult patients underwent RT-3DTEE were included in this study.Full-volume 3D images of aortic root were acquired and analyzed offline with QLab-3DQ (iE33, Philips).The three mutually perpendicular plane were determined.Results 1 )Aortic root:At the end of diastole,the diameter and area of coronary artery sinus bottoms level was 1 .84 cm and 3.45 cm2 ;the diameter and area of top commissural level was 2.97 cm and 7.77 cm 2 ;the diameter and area of sino-tubular junction level was 2.72 cm and 5.44 cm 2 .2)Aortic sinus:right coronary sinus was widest,left coronary sinus was the most stenosis(P <0.05).The repeatability of each parameters was well (P >0.50).The measurement of each parameter,which analysis among different angles showed that 0° region were more accurate than others.Conclusions 3D quantitative analysis to aortic root can be established by full-volume RT-3DTEE images and has better reliability and repeatability.

Objective To analyze the change of cysteinyl leukotriene ( Cys-LTs) levels and 8-Isopros-tane (8-iso-PG) levels in the exhaled breath condensate (EBC) of asthmatic children from acute exacerbation to clinical remission, and investigate the role of the detection of Cys-LTs and 8-iso-PG in EBC in its severity and pathogenesis , and explore the relationship between the Cys-LTs and 8-iso-PG through measuring Cys-LTs levels and 8-iso-PG levels in the EBC of asthmatic children. Methods The outpatient or inpatient asthmatic children of the pediatrics and a group of healthy children were studied. All subjects′ EBC were collected by the R-Tube produced by American Respiratory Research. The concentration of Cys-LTs and 8-iso-PG in EBC were measured by enzyme-linked immunosorbent assay (ELISA), and compared among children in asthmatic exacerbation, asthmatic remission, and healthy condition. The relevance of their change would be explored at the same time. Results (1) Cys-LTs levels in EBC were higher in asthma exacerbation, compared to healthy controls (P<0. 05), while no significant difference were found between asthmatic remission and asthmatic exacerbation or healthy controls ( P>0. 05 ) . ( 2 ) 8-iso-PG levels was higher in asthmatic exacerbation compared to asth-matic remission ( P<0. 05 ) . Moreover, the 8-iso-PG levels were significantly higher in asthmatic remission than in healthy controls (P<0. 05). (3) Through the relevance analysis of the Cys-LTs and 8-iso-PG levels in EBC among the three groups, Cys-LTs levels in EBC of asthmatic exacerbation significantly were correlated with 8-iso-PG levels (n1 =35, r1 =0. 61, P<0. 05), while there was no significant correlation between 8-iso-PG levels and Cys-LTs levels in asthmatic remission. Conclusion The increase of 8-iso-PG levels in EBC of bronchial asthmatic patients correlates with the disease and its control. Therefore, 8-iso-PG can be an objective indicator for asthmatic diagnosis and healing efficacy. Cy-LTs levels increase in the EBC of bronchial asthmatic according to disease severity. The two levels correlate during asthmatic exacerbation, indicating that a link be-tween airway oxidative stress and inflammation among asthmatics.

Protracted bacterial bronchitis is Chronic lower respiratory infection,defined as chronic moist cough for more than 4 weeks and resolution of symptoms in the majority when antibiotic therapy is given for at least 2 to 3 weeks.After airway epithelial cells impaired by various factors,bacteria such as haemophilus influenzae and streptococcus pneumoniae colonizes on bronchial mucous membranes and leads to neutrophil infiltration.The diagnosis of protracted bacterial bronchitis is mainly based on chronic moist cough persisting for more than 4 weeks,sometimes accompanied by wheezing,with normal chest x-ray and bronchial wall thickened on high-resolution computed tomography,revealed redness and edema of the bronchial mucous membranes sometimes accompanied by tracheobronchomalacia as the main characteristic of bronchoscopy.The definite diagnosis can be made if the culture of bronchoalveolar lavage fluid is positive.If the majority of symptoms cannot be removed after 4-week therapy,the underline pathogenesis should be searched.Curing of of acute bacterial infection can prevent protracted bacterial bronchitis.New vaccines offering all serotype protection are needed to prevent protracted bacterial bronchitis caused by haemophilus infiuenzae and streptococcus pneumoniae.

The expensive production of bioethanol is because it has not yet reached the 'THREE-HIGH' (High-titer, high-conversion and high-productivity) technical levels of starchy ethanol production. To cope with it, it is necessary to implement a high-gravity mash bioethanol production (HMBP), in which sugar hydrolysates are thick and fermentation-inhibitive compounds are negligible. In this work, HMBP from an atmospheric glycerol autocatalytic organosolv pretreated wheat straw was carried out with different fermentation strategies. Under an optimized condition (15% substrate concentration, 10 g/L (NH4)2SO4, 30 FPU/g dry matter, 10% (V/V) inoculum ratio), HMBP was at 31.2 g/L with a shaking simultaneous saccharification and fermentation (SSF) at 37 degrees C for 72 h, and achieved with a conversion of 73% and a productivity of 0.43 g/(L x h). Further by a semi-SFF with pre-hydrolysis time of 24 h, HMBP reached 33.7 g/L, the conversion and productivity of which was 79% and 0.47 g/(L x h), respectively. During the SSF and semi-SSF, more than 90% of the cellulose in both substrates were hydrolyzed into fermentable sugars. Finally, a fed-batch semi-SFF was developed with an initial substrate concentration of 15%, in which dried substrate (= the weight of the initial substrate) was divided into three portions and added into the conical flask once each 8 h during the first 24 h. HMBP achieved at 51.2 g/L for 72 h with a high productivity of 0.71 g/(L x h) while a low cellulose conversion of 62%. Interestingly, the fermentation inhibitive compound was mainly acetic acid, less than 3.0 g/L, and there were no other inhibitors detected, commonly furfural and hydroxymethyl furfural existing in the slurry. The data indicate that the lignocellulosic substrate subjected to the atmospheric glycerol autocatalytic organosolv pretreatment is very applicable for HMBP. The fed-batch semi-SFF is effective and desirable to realize an HMBP.
Biofuels ; Carbohydrates ; chemistry ; Cellulose ; chemistry ; Ethanol ; metabolism ; Fermentation ; Furaldehyde ; chemistry ; Glycerol ; chemistry ; Hydrolysis ; Triticum

The occurrence and development of the tumor are closely associated with the tumor microenvironment (TME) and host immune status. Traditional TNM staging has gradually been insufficient in the assessment of patients' outcomes, as the TNM system solely evaluated tumor cell characteristics and failed to predict clinical outcomes based on immune factors. Therefore, immunoscore (IS), derived from the concept of immune contexture, was proposed to establish a more comprehensive and accurate TNM-I staging above the TNM staging. Recently, increasing studies have shown that IS can predict the survival outcome and treatment efficacy more accurately than TNM staging. Moreover, IS possess characteristics such as feasibility, convenience, robustness and reproducibility, which make it possible for IS to be used as a biomarker for clinical application, to classify patients better and contribute to developing individualized treatment strategies, ultimately, to improve the overall survival of patients with cancer. This article reviews of the progress of immunoscore in predicting patients' prognosis and response to therapy among different tumors.

Objective: To explore the related factors for primary hepatic carcinoma (PHC) caused by chronic hepatitis B (CHB) and hepatitis C (CHC). Methods: According to the principle of cross-sectional study, a cluster random sample method was used, a total of 366 chronic hepatitis patients in hospitals were recruited from three provincial tertiary hospitals in Shanxi, Henan and Jilin between July 2016 and October 2016, respectively. Using a self-designed unified questionnaire, face-to-face interviews was conducted on subjects, including sex, age, alcohol consumption, coffee consumption, green tea consumption, fish consumption, smoking, HBV/HCV diagnosis and treatment, diabetes mellitus, family history of PHC (whether PHC in first-degree relatives), etc. Multivariate unconditional logistic regression were performed to identify the related factors for PHC with CHB and CHC. According to the clinical diagnosis the patients were divided into a chronic hepatitis group (not developing to PHC) and a PHC group. Results: Among 366 cases patients, 287 (78.4%) cases were male, 79 cases were female (21.6%), average age was (52.7±9.3) years. 202 cases were chronic hepatitis group, 164 cases were PHC group. Multivariate unconditional logistics regression analysis indicated that alcohol consumption (odds ratio (OR)=2.11, 95%CI: 1.18-3.75), family history of PHC (OR=5.12, 95%CI: 2.60-10.08) were positively correlated with the development of PHC in chronic b, green tea consumption (OR=0.45, 95%CI: 0.23-0.88), antiviral treatment (OR=0.19, 95%CI: 0.11-0.32) were negatively correlated. Alcohol consumption (OR=3.98, 95%CI: 1.14-13.85) was positively correlated with the development of PHC in chronic c, antiviral treatment (OR=0.14, 95%CI: 0.04-0.50) was negatively correlated. Conclusion Alcohol consumption, family history of PHC, green tea consumption and antiviral treatment were the related factors for the development of PHC in chronic hepatitis b. Alcohol consumption and antiviral treatment were the related factors for the development of PHC in chronic hepatitis c.

Objective:To compare surgical methods and clinical efficacy among different types of cesarean scar pregnancy (CSP).Methods:A total of 158 patients with CSP who received treatment in Yuncheng Central Hospital from January 2016 to June 2019 were included in this study. According to Expert Consensus on Diagnosis and Treatment of Cesarean Scar Pregnancy (2016 version), type I CSP was found in 55 patients, type II in 86 patients and type III in 17 patients. These patients were divided into groups A (ultrasound-guided suction curettage), B (uterine artery chemoembolization + ultrasound-guided suction curettage) and C (laparoscopic scar pregnancy lesion resection + scar repair) according to different surgical methods. The amount of intraoperative blood loss, the difference in human chorionic gonadotropin (HCG) level between before and after surgery, the time to postoperative HCG level returning to normal level, menstruation recovery, and re-pregnancy were compared between groups.Results:The amount of intraoperative blood loss in the groups A, B and C was (43.33 ± 72.31) mL, (34.41 ± 17.16) mL, (65.71 ± 70.52) mL, respectively. There was significant difference between groups ( F = 8.51, P = 0.014]. The difference in HCG level between before and after surgery in groups A, B and C was (0.64 ± 0.18), (0.79 ± 0.10), (0.76 ± 0.19), respectively. There was significant difference in the difference in HCG level between groups ( F = 19.21, P < 0.001). There was significant difference in the incidence of postoperative menstrual volume reduction between group B and the other two groups ( χ2 = 6.73, P = 0.003). After surgery, intrauterine pregnancy occurred in 12 patients, including 8 patients in group A (type I CSP in 2 patients, type II CSP in 3 patients, type III CSP in 3 patients), 4 patients in group B (type I CSP in 3 patients, type II CSP in 1 patient). Finally, full-term fetus delivery by cesarean section was performed in 6 patients (4 patients in group A and 2 patients in group B). Conclusion:Uterine artery chemoembolization combined with uterine curettage had less blood loss, during surgery and leads to an obvious decrease in HCG level, but it can result in reduction of menstrual volume. Ultrasound-guided suction curettage is preferred for type I and type II CSP. Balloon compression can be used to stop bleeding if massive bleeding occurs. Laparoscopic scar pregnancy lesion resection plus scar repair is recommended for type III CSP.