A 74-year-old man presented with yellowish red nodules and plaques on the trunk for more than one year.Physical examination showed more than 20 scattered,irregularly shaped,well-demarcated,yellowish red nodules and plaques measuring 0.5-15 cm in diameter on the trunk.The plaques on the right lower abdomen showed central ulceration and atrophy with scar formation.Plasma protein electrophoresis revealed that the levels of immunoglobulin G (IgG) and kappa light chain were 18.3 g/L and 20.70 g/L respectively.Histopathologically,large necrobiotic areas and granuloma were observed alternately in the dermis and subcutis.There were numerous Touton giant cells,foreign body giant cells and foamy histiocytes in the granuloma,and many cholesterol clefts were found in the center of necrobiotic areas with the formation of lymphoid follicles in some regions.Both eyes of the patient were involved to different degrees.He was diagnosed as necrobiotic xanthogranuloma with IgG kappa paraproteinemia and eve involvement.

Objective To investigate the expression level of tumor necrosis factor α( TNF-α) , heat shock protein 70 (HSP70) in serum and to analyze the correlation of TNF-αand HSP70 with the incidence of type 2 diabetes mellitus (T2DM) among Hui and Han nationalities in Ningxia .Methods Using the method of case-control study and according to the inclusion and exclusion criteria of case and control groups , 225 patients with T2DM who were treated by Department of Endocrinology and 600 healthy people during health checkups were enrolled in the study between October 2011 and October 2012 .A double antibody sandwich enzyme-linked immunosorbent assay ( ELISA) was used to determine the protein expres-sion levels of TNF-αand HSP70 in serum.Results The expression levels of TNF-αin the total population investigated and Hui population in T2DM group were significantly higher than in the control (t=-3.512,-3.791,all P<0.01).The difference in expression levels of TNF-αbetween the Han people of T 2DM group and control group , and that in the expression levels of HSP70 between the case group and control group were not statistically significant ( t =-0.565,-0.020,-1.251,-0.809,all P>0.05).The elevated serum levels of TNF-αincreased the risk for T2DM(OR=1.500, 95%CI:1.075-2.093,P=0.017).The expression levels of TNF-αin the total people, case and control of Hui people were significant lower than the homologous Han people (t=9.373,2.223,9.734, all P<0.01 or 0.05).Pearson analysis showed that the high expression of TNF-αwas positively correlated with blood glucose level (r=0.110,P=0.001),but there was no correlation between the high expression of HSP 70 and blood glucose level (r=0.023, P=0.504).The result of multiple logistic regression analysis indicated that gender and waist-to-hip ratio(WHR) were risk factors for high levels of TNF-α(P<0.01 or 0.05)while HSP70 and nationalities were protective factors.Systolic blood pressure(SBP) and WHR were risk factors for the high level of HSP70(all P<0.01), but TNF-αwas protective factors.HSP70, TNF-α, gender, family history, BMI, SBP, triglycerides(TG), low density lipoprotein cholesterol (LDL-C), alanine trans-aminase(ALT), and psychological stress were risk factors for T2DM, but high density lipoprotein cholesterol (HDL-C) was a protective fac-tor.Conclusion The high expression of TNF-αin serum is closely related to elevated fasting plasma glucose ( FPG) and T2DM onset.The expression level of TNF-αin serum in Hui people is lower than in Han people ,possibly correlated with ethnic heredity.The high expression of HSP70 in serum may induce T2DM onset.

Objective To identify hot research areas of nursing human caring in PubMed from 2012 to 2016, and to explore the present research status and development directions. Methods PubMed was searched using key words human caring. BICOMB 2.0 and SPSS 11.5 software were used to analyze high-frequency keywords and conduct co-word clustering analysis. Results We searched for 3088 related articles and extracted 42 high-frequency keywords (30.97%). Seven hot research areas were identified,including:human caring in nursing practice;nursing models,nursing theories;nursing education of human caring;hospice care;relationship between human caring and nurse-patient relation;human caring of cancer patients;family system,social support and human caring. Conclusion Analysis of research areas of nursing human caring in past 5 years is beneficial to understanding the present research status and development directions,and providing references for practice,research and education of human caring.

Results There was no significant difference in the distribution of genotypes and allele frequencies of HSP 70-1 and HSP70-hom between case group and control group (P>0.05), but there was significant difference in the distribution of genotypes and allele frequencies of HSP70-2 between the two groups(P<0.05).There was no significant difference in the distribution of genotypes and allele frequencies of HSP70-1,HSP70-2 and HSP70-hom between Hui and Han people (P>0.05)or in the distribution of genotypes of HSP 70-2 between males and females in case group, but there was significant difference in the distribution of allele frequencies of HSP 70-2 in case group .There was no significant difference in the distribution of genotypes and allele frequencies of HSP 70-1 and HSP70-hom between males and females in case or control group .Logistic analysis confirmed that the WC, TG, TC, LDL-C, SBP, family history of diabetes and G allele were risk factors of T 2DM. Conclusion GG genotype and G allele of HSP 70-2 (+1267 ) SNP may be genetic markers for the susceptibility of type 2 diabetes.There is no significant difference in the distribution of genotypes and allele frequencies of HSP 70-1,HSP70-2 and HSP70-hom between Hui and Han nationalities .Family history of diabetes, LDL-C, TC, and G allele of HSP70-2 (+1267) SNP are the main risk factors of T2DM while HDL-C is a protective factor.

Objective To explore the endogenesis metabolizer character of kidney-yang insufficiency syndrome model rats caused by hydrocortisoni natrii succinas with metabolomics technology. Methods Twenty four Sprague-Dawley(SD)male rats were divided randomly into a normal group, a kidney-yang insufficiency model group, and a oral administration group, eight rats in each group. After producing kidney-yang insufficiency model by injecting hydrocortisoni natrii succinas intramuscularly, oral administration group rats were administered orally with white prepared lateral root of aconite every day for two weeks. After twenty-four hour the last oral administration, the blood plasm were prepared and used for testing endogenesis metabolism with the liquid phase color spectrum-mass spectra (LC/MS) metabolomics technology. Results Apices shape change of lysophosphatidyl choline (LPC) and lysophosphatidyl ethanolamine(LPE) and 468.4m/z unbeknown chemical compound of normal rats were distinct from those of model rats. Above-mentioned chemical compound as chief material symbols of kidney-yang insufficiency syndrome might be farther studied. Conclusion Finding out differential symbol from endogenesis metabolizer with metabolomics technology was redounded to deep exploring the biology essence of traditional Chinese medicine syndrome.

Background and purpose:The risk of recurrence for colorectal cancer after curative surgery is up to 30%-40%. We aimed to evaluate the relationship between time to relapse (TTR) of colorectal cancer with clinical pathological parameters and overall survival after recurrence. Methods:We carried out the analysis of clinical data, pathological examination and follow up information of 375 colorectal cancer patients who admitted to Liaoning Cancer Hospital. Patients were categorized into relapse at<2, 2-5 and>5 years following their initial surgery. Results:TTR was associated with the clinical stage at diagnosis and liver or lung metastasis status. Short TTR (<2 years) was positively associated with survival. However, there was no significant difference in survival between patients who relapsed at 5 years or later compared with those who relapsed between 2 and 5 years. Conclusion:TTR within 2 years is an important predictor of shorter survival for colorectal cancer patients who experienced a relapse.

In 1930s, Wolf created the first partogram. In 1950s, Friedman proposed the classical model of partogram that has been applied in clinical labor assessment ever since. Over the past ten years, Zhang has made great improvement in this field. Here, we reviewed the three different stages in partogram research (the first proposed stage, Friedman's classical stage and Zhang's stage) in terms of its background, demographic characteristics and clinical application. Moreover, this article also emphasized the necessity of partogram research and discussed the prospects for future research and clinical application based on the recent progress in China.

ObjectiveTo investigate the protective effect of Lycium barbarum polysaccharide (LBP) combined with aerobic exercise (AE) on the liver of rats with nonalcoholic steatohepatitis (NASH) induced by high-fat diet based on the p38 mitogen-activated protein kinase (p38 MAPK)-nuclear factor-κB (NF-κB) pathway. MethodsAfter 1 week of adaptive feeding, 45 Sprague-Dawley rats, aged 8 weeks, were randomly divided into control group (10 rats fed with normal diet) and high-fat group (35 rats fed with high-fat diet). At the end of week 28, the high-fat group was randomly divided into model group, LBP group, AE group, and LBP+AE group, with 8 rats in each group, and intervention was performed for 10 weeks. At the end of the experiment, fasting blood glucose was measure for all rats, and serum samples, liver tissue, and visceral fat were collected. Biochemical kits were used to measure the serum levels of triglyceride (TG), total cholesterol (TC), alanine aminotransferase (ALT), and aspartate aminotransferase (AST); ELISA kits were used to measure the serum levels of fasting insulin (FINS), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and monocyte chemotactic protein-1 (MCP-1); quantitative real-time PCR and Western blot were used to measure the mRNA and protein expression levels of Toll-like receptor 4 (TLR4), p38 MAPK, and NF-κB in liver tissue. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. ResultsCompared with the control group, the model group had significant increases in TG, TC, AST, ALT, FINS, and homeostasis model assessment of insulin resistance (HOMA-IR) (all P ＜0.05), a tendency of increases in the serum levels of the inflammatory factors MCP-1, TNF-α, and IL-6 (all P ＜0.05), and significant increases in the mRNA and protein expression levels of TLR4, p38 MAPK, and NF-κB in liver tissue (all P ＜0.05). Compared with the model group, each intervention group had significant reductions in TG, TC, AST, ALT, FINS, and HOMA-IR (all P ＜0.05), a tendency of reductions in the serum levels of the inflammatory factors MCP-1, TNF-α, and IL-6 (all P ＜0.05), and significant reductions in the mRNA and protein expression levels of TLR4, p38 MAPK, and NF-κB (all P ＜0.05). Compared with LBP group, the LBP+AE group had significant reductions in TG, ALT, FINS, HOMA-IR, MCP-1, the mRNA expression level of TLR4, protein expression levels of p38 MAPK and NF-κB(all P＜0.05). Compared with Ae group, the LBP+AE group had significant reductions in FINS, HOMA-IR, IL-6, MCP-1, the mRNA expression level of TLR4 (all P＜0.05). ConclusionLBP combined with AE may improve inflammation in NASH rats by regulating the p38 MAPK/NF-κB pathway.

Objective:To investigate the changes of Toll-like receptor 4(TLR4) level in peripheral blood of endometriosis (EMT) patients with infertility and its relationship with clinicopathological types and pregnancy outcomes.Methods:A total of 150 patients with EMT complicated with infertility (study group) admitted to Huangzhou District People′s Hospital of Huanggang City from May 2019 to March 2021 and 50 healthy married women (control group) who participated in physical examination during the same period were selected as the research objects. Reverse transcription polymerase chain reaction (RT-PCR) was used to determine the level of TLR4 in peripheral blood of the two groups, and different pathological types of EMT were compared. The receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of TLR4 expression for postoperative pregnancy in EMT patients with infertility. At the same time, the relationship between changes in TLR4 level in peripheral blood and pregnancy outcomes was analyzed according to the TLR4 cut-off value.Results:The expression of TLR4 mRNA in peripheral blood in the study group was higher than that in the control group: 98.65 ± 10.63 vs. 1.27 ± 0.20, there was statistical difference ( t = 64.66, P<0.01). After treatment, the expression of TLR4 mRNA in peripheral blood of patients with simple peritoneal type, internal cystic type and adenomyosis type EMT complicated were decreased :81.13 ± 8.89 vs. 64.31 ± 6.44, 103.58 ± 10.01 vs. 85.40 ± 8.78, 118.69 ± 12.76 vs. 96.38 ± 9.96, There were statistical differences ( P<0.05); No matter before or after treatment, the expression of TLR4 mRNA in peripheral blood of patients with adenomyosis was higher than that of patients with internal cystic type and simple peritoneal type, while the expression of TLR4 mRNA in peripheral blood of patients with internal cystic type was higher than that of simple peritoneal type, and there were statistical differences ( P<0.05). The results of ROC curve analysis showed that when the area under the curve (AUC) was 0.787(95% CI 0.701 - 0.863, P<0.05) and the best cut-off value was 41.75, the sensitivity, specificity and accuracy of TLR4 mRNA expression in peripheral blood to predict postoperative pregnancy in EMT patients with infertility were 80.12%, 81.57% and 80.30%, respectively. Using the peripheral blood TLR4 mRNA expression of 41.75 as the cut-off value, 143 patients with EMT and infertility with complete follow-up data were divided into high expression group (58 cases, TLR4 mRNA≥41.75) and low expression group (85 cases, TLR4 mRNA < 41.75). The postoperative intrauterine pregnancy rate and total pregnancy rate in the high expression group were lower than those in the low expression group: 44.83% (26/58) vs. 70.59% (60/85), 58.62% (34/58) vs. 81.18% (69/85), and there were statistical differences ( χ2 = 9.54, 8.71, P<0.05). Conclusions:There is abnormal expression of TLR4 in peripheral blood of EMT patients with infertility, and its high expression is closely related to adverse clinicopathological features and pregnancy outcomes. Effective intervention of treatment and postoperative recovery according to the expression level of TLR4 mRNA can further improve the natural pregnancy rate of such patients.

Objective To construct a human renal epithelial cell line HEK293T by CRISPR-Cas9-based site-directed knock-in of vascular endothelial growth factor 165 (VEGF165) gene, and avoid the off-target effect caused by lentivirus infection. Methods The VEGF165 expression vector with homologous arm (pUCm-T-VEGF165 plasmid) and the sgRNA expression vector [pSpCas9(BB)-2A-Puro-sgRNA plasmid] were designed and constructed based on the DNA sequence of the EZH2 gene, and then co-transfected into HEK293T cells. The expression of VEGF165 mRNA was detected by qPCR and the expressions of VEGF165 proteins were detected by Western Blot. Results The qPCR and Western Blot results showed that, comparing with the control, the pUCm-T-VEGF165 plasmid and pSpCas9(BB)-2A-Puro-sgRNA plasmid, the expression of the co-transfection plasmid were significantly increased, i.e. 3.42±0.30 vs. 1.02±0.21, 1.13±0.16 and 0.98±0.18 for the VEGF165 mRNA level (all P<0.01), and 1.13±0.16 vs. 1.02±0.06, 0.88±0.03 and 0.80±0.05 for the VEGF165 protein level (all P<0.01), respectively. Besides, the expression of EZH2 was significantly down-regulated, i.e. 0.14±0.06 vs. 1.08±0.11, 1.02±0.12 and 1.13±0.16 for the EZH2 mRNA level (all P<0.01), and 0.23±0.03 vs. 1.05±0.13, 0.91±0.04 and 0.81±0.06 for the EZH2 protein level (all P<0.01), respectively. This result showed that the VEGF165 was successfully inserted into the EZH2 genome, interfering the EZH2 expression. Conclusions VEGF165 gene can be successfully knocked into HEK293T cells by CRISPR/Cas9 system.