Objective To investigate the immune injury in genital tract of BALB/c mice induced by plasmid protein pORF5 of Chlamydia trachomatis and its possible mechanism.Methods GST(glutathione-S-transferases)-pORF5 fusion protein was expressed and digested with PreScission Protease to obtain the target protein without GST tag.After further purification and endotoxin removal,pORF5 protein was injected into the posterior fornix of BALB/c mice on day 1,3 and 6,while the control groups were injected with PBS or GST protein respectively,and then all the mice were sacrificed on day 7 to evaluate genital tract gross pathology and histopathological characterization.The levels of TNF-α,IL-1β and IL-6 in serum,splenocytes culture supernatant and vaginal douche were detected by ELISA.Results Mice in pORF5 group developed different degrees of swelling in isthmic portion and ampulla of uterine tube,connective tissue adhesion and hydrosalpinx in the genital tract tissues,while the PBS group and the GST group did not show any obvious change.The inflammatory score showed that the genital tract pathology in pORF5 group was much more severe than PBS and GST control groups (P＜0.O1).The levels of TNF-α,IL-1β and IL-6 in vaginal douche and splenocytes culture supernatants in pORF5 group were obviously higher than those of PBS and GST groups (P＜0.05).The levels of TNF-α and IL-1β in serum were also higher than those of GST and PBS groups (P＜0.01).Conclusion pORF5 plasmid protein could induce pathological immune response in the genital tract of BALB/c mice,which may be associated with the increase of the production of the inflammatory cytokines TNF-α,IL-1β and IL-6 in BALB/c mice.

Objective To investigate the relationship between H type hypertension as well as the changes of serum lipid and white matter lesions(WML).Methods From January 2015 to October 2017,the clinical characteristics of 507 WML patients who admitted to the Affiliated Hospital of Chengde Medical College were analyzed retrospectively. The patients were divided into simple hypertension group(A group,hypertension accompanied by Hcy ＜10μmol/L, 111cases),simple homocysteine group(B group,patients without high blood pressure with homocysteine ＞10μmol/L, 132cases)and H type hypertension group (C group,hypertension accompanied by homocysteine ＞10μmol/L,264cases)according to homocysteine concentration and hypertension.The patients'clinical data,including imaging information such as MRI,diffusion weighted imaging(DWI),and levels of homocysteine (Hcy),serum lipid were collected.The patients were divided into three subgroups based on the severity of WML,including the mild,moderate,severe.The differences of TG,TC,HDL -C,LDL -C,Apo -A1,Apo -B in each group were compared.Results The levels of TC in A,B and C group were (4.14 ±1.16)mmol/L,(4.39 ±1.39)mmol/L,(3.67 ±1.29)mmol/L,respectively.The levels of LDL -C in the three groups were (2.24 ±0.88)mmol/L,(2.38 ±0.91)mmol/L and (1.99 ±0.89)mmol/L,respectively.Compared with A group and B group,the levels of TC and LDL -C in C group were lower(F =15.411,9.271,all P <0.05).In A group,the number of mild WML,moderate and severe WML accounted for 51.4%,32.4% and 16.2%,which in B group accounted for 50.0%,33.3% and 16.7%,which in C group accounted for 32.6%,33.3% and 34.1%.The number of WML patients had statistically significant differences between A group and C group(χ2 =16.407,P <0.05),and B group and C group(χ2 =15.912,P <0.05).In A group,the TC levels in the moderate group [(4.45 ±1.07)mmol/L]and severe group[(5.04 ±0.99)mmol/L] were significantly higher than that in the mild group [(3.68 ±1.03)mmol/L],the difference was statistically significant(F =22.391,P <0.05);the LDL -C level in the severe group[(2.88 ±0.65)mmol/L]was significantly higher than (1.98 ±0.84)mmol/L in the mild group and (2.33 ±0.89)mmol/L in the moderate group(F =14.764,P <0.05).In B group,the TC levels in the moderate group [(4.79 ±1.38)mmol/L]and the severe group [(5.20 ±1.43)mmol/L]were significantly higher than (3.85 ±1.16)mmol/L in the mild group,the difference was statistically significant(F =20.515,P <0.05).Compared with the mild group[(2.13 ±0.83)mmol/L],the LDL –C level was higher in the severe group[(2.81±1.01)mmol/L],the difference was statistically significant(F =9.235, P <0.05).In C group,the levels of TC and LDL -C in the moderate group were (3.94 ±1.22)mmol/L and (2.02 ± 0.74)mmol/L,respectively,which in the severe group were (3.93 ±1.16)mmol/L and (2.30 ±0.85)mmol/L,respectively,which were significantly higher than those in the mild group [(3.12 ±1.34 )mmol/L,(1.62 ±0.88)mmol/L],the differences were statistically significant(F =27.141,27.078,all P <0.05).Spearman correlation analysis showed that there was a positive correlation between hypertension,TC,LDL -C and the severity of WML(H type hypertension:r =0.211,P <0.05;TC:r =0.266,P <0.05;LDL -C:r =0.258,P <0.05).Conclusion H type hypertension and high levels of TC,LDL -C can increase the number and severity of WML.

Objective To explore the relationship between urinary iodine level and breast cancer,we compare urinary iodine excretion levels in patients with breast cancer,benign breast disease,other female malignant tumors and control subjects in Xiangya Hospital of Central South University.Methods From December 2018 to January 2019,64 patients with newly diagnosed breast cancer in Xiangya Hospital of Central South University were selected as case group,benign breast disease group (n =49),other female malignant tumor group (n =39) and health examination group (n =50) as control group.Urinary iodine was determined by colorimetry.According to the urinary iodine level the patients divided into three groups:iodine excess (＞300 μg/L),medium iodine (100-300 μg/L) and iodine deficiency (＜ 100 μg/L).The relationship between urinary iodine and clinicopathology of breast cancer was analyzed.Results The level of urinary iodine in benign breast nodule group 319.13 (163.98) μg/L ＞ breast cancer group 273.96 (151.30) μg/L ＞ female other malignant tumor group 212.95 (161.71) μg/L ＞ normal control group 199.15 (194.45) μg/L,with significantly differance (H =9.936,P =0.019).Urinary iodine level in the normal control group was significantly lower than that in the benign breast disease group (P =0.013).The patients were further divided into three groups according to the urinary iodine level:iodine excess,iodine medium and iodine deficiency,the number of urine iodine ＜ 100 μg/L in the normal control group was significantly higher than that in the breast cancer group (P =0.021).The level of urinary iodine was negatively correlated with the size of the primary focus of breast cancer (Z =-2.307,P =0.021).The effect of urinary iodine was analyzed by multiple linear regression method.The size of primary focus was included in the regression equation (R2 =0.136,P=0.007),but had nothing to do with lymph node metastasis and the expression status of estrogen receptor (ER),androgen receptor (AR),progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER-2).Conclusions There is a negative linear correlation between urinary iodine level and the size of primary focus of breast cancer,but it has nothing to do with lymph node metastasis and the expression of ER,AR,PR and HER-2.

Objective To determine if preventive antibiotics is effective in stroke associated pneumonia in patients with acute stroke.Methods Medline (January 1950 to January 2017),EMBASE (January 1974 to January 2017),Cochrane Library (January 2009 to January 2017),CNKI (January 1979 to January 2017)and Wanfang data (January 1998 to January 2017) were searched for randomized controlled trial comparing preventive antibiotics with placebo/blank controls for stroke associated pneumonia in patients with acute stroke.The included studies were screened out strictly based on the criterion of inclusion and exclusion.The quality of included studies was evaluated and the data were extracted by two researchers independently.RevMan 5.1 was used for Meta analysis.Results A total of 4 studies involving 3894 patients were included.The results of Meta-analysis indicated that there was no significant difference in the incidence of stroke associated pneumonia between preventive antibiotics and control groups (OR=0.96,95％CI:0.72-1.29,P=0.810);and there were no statistically significant differences in mortality (OR=1.05,95％CI:0.88-1.25,P=0.570) and good outcome (modified Rankin scale ≤ 2,OR=1.02,95％CI:0.89-1.17,P=0.780).There were no serious adverse reactions related to the studied drugs in 4 studies.Conclusion Preventive antibiotics could neither reduce the incidence of stroke associated pneumonia nor decrease the mortality or improve the proportion of good outcome.

Objective:To develop and validate a nomogram model for predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC) based on preoperative enhanced computed tomography imaging features and clinical data.Methods:The clinical data of 210 patients with HCC undergoing surgery in the Second Affiliated Hospital of Anhui Medical University from May 2018 to May 2022 were retrospectively analyzed, including 172 males and 38 females, aged (59±10) years old. Patients were randomly divided into the training group ( n=147) and validation group ( n=63) by systematic sampling at a ratio of 7∶3. Preoperative enhanced computed tomography imaging features and clinical data of the patients were collected. Logistic regression was conducted to analyze the risk factors for HCC with MVI, and a nomogram model containing the risk factors was established and validated. The diagnostic efficacy of predicting MVI status in patients with HCC was assessed by receiver operating characteristic (ROC) curve, calibration curves, decision curve analysis (DCA), and clinical impact curve (CIC) of the subjects in the training and validation groups. Results:The results of multifactorial analysis showed that alpha fetoprotein ≥400 μg/ml, intra-tumor necrosis, tumor length diameter ≥3 cm, unclear tumor border, and subfoci around the tumor were independent risk factors predicting MVI in HCC. A nomogram model was established based on the above factors, in which the area under the curve (AUC) of ROC were 0.866 (95% CI: 0.807-0.924) and 0.834 (95% CI: 0.729-0.939) in the training and validation groups, respectively. The DCA results showed that the predictive model thresholds when the net return is >0 ranging from 7% to 93% and 12% to 87% in the training and validation groups, respectively. The CIC results showed that the group of patients with predictive MVI by the nomogram model are highly matched with the group of patients with confirmed MVI. Conclusion:The nomogram model based on the imaging features and clinical data could predict the MVI in HCC patients prior to surgery.

Objective:To explore the clinical application value of routine indicators such as blood routine and liver and kidney function in auxiliary diagnosis and prognosis of COVID-19 patients.Methods:SNK-q and other methods were used to retrospectively analyzed the differences of blood routine test, liver and kidney function and other inflammatory indexes of 30 patients with covid-19, 29 patients with other viral pneumonia, 35 patients with influenza A/B and 25 healthy persons from January 28 to February 14, 2020 in Xiangya Hospital of Central South University.Results:The neutrophils count increased gradually in COVID-19 group, influenza A/B group and other types of viral pneumonia group, and the difference between COVID-19 group and other viral pneumonia groups was statistically significant( H=-19.064, P<0.05); The lymphocyte count decreased gradually in the control group, influenza A/B group, other viral pneumonia group and COVID-19 group. In addition, DB, UA and GLU were also different among groups. Subgroup analysis showed that there were statistically significant differences in N( F=9.581, t=-0.152, P<0.05), N%( F=5.723, t=-0.600, P<0.05), NLR( F=4.773, t=-1.161, P<0.05), PCT( F=17.464, t=-1.477, P<0.05)and CRP( F=7.656, t=-1.973, P<0.05) between patients with lung involvement +-++ and patients with lung involvement +++-++++. There were statistically significant differences in NLR( F=63.931, t=-2.815, P<0.01), AST( F=15.704, t=-1.930, P<0.01), ALT( F=35.551, t=-2.199, P<0.01), LDH( F=7.715, t=-2.703, P<0.05) and GLU( F=6.306, t=-5.116, P<0.05) between the light+common subgroup and the heavy+critical subgroup of COVID-19 clinical classification. Correlation analysis showed that clinical stage and imaging credit period were significantly correlated with NLR ( r=0.406 , P=0.026; r=0.397 , P=0.030), ALT ( r=0.403 , P=0.049; r=0.418 , P=0.047), LDH ( r=0.543 , P<0.01; r=0.643 , P<0.01) and GLU( r=0.750 , P<0.01; r=0.471 , P=0.042). A total of 5 principal components were extracted from all the included indicators, and the comprehensive information extraction rate was 82.86%. Indicators of a large load included Ur, PCT and CRP in PC1; ALT, AST and GLU in PC2; N%, L%, L and NLR in PC3. It indicated that the indicators of acute infection, liver function and blood routine had certein warning effect on disease surveillance. The results of ROC curve analysis showed that the combined detection of N+TB+Urea was the best practice to distinguish COVID-19 and other viral pneumonia, while the combined detection of N+L+UA was the most effective solution to make a distinction between COVID-19 and influenza A/B patients. In the aspect of disease evaluation, NL+LDH+GLU+ALT combined detection represent the best diagnostic performance to distinguish the clinical stage of light+common type and heavy+critical type, achieving the AUC (ROC) to 0.904, with the sensitivity 75% and the specificity 100% at the cut-off value of 0.477. Conclusion:In addition to etiology and imaging examination, doctors can also improve the routine laboratory tests such as blood routine test, liver and kidney function to assist diagnosis and disease prediction of patients with respiratory tract infection.

Objective:To explore the clinical application value of routine indicators such as blood routine and liver and kidney function in auxiliary diagnosis and prognosis of COVID-19 patients.Methods:SNK-q and other methods were used to retrospectively analyzed the differences of blood routine test, liver and kidney function and other inflammatory indexes of 30 patients with covid-19, 29 patients with other viral pneumonia, 35 patients with influenza A/B and 25 healthy persons from January 28 to February 14, 2020 in Xiangya Hospital of Central South University.Results:The neutrophils count increased gradually in COVID-19 group, influenza A/B group and other types of viral pneumonia group, and the difference between COVID-19 group and other viral pneumonia groups was statistically significant( H=-19.064, P<0.05); The lymphocyte count decreased gradually in the control group, influenza A/B group, other viral pneumonia group and COVID-19 group. In addition, DB, UA and GLU were also different among groups. Subgroup analysis showed that there were statistically significant differences in N( F=9.581, t=-0.152, P<0.05), N%( F=5.723, t=-0.600, P<0.05), NLR( F=4.773, t=-1.161, P<0.05), PCT( F=17.464, t=-1.477, P<0.05)and CRP( F=7.656, t=-1.973, P<0.05) between patients with lung involvement +-++ and patients with lung involvement +++-++++. There were statistically significant differences in NLR( F=63.931, t=-2.815, P<0.01), AST( F=15.704, t=-1.930, P<0.01), ALT( F=35.551, t=-2.199, P<0.01), LDH( F=7.715, t=-2.703, P<0.05) and GLU( F=6.306, t=-5.116, P<0.05) between the light+common subgroup and the heavy+critical subgroup of COVID-19 clinical classification. Correlation analysis showed that clinical stage and imaging credit period were significantly correlated with NLR ( r=0.406 , P=0.026; r=0.397 , P=0.030), ALT ( r=0.403 , P=0.049; r=0.418 , P=0.047), LDH ( r=0.543 , P<0.01; r=0.643 , P<0.01) and GLU( r=0.750 , P<0.01; r=0.471 , P=0.042). A total of 5 principal components were extracted from all the included indicators, and the comprehensive information extraction rate was 82.86%. Indicators of a large load included Ur, PCT and CRP in PC1; ALT, AST and GLU in PC2; N%, L%, L and NLR in PC3. It indicated that the indicators of acute infection, liver function and blood routine had certein warning effect on disease surveillance. The results of ROC curve analysis showed that the combined detection of N+TB+Urea was the best practice to distinguish COVID-19 and other viral pneumonia, while the combined detection of N+L+UA was the most effective solution to make a distinction between COVID-19 and influenza A/B patients. In the aspect of disease evaluation, NL+LDH+GLU+ALT combined detection represent the best diagnostic performance to distinguish the clinical stage of light+common type and heavy+critical type, achieving the AUC (ROC) to 0.904, with the sensitivity 75% and the specificity 100% at the cut-off value of 0.477. Conclusion:In addition to etiology and imaging examination, doctors can also improve the routine laboratory tests such as blood routine test, liver and kidney function to assist diagnosis and disease prediction of patients with respiratory tract infection.

Objective:To investigate the survival and prognosis of B-lineage acute lymphoblastic leukemia (B-ALL) patients with TP53 mutation.Methods:The clinical data of 479 newly diagnosed B-ALL patients treated in the First Affiliated Hospital of Soochow University from January 2016 to December 2019 were retrospectively analyzed.Results:Among 479 B-ALL patients, 34 cases (7.1%) were positive for TP53 gene mutation, and a total of 36 TP53 mutations were detected, including 10 frameshift gene mutations (27.8%) , 23 missense mutations (63.9%) and 3 nonsense mutations (8.3%) . A total of 34 (94.4%) mutations were located in the DNA binding domain (exons 5-8) .The average number of mutated genes in patients with TP53 gene mutation (2.3) and the group without TP53 gene mutation (1.1) were statistically different ( P<0.001) . The proportion of Ph positive and Ph-like positive patients in the TP53 gene mutation negative group was significantly higher than that of the TP53 mutation positive group, and the difference was statistically significant ( P<0.001) . The 3-year OS and EFS rates of the TP53 gene mutation negative group were significantly higher than those of the TP53 gene mutation positive group. The differences in OS and EFS rates between the two groups were statistically significant ( χ2= 4.694, P = 0.030; χ2= 5.080, P= 0.024) . In the multivariate analysis, failure to achieve remission (CR) after one course of induction chemotherapy was an independent adverse prognostic factor affecting OS.Of the 34 patients with TP53 mutation, 16 underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the CR 1 state, and 2 patients with recurrence after transplantation obtained CR 2 after infusion of donor-derived anti-CD19 chimeric antigen receptor T (CAR-T) cells. Among the 11 patients with TP53 gene mutation who relapsed during consolidation chemotherapy, 6 received anti-CD19 CAR T cell therapy, 4 patients achieved remission and minimal residual disease (MRD) turned negative, followed by bridging allo-HSCT, and 2 of them sustained CR. Conclusion:Missense mutations are the most common in B-ALL patients with TP53 gene mutation, and the majority of mutations were located in the DNA binding domain. B-ALL patients with TP53 gene mutation should undergo allo-HSCT as soon as possible after CAR-T cell therapy has cleared the MRD after recurrence. B-ALL patients with TP53 gene mutation still have a higher recurrence rate after allo-HSCT, and the infusion of donor-derived CAR-T cells can achieve better sustained remission.

Objective To organize the list of medicinal plants in Longzhong region;To conclude the species and distribution of medicinal plants in the region;To provide reference for the protection,development and utilization of TCM resources in the region.Methods The data of the fourth national census of TCM resources were obtained through the database of TCM resources census,and reference was made to the Chinese Botanical Records,Flora of the Loess Plateau,Gansu Herbal Resources Records,Gansu Provincial Standard of Chinese Materia Medica(2020 edition),Gansu Provincial Standard of Chinese and Tibetan Materia Medica(2020 edition),and other books and relevant literature supplementation,to summarize the medicinal plant species and distribution in Longzhong region.The status was summarized and analyzed.Results There are totally 178 families,829 genera and 2 101 species of medicinal plant resources in Longzhong region,mainly exist in angiosperms,gymnosperms and ferns and other groups,of which the dominant families are mainly concentrated in the Compositae,Rosaceae,Leguminosae,etc.The main medicinal parts for the whole grass class,mainly heat-clearing medicines,and 51 species of cultivated medicinal plants,including Astragalus membranaceus(Fisch.)Bge.var.mongholicus(Bge)Hsiao,Rosa rugosa Thunb.,Lonicera japonica Thunb.and so on.Conclusion Longzhong region is rich in plant resources and has many kinds of medicinal plants,which should be rationally developed and utilized on the basis of protection and vigorously develop characteristic TCM industry according to the geographical environment.