AIM: To clone and express the metalloproteinase domain of human von Willebrand factor-cleaving protease (vWF-cp). METHODS: The metalloproteinase domain of human vWF-cp, amplified from the plasmid containing the vWF-cp cDNA gene by using polymerase chain reaction, was cloned into pUC18, and its accuracy was verified by sequencing. Then the domain was inserted into the multiclone site of pET28a(+) and included a 6?His Tag at its amino terminal. After induced by IPTG, the recombinant protein was purified by using a Ni-NTA column and confirmed by Western blot. RESULTS: Comparison of the nucleotide sequence of our cloned domain with the GenBank sequence revealed no difference. High-level expression of the recombinant protein was yielded after 5-hour induction, which amounted to 28% of total bacteria protein in inclusion body. Western blot demonstrated that it possessed high specificity. CONCLUSION: The metalloproteinase domain of vWF-cp was high efficiently expressed in Escherichia coli. This might contribute to the further study of the relationship between its structure and function. [

Pathologic experiment teaching is special feature and stresses morphologic teaching,It is easy for stuents to learn passively.Problem-basedlearning ( PBL ) was introduced in pathologic experiment teaching in eight-year clinical medicine.program courses.In pathologic experiment class,questions was produced by analyzing various diseases,observing macroscopic and microscopic changes,discussed by clinical cases and solved by students themselves with bilingualistic teaching.In conclusion,PBL was significant in improving the quality of pathological experiment teaching,overcoming the shortage of morphologic learning,and making students more active in learning pathology.

Objective To analyze the impact of lymphocyte subsets on chemotherapy efficacy and long-term survival of patients with advanced non-small cell lung cancer(NSCLC).Methods Totally 125 NSCLC patients who had received first-line chemotherapy including paclitaxel and pemetrexed with/without platinum were enrolled in this study.Lymphocytes from peripheral blood were collected before and after two cycles of first-line chemotherapy.Flow cytometry was performed to determine the expressions of 21 fluorescence-labeled lymphocyte subsets.Based on the imaging findings,chemotherapy efficacy was evaluated,and impact of the lymphocyte subsets on progression-free survival(PFS)and overall survival(OS)were analyzed.Results The baseline peripheral lymphocyte subsets showed no significant difference among groups receiving different treatment protocols(all P>0.05).After 2 cycles of chemotherapy,the percentage of CD4CD29lymphocytes was(16.87±5.28)% in progressive disease group,which was significantly lower than those in complete remission+partial remission group [(22.42±7.88)%,P=0.013] and stable disease group [(21.88±6.81)%,P=0.009].The median PFS was 7.07 months and median OS was 23.00 months.Cox multivariable regression analysis showed that the percentages of HLA-DR(HR:1.03,95%CI:1.01-1.05,P<0.001) and CDHLA-DRlymphocytes (HR:1.05,95%CI:1.01-1.08,P<0.001)were positively correlated with OS.Conclusions The rise of CD4CD29T lymphocytes in patients after chemotherapy indicates good chemotherapy efficacy.Higher percentage of HLA-DRand CD3HLA-DRlymphocytes in peripheral blood before chemotherapy predicts favorable prognosis.

BACKGROUND:Simple pedicle screw fixation for thoracolumbar fractures has better outcomes, but there are some deficiencies, such as poor applicability for severe compression or burst fractures, strong vertebral pain, easy to cause vertebral wound denervation and paraspinal muscle injury, and slow recovery. OBJECTIVE:To investigate the clinical effects of pedicle screw fixation combined with artificial bone graft for the treatment of thoracolumbar fractures. METHODS:A total of 126 patients with thoracolumbar vertebral compression fractures, who had undergone pedicle screw fixation without bone graft (control group,n=62) and with bone graft (test group,n=64) were enroled. The fracture healing, anterior vertebral height ratio, sagittal Cobb angle, and loss rate of vertebral height after 6 months were observed by X-ray in the two groups. RESULTS AND CONCLUSION:Al patients were folowed up, and had complete fracture healing after 12-16 months. The anterior vertebral height and Cobb angle were both improved in the two groups at 1 week after operation (P < 0.01), but there was no difference between the two groups (P > 0.05). New bone formation was observed in the test group at 6 months after operation, and patients were pain-free; but the speed of bone formation was slower in the control group, and patients stil suffered from painful thoracolumbar fractures. There was no difference in the loss of anterior vertebral height and Cobb angle between the two groups (P> 0.05). These findings indicate that pedicle screw fixation combined with artificial bone graft lead to a better recovery in thoracolumbar fractures.

Objective To explore the effectiveness of a respiratory function training instrument with stable chronic obstructive pulmonary disease (COPD) patients.Methods Sixty-seven COPD patients in the stable period were randomly divided into a treatment group of 36 and a control group of 31 using a random number table.Both groups were given conventional pulmonary rehabilitation,including half-closed lip respiration,abdominal respiration and upper limb training.The treatment group was additionally provided with 30 minutes of respiratory training using a respiration function training instrument 5 times per week for 6 months.Both groups were assessed for their mobility,life quality and pulmonary function using the 6-minute walk test (6 MWT),a COPD assessment test (CAT),the BODE index,forced vital capacity (FVC),forced expiratory volume in one second (FEV1) and surface electromyography (SEMG) of the respiratory muscles before and after the 6-month intervention.Results Before the treatment there were no significant differences between the two groups in terms of any of the measurements.After the treatment,significant improvement was observed in the average 6 MWT,CAT,BODE index and SEMG results in both groups,but with significantly greater improvement in the treatment group.The average FVC and FEV1 results did not improve significantly,so after the intervention there was still no significant difference between the groups.Conclusions Respiratory training using the pulmonary function training instrument can improve the mobility,life quality and the functioning of the respiratory muscles of COPD patients in the stable period.

The various mechanisms of kyphosis of the spine and the differential diagnosis of related diseases to guide the selection of appropriate surgical timing, correct spinal osteotomy and reasonable surgical methods. The 24 patients with kyphosis from January 2016 to January 2018 were diagnosed. All patients underwent kyphosis orthopedics, mainly spinal wedge osteotomy, to obtain orbital purpose by wedge osteotomy. The indexes of the spine form, activity, and pain were observed after operation. Of the 24 patients with kyphosis, 5 patients were treated conservatively, and the symptoms of kyphosis were effectively relieved. 19 patients underwent kyphosis orthopedic surgery, and the anterior spine and posterior closed osteotomy. The patients recovered well after surgery and were followed up regularly. The treatment of high anterior spine and posterior closed osteotomy in patients with kyphosis has accurate surgery effect. There are no complications such as pain and internal fixation during the regular follow-up.

OBJECTIVETo study the feasibility of subtotal colectomy with cecorectal end-side anastomosis for slow transit constipation.

METHODSRetrospective analysis was performed on 23 patients with colon slow transit constipation treated by subtotal colectomy with cecorectal end-side anastomosis in our department from March 2006 to April 2013. The main measure outcome was the curative effect on constipation by this type of surgery.

RESULTSTwenty-three patients were successfully treated. Anastomotic leakage occurred in one case, and urinary retention in 1 case, while no anastomotic stricture, abdominal bleeding, abdominal hernia, incontinence and other complications occurred. During follow-up of 2 months to 7 years, defecation frequency was 1-4 times a day with no need of antidiarrheal agents. Each time of defecation was less than 5 min. All the patients had no recurrence of constipation.

CONCLUSIONSubtotal colectomy with cecorectal end-side anastomosis can be used to treat colon slow transit constipation, while accurate preoperative evaluation and strict indications for the surgery is the key to success.

Anastomosis, Surgical ; Cecum ; surgery ; Colectomy ; Colon ; surgery ; Constipation ; surgery ; Defecation ; Humans ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo analyze the cause of atypical manifestation of hepatocellular carcinoma (HCC) in triple-phase spiral CT enhanced scan.

METHODSTriple-phase spiral CT scan was performed in 75 patients with HCC. The hepatic arterial phase (HAP), portal venous phase (PVP) and delayed phase (DP) images were started at 25 to 30 s, 65 to 70 s and 3 tp 5 min after injection of contrast medium. The contrast enhanced patterns of lesion were observed and analyzed.

RESULTSNinety-two lesions were found in 75 patients. Typical enhanced findings such as hyperdense in HAP and hypodense in PVP and DP was found in 60 of 92 lesions. Atypical enhanced findings were observed in the other 32 lesions. Fourteen of 32 atypical enhanced lesions were hyperdense in HAP and isodense in PVP, of which 8 were seen in liver cirrhosis and 3 in fatty liver. In DP, 10 were hypodense and 4 still isodense. Eight of the 32 lesions were hyperdense both in HAP and PVP, of which 6 were seen in fatty liver. In DP, 3 were isodense and 5 were hypodense. Six of 32 lesions were isodense in HAP which became hypodense in PVP and DP. Four of 32 lesions were all hypodense in HAP, PVP and DP.

CONCLUSIONMultiple atypical enhanced manifestations are present by triple-phase spiral CT scan in HCC. Pattern of blood supply, scanning technique and pathophysiologic status are usually the cause of these findings.

Adult ; Aged ; Carcinoma, Hepatocellular ; diagnostic imaging ; Contrast Media ; Humans ; Liver Neoplasms ; diagnostic imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

Objective To explore the common CT signs of acquired immune deficiency syndrome(AIDS)-associated pneumocystis jirovecii pneumonia(PJP).Methods The chest CT data of 123 patients with AIDS-associated PJP were analyzed retrospectively.Results Multifocal lesions in both lungs were found in all cases.Distribution characteristics were as follows:diffuse and symmetrical distribution in both lungs in 100 cases(81.3％),diffuse and asymmetrical distribution in both lungs in 15 cases(12.2％),and scattered distribution in both lungs in 8 cases(6.5％).The density and morphological features were as follows:ground glass opacity in 120 cases(97.6％);"lunate arch sign"in 25 cases(20.3％);pulmonary interstitial proliferation in 103 cases(83.7％);crazy paving pattern in 14 cases(11.4％);patchy or consolidation shadow in 55 cases(44.7％);pulmonary cysts in 26 cases(21.1％);and nodular in 26 cases(21.1％).Other rare signs included pleural effusion in 11 cases,pericardial effusion in 6 cases,mediastinal and hilar lymphadenopathy in 9 cases,and mediastinal emphysema in 1 case.Conclusion The chest CT manifestations of AIDS-associated PJP have certain characteristics,including diffuse and symmetrical distribution of lesions in both lungs,as well as ground glass opacity and interstitial hyperplasia as common signs,especially,"lunate arch sign"and pulmonary cysts are more specific signs.

Objective:To observe the changes of blood cell count, and levels of hormone, glucose, and electrolytes at adrenocorticotrophic hormone (ACTH) and thyrotropic hormone (TSH) axes in patients with traumatic brain injury (TBI) at early stage, and explore the correlations among these indicators.Methods:Prospective selection of 93 patients with TBI (TBI group), admitted to our hospital from March 2018 to July 2019, and 18 health subjects accepted physical examination (control group) during the same period was performed. TBI patients were divided into mild, moderate, and severe subgroups according to Glasgow coma scale (GCS) scores at admission. The changes of blood cell count, and levels of hormone, glucose, and electrolytes of these TBI patients and the control subjects were detected on the 2 nd, 8 th, and 15 th d of TBI. Results:(1) The cortisol (COR) level in TBI group was significantly higher than that in control group on the 2 nd and 8 th d of TBI (P<0.05); COR level in TBI group was decreased on the 2 nd, 8 th, and 15 th d of TBI, successively. TSH level in the TBI group was significantly lower than that in control group on the 2 nd d of TBI; TSH level in patients from the TBI group on the 8 th and 15 th d of TBI was significantly higher than that on the 2 nd d of TBI (P<0.05). Triiodothyronine (T3) level in the control group, and mild, moderate, and severe TBI subgroups decreased successively on the 2 nd d of TBI; and T3 level in TBI group was significantly lower than that in the control group on the 8 th and 15 th d of TBI; T3 level in the TBI group on the 15 th d of TBI was significantly higher than that on the 2 nd and 8 th d of TBI (P<0.05). Tetraiodothyronine (T4) level in the control group, and mild, moderate, and severe TBI subgroups decreased successively on the 2 nd d of TBI; and T4 level in the control group was significantly higher than that in the mild and severe TBI subgroups on the 8 th d of TBI(P<0.05); patients in the severe TBI subgroup had increased T4 level successively on the 2 nd, 8 th, and 15 th d of TBI. Free triiodinated thyroxine (FT3) level in the control group, and mild, moderate and severe TBI subgroups decreased successively on the 2 nd d of TBI; and FT3 level in the TBI group was significantly lower than that in the control group on the 8 th and 15 th d of TBI; FT3 level in TBI group on the 15 th d of TBI was significantly higher than that on the 2 nd and 8 th d of TBI (P<0.05). Free tetraiodothyronine (FT4) level in the control group and moderate TBI subgroup was significantly higher than that in the mild and severe TBI subgroups on the 2 nd and 8 th d of TBI (P<0.05). (2) The white blood cell (WBC) count of the TBI group was significantly higher than that of the control group on the 2 nd d of TBI (P<0.05); the WBC count in the moderate TBI subgroup, severe TBI subgroup, mild TBI subgroup and control group decreased, successively, on the 8 th d of TBI; the WBC count in the severe TBI subgroup, mild TBI subgroup, moderate TBI subgroup and control group decreased, successively, on the 15 th d of TBI; the WBC count in the patients of mild TBI subgroup on the 8 th and 15 th d of TBI was significantly lower than that on the 2 nd d of TBI, and that in patients of moderate and severe TBI subgroups on the 15 th d of TBI was significantly lower than that on the 2 nd and 8 th d of TBI (P<0.05). The red blood cell (RBC) count in the mild, moderate, and severe TBI subgroups, and control group were increased, successively, on the 2 nd, 8 th, and 15 th d of TBI. The platelet (PLT) count in the TBI group was significantly lower than that in the control group on the 2 nd d of TBI, and the PLT count in the mild and moderate TBI subgroups, and control group was significantly lower than that in the severe TBI subgroup on the 15 th d of TBI (P<0.05); the PLT count in the TBI group increased successively on the 2 nd, 8 th, and 15 th d of TBI. The blood glucose level in the control group, and mild, moderate and severe TBI subgroups increased, successively, on the 2 nd d of TBI, and the blood glucose in the severe TBI subgroup was statistically higher than that in the control group on the 8 th d of TBI; the blood glucose level in the TBI subgroup decreased, successively, on the 2 nd, 8 th, and 15 th d of TBI. Potassium level in the mild, moderate and severe TBI subgroups was significantly higher than that in the control group on the 15 th d of TBI; significantly higher potassium level on the 8 th and 15 th d of TBI was noted than that on the 2 nd d of TBI in patients from the moderate and severe TBI subgroups (P<0.05). The sodium content in the severe TBI subgroup was significantly higher than that in the mild and moderate TBI subgroups and control group on the 2 nd d of TBI; the sodium content in the severe TBI subgroup was statistically lower than that in the control group on the 15 th d of TBI (P<0.05). In patients from the severe TBI group, the sodium and chlorine contents on the 8 th and 15 th d of TBI were significantly lower than those on the 2 nd d of TBI. The blood calcium content in the moderate TBI subgroup and control group was significantly higher than that in the mild and severe TBI subgroups on the 2 nd d of TBI, and the calcium content in the severe TBI subgroup was significantly lower than that in the control group on the 15 th d of TBI; calcium content in the mild and severe TBI subgroups on the 8 th and 15 th d of TBI was significantly higher than that on the 2 nd d of TBI ( P<0.05). (3) In TBI patients, WBC count and blood glucose level were positively correlated with COR, and negatively correlated with TSH, T3 and FT3 levels ( P<0.05). RBC count was negatively correlated with TSH level, and positively correlated with FT4 level ( P<0.05). PLT count was negatively correlated with COR and positively correlated with ACTH, TSH, T3, T4 and FT3 levels ( P<0.05). Potassium was positively correlated with TSH, T3, T4, FT3 levels, and negatively correlated with COR ( P<0.05). Sodium was negatively correlated with TSH, T4, FT3 and FT4 levels, and positively correlated with COR ( P<0.05). Chlorine was negatively correlated with COR, TSH, T4, FT3 and FT4 levels ( P<0.05). Calcium was positively correlated with T3, T4, FT3 and FT4 levels ( P<0.05). Conclusions:The more severe the injury of TBI patients, the more significant the decline of T3, FT3, and FT4 levels and RBC count, and the more significant the increase of WBC count and glucose level. Most of them gradually returns to normal within one-2 weeks of injury. It is recommended to evaluate ACTH axis and TSH axis functions when blood cell count, glucose, and electrolytes are abnormal after TBI.