Objective To assess the early diagnostic value of white blood cell count (WBC), neutrophil percentage (NEU%), C-reactive protein (CRP) and procalcitonin (PCT) in blood bacterial infection.Methods Clinical data of 114 patients with bacterial blood stream infections(BSI group) and 247 patients without bloodstream infections (control group) admitted to Taiyuan Third People''s Hospitalin 2015 were retrospectively analyzed.The WBC, NEU%, CRP and PCT were measured in all patients.Receiver opearating characteristic curve (Roc) was used to evalute the accuracy of WBC, NEU%, CRP and PCT in the diagnosis of blood stream bacterial infectious.Results There were no significant differences in gender and age between two groups (χ2=0.7731, t=0.9900, both P>0.05).The WBC, NEU%, CRP and PCT levels in BSI group were significantly higher than those in control group (all P<0.05).There were no significant differences in WBC, NEU% and CRP levels between G+ bacterial and G-bacterial infections in bacteremia group (P>0.05), while there was significant difference in PCT level (P<0.05).In diagnosis of bacteremia, the area under the ROC curve of PCT(0.827) was the largest, followed by CRP (0.721), NEU% (0.677) and WBC (0.593), the differences were statistically significant(Z=2.332, 3.355 and 3.786, P<0.05 or <0.01).Conclusion WBC, NEU%, CRP and PCT levels are of certain diagnostic value for bacterial bloodstream infections, particularly the PCT.In addition, PCT can predict G+ bacterial and G-bacterial infections.

Objective To evaluate the incidence and mortality of acute kidney injury (AKI) in coronary care unit (CCU),and to identify the risk factors of the incidence of AKI and the mortality of CCU patients.Methods A total of 414 patients in CCU from January 1,2014 to June 1,2015 at Zhongnan Hospital of Wuhan University were enrolled.Based on the KDIGO-AKI criteria,these patients were classified into two groups:NAKI group (patients without AKI) and AKI group.Clinical characteristics and laboratory data of two groups were compared.The risk factors of the incidence of AKI and the mortality of CCU patients was analyzed by logistic regression,and then the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of these risk factors.Results (1) Among 414 patients,136(32.9％) patients fulfilled the criteria for AKI,and 14.0％ patients in AKI stage 1,10.9％ in AKI stage 2 and 8.0％ in AKI stage 3.(2) The total CCU mortality was 15.0％.Mortality of AKI patients in the CCU was 33.3％,higher than 6.1％ in patients without AKI (OR=7.735,95％CI 4.215-14.196,P ＜ 0.001).The mortality worsened with increasing severity of AKI (22.4％ for AKI stage 1 group,37.8％ for AKI stage 2 group,45.4％ for AKI stage 3 group).(3) Anemia (OR=8.274,95％ CI 4.363-15.689),history of chronic illness (OR=2.582,95％ CI 1.400-4.760),APACHE]Ⅱ seores (OR=1.813,95％CI 1.739-1.895),male (OR=3.666,95％CI 1.860-7.226) were the independent risk factors for AKI,while the normal mean arterial pressure (MAP) (OR=0.292,95％CI 0.153-0.556) and normal estimated glonerular filtration rate (eGFR) (OR=0.166,95％CI 0.090-0.306) are the protective factors for AKI (all P ＜ 0.05).(4) AKI was the most powerful independent factor associated with the mortality of CCU patients (OR=7.050,95％ CI 2.970-16.735,P ＜ 0.001).Other independent risk factors for CCU mortality included history of chronic illness,ejection fraction and APACHE Ⅱ ≥ 15 scores (all P ＜ 0.05),while the normal MAP and normal eGFR were the protective factors (all P ＜ 0.05).(5) For predicting AKI,eGFR displayed an excellent areas under the ROC curve (AUC=0.815,P ＜ 0.001),and for CCU mortality,APACHE Ⅱ scores had the highest overall correctness of prediction (AUC=0.757 P ＜ 0.001).Conclusions CCU patients have high morbidity of AKI,which is the most powerful independent factor associated with the increased CCU mortality.The eGFR is the best predictor for AKI,and then through the evaluation of eGFR for CCU patients,we can evaluate high-risk groups,make early interventions and then improve the prognosis of CCU patients.

Objective To investigate the effect and long-term prognosis of patients who underwent hepatectomy for hepatolithiasis. Methods We retrospectively analyzed the medical records of 98 patients with hepatolithiasis who were treated by hepatectomy in Peking Union Medical College Hospital.Results Male/femah:1/1.7;median age:55 years old.58 cases(59.2%)had been treated before;among them.50 by surgery.In 88 cages(89.8%)hepatolithiasis involved the left lobe only,in 2(2.0%) only the right lobe involved.and in 8(8.2%)both left and right lobe were involved.51(52.0%)had extrahepatic biliary stones,30(30.6%)had biliary duct strictures,28(28.6%)had a history of biliary ascariasis.and 5(5.1%)had a concurrent biliary tract malignancy.All received partial hepatectomy according to the stone location;for the 8 bilaterally involved patients,left hepatectomy and right lithotomy were performed.Postoperative complications occurredin 14 cases(14.3%),and there were2perioperative deaths(2.0%).Seventy-eight patients(79.6%)have beenfollowedupfor over1 yearwith no tumors;the results were excellent or good in 91.0%;the stone residue and recurrence rate were both 2.0%.Conclusions Hepatectomy not only eliminates calcuci,but also removes diseased biliary tracts,with advantages of low residue stone and recurrence rate.

Objective:To investigate the relationship between key molecules of interleukin-6/signal transducer and activator of transcription 3 (IL-6/STAT3) signaling pathway and breast cancer susceptibility.Methods:A case-control study design was adopted. 136 patients with breast cancer admitted to Department of Breast Surgery, Yantai Yantaishan Hospital from Mar. 2021 to Mar. 2023 were selected as the case group, and 136 healthy subjects of the same age were matched as the control group in a 1:1 ratio. The clinical data and key molecules of IL-6/STAT3 signaling pathway were compared between the two groups. The risk factors of breast cancer susceptibility were evaluated by conditional Logistic regression and addition analysis, and the diagnostic efficiency of receiver operating characteristic curve (ROC) and area under curve (AUC) were plotted.Results:The body mass index (BMI) (22.21±0.68 vs. 21.30±0.70 kg/m 2), age at menarche (13.50±1.24 years vs. 14.83±1.42 years), IL-6 (3.50±1.05 vs. 2.41±0.74), Janus protein kinase 1 (JAK1) mRNA (1.23±0.36 vs. 0.88±0.26), STAT3 mRNA (1.68±0.50 vs. 1.17±0.35), and menopause (30.15% vs. 55.88%), breastfeeding (82.35% vs. 92.65%), physical exercise (44.12% vs. 58.09%) were significantly different between the case group and the control group ( t=10.87, 8.23, 9.89, 9.19, 9.75, χ2=18.37, 6.59, 5.31, P<0.05). Breastfeeding [odd ratio ( OR) : 0.550], interleukin-6 (IL-6) ( OR: 4.409), janus protein kinase 1 (JAK1) ( OR: 5.370) and signal transducer and activator of transcription 3 (STAT3) ( OR: 4.386) mRNAs were risk factors for breast cancer susceptibility ( P<0.05). ROC curve showed that the combined diagnostic efficacy of IL-6, JAK1, STAT3 mRNA in breast cancer was significantly better than that of a single diagnostic efficacy. The incidence rate of breast cancer in those who were exposed to IL-6 mRNA and breast feeding was 3.508 times higher than that in those who were not exposed. The incidence rate of breast cancer in those who were exposed to JAK1 mRNA and breast feeding at the same time was 4.136 times higher than that in those who were not exposed. The incidence rate of breast cancer in those who were exposed to STAT3 mRNA and breast feeding was 3.537 times higher than that in those who were not exposed. Conclusion:The key molecules of IL-6/STAT3 signaling pathway and breast-feeding are predisposing factors of breast cancer, and they have additive interaction, thus increasing the susceptibility of breast cancer, which has significant practical significance for the differential diagnosis and treatment of this disease.

OBJECTIVETo investigate the role of CCL20/CCR6/Th17 axis in vascular invasion and metastasis of primary hepatocellular carcinoma (HCC).

METHODSExpression levels of CCL20 mRNA in the normal human liver cell line L-02, and human hepatocellular carcinoma cell lines Hep3B, Huh7 and HepG2 were quantified by using SYBR green real time PCR. CCL20 secretions from these cell lines were quantified by using ELISA. The chemotactic effect of HCC cell line Hep3B on human peripheral blood mononuclear cells was determined by using transwell chemotaxis assay. Pre-therapy serum levels of IL-1α, IL-1β, IL-6, IL-8, IL-10, IL-17, IL-23, IFN-γ, TNF-α and CCL20 in 93 patients with HCC were measured by using 9-plex array and ELISA. All the patients were chronic hepatitis B virus associated HCC, and 51 cases were those with vascular invasion and metastasis (metastasis group) and 42 cases were not (non-metastasis group). CCL20 and CCR6 mRNA expressions in the HCC and tumor-adjacent tissues were determined by using SYBR Green real time PCR in 41 patients, among them, 20 cases were from the group of patients with metastasis and 21 cases were from the group of patients without metastasis. The CCL20 expression was further determined by immunohistochemistry.

RESULTSThe HCC cell lines expressed and secreted higher amount of CCL20, which effectively recruited CCR6(+) T cells. Pre-therapy serum levels of CCL20 in 93 HCC patients were (38.2 ± 28.4)pg/ml, significantly increased than those with benign hepatic hemangiomas [(7.8 ± 17.8)pg/ml, P < 0.01]. In addition, the serum levels of CCL20 were positively correlated with the tumor diameters in HCC patients (r = 0.32, P = 0.0018). CCL20 was dominantly expressed in the cytoplasm in HCC cells, and it was also expressed by some infiltrating immune cells. The mRNA expression levels of CCL20 of the tumor tissues were significantly higher than that in the tumor-adjacent tissues (P < 0.05). Multivariate logistic regression analysis showed that serum levels of IL-17 and CCL20 were independent risk factors of metastasis in HCC patients (P < 0.05 for both). CCL20 mRNA showed no statistically significant differences between patients with metastasis and without metastasis in both tumor tissues and tumor-adjacent tissues (P > 0.05 for both). But the patients with metastasis showed significantly higher expressions of CCR6 both in their tumor [5.75 (1.79, 19.13)]and tumor-adjacent tissues [7.99 (4.49, 19.54)] than those with non-metastasis [1.69 (0.76, 2.87) and 3.58 (1.84, 4.32), P < 0.05 for both].

CONCLUSIONCCL20/CCR6/Th17 axis may promote vascular invasion and metastasis hepatocellular carcinoma.

Bile Duct Neoplasms ; Carcinoma, Hepatocellular ; metabolism ; Chemokine CCL20 ; metabolism ; Humans ; Interleukin-10 ; metabolism ; Interleukin-17 ; metabolism ; Interleukin-23 ; metabolism ; Interleukin-6 ; metabolism ; Interleukin-8 ; metabolism ; Leukocytes, Mononuclear ; Liver Neoplasms ; metabolism ; RNA, Messenger ; Th17 Cells ; Tumor Necrosis Factor-alpha ; metabolism

Dendritic Cells ; cytology ; metabolism ; Enzyme-Linked Immunosorbent Assay ; HEK293 Cells ; Humans ; Interferon Regulatory Factor-7 ; metabolism ; Interferon Type I ; metabolism ; Interferon-gamma ; analysis ; Interleukin-6 ; analysis ; Oligonucleotides ; metabolism ; RNA Interference ; RNA, Small Interfering ; metabolism ; Real-Time Polymerase Chain Reaction ; Receptors, Tumor Necrosis Factor ; antagonists & inhibitors ; genetics ; metabolism