Hemorrhagic Disorders ; genetics ; Humans

Regulatory T cells play an important role in regulating immune responses.Recently,a novel immune Treg cell with phenotype TCRαβ + CD3 + CD4-CD8-NK1.1-was known as the Double-negative T cells (DNT).DNT cells are able to suppress CD4 + and CD8 + T cells,B cells as well as NK cells and dendritic cells(DCs) and play an important role in regulating immune responses in models of autoimmunity,infection,inflammatory disease,transplantation and tumor immunity.Now DNT cells have already become a hot point in the research of the immunotherapy.This article mainly introduces the possible sources of DNT cells and the mechanisms of their functions.

As small non-coding RNAs,microRNAs (miRNAs)have been recognized as important reg-ulatory factors in the post-transcription regulation network.Studies have shown that miR-133a and miR-133b, as members of miR-133 family,can regulate the expression of target genes such as epidermal growth factor receptor and oncogene.They regulate the mitogen-activated protein kinases and protein kinase B signaling path-ways,which affect tumor cell proliferation,invasion and migration.MiR-133 plays a key role in the process of tumor development and progression,suggesting that it could be served as a new target for cancer treatment.

Spatial statistics plays an important role in spatial epidemiology studies of echinococcosis .Spatial statistics can be used to describe the spatial distribution ,predict the prevalence ,identify disease clusters ,and analyze the influencing factors of echinococcosis .To describe spatial distribution and predict the prevalence ,we can use spatial interpolation ,empirical bayes smoothing and ellipsoidal gradient .Spatial autocorrelation always used to identify disease clusters .Moran's I value ,Getis'G val‐ue and spatial scan statistics are used to judge spatial autocorrelation .Molding plays an important role on analyzing risk factors of echinococcosis .Generalised linear mixed models and Bayesian model are always performed with both spatial factors ,such as geomorphologic features ,climatic characteristics ,vegetation index and factors which make great effect on disease transmission . To figure out the spatial distribution of echinococcosis is significant for echinococcosis control and prevention .

Objective To analyze the clinical effect and safety of cortical bone decortication combined locking plate fixation for treatment of long bone nonunion of limbs. Methods Eighty patients with long bone nonunion of limbs who were treated in the Zhongshan Hospital Affiliated to Dalian University from Jun. 2010 to Jun. 2013 were selected as our subjects and their clinical data were recorded. According to different treatment methods,the patients were divided into control group and observation group,and each group with 40 cases. Patients in observation group were treated with cortical bone decortication combined locking plate fixation, while in control group were treated with locking plate combined slotted bone graft. Clinical effects and safety of two groups were compared. Results Excellent and good rate in observation group was 100%(40/40),obviously higher than that of control group(90. 0%(36/40);χ2 =4. 21,P﹤0. 05). Bleeding amount during operation in observation group was(370. 5 ± 56. 5)ml,obviously less than that of control group((486. 5 ± 64. 5)ml;t=8. 56,P﹤0. 01). And the fracture healing time was(5. 6 ± 1. 2)months in observation group,shorter than control group((7. 2 ± 1. 5)months;t =5. 27,P ﹤0. 01). The postoperative complication occurrence rate was 5. 0%(2/40),significantly lower than control group(20. 0%(8/40);χ2 =4. 11,P ﹤0. 05). Conclusion Cortical bone decortication combined locking plate fixation for treatment of long bone nonunion of limbs is safe and effective,and it can reduce operation injury and accelerate postoperative healing of fracture.

Objective To compare the treatment effects of catheter directed thrombolysis and thrombetomy for acute ar?terial ischemia of the lower extremity. Methods Patients who visited Tianjin Medical University General Hospital from 2011 to 2013 and were attacked by acute ischemic disease of lower extremities within 3 days (n=66) were investigated. Thrombetomy and thrombolysis treatment had been performed to 32 cases and 34 cases respectively according to patients’ own willingness. Postoperative symptom remission rate, limb salvage rate, fatality rate, reperfusion injury rate (including re?nal inadequacy, heart failure, muscle fascia compartment syndrome), bleeding rate and limb dysfunction rate were compared between these two groups. Results There was no statistical difference on the rate of symptom remission (93.8% vs 94.1%), limb salvage(96.9%vs 100%), case fatality rate(3.1%vs 0), bleeding rate(0 vs 8.8%)and limb dysfunction rate (0 vs 5.9%)between these two groups. However, the incidence of reperfusion injury was higher in the group of thrombectomy (37.5%vs 2.9%, P<0.05)compared to that of the other group. Conclusion Similar effect of treatment and less reperfusion injury, especially renal injury, had been achieved by CDT compared with thrombetomy.

Objective To investigate the expression levels and clinical significance of programmed cell death 1 ligand (PD-L1) and programmed cell death factor-1 (PD-1) in peripheral T-cell lymphoma (PTCL). Methods Immunohistochem?istry was used to detect expression levels of PD-L1 and PD-1 in PTCL (test group, n=51) and benign proliferative lesions of lymph node tissues (control group, n=20). The correlations of PD-L1 and PD-1 expressions with clinical pathological param?eters and prognosis were analyzed between two groups. Results The expression level of PD-L1 was significantly higher in PTCL group than that in control group (74.51%vs 35.00%,χ2=9.662, P<0.05). The positive expression of PD-1 was signifi?cantly higher in PTCL group than that in control group (66.67%vs 25.00%,χ2=10.074, P<0.05). There were significant dif?ferences in PD-L1 and PD-1 expressions between different peripheral lactate dehydrogenase (LDH) levels of PTCL group (P<0.05). After two cycles of CHOP or ECHOP treatments, the response rate (RR) was higher in PD-L1 negative group than that in positive group (84.6%vs 47.4%,χ2=5.478, P<0.05), and RR was higher in PD-1 negative group than that in positive group(82.4%vs 44.1%,χ2=6.755, P<0.05). The median overall survival (OS) time was higher in PD-L1 negative group than that in positive group (29.8 months vs 17.6 months,χ2=4.413, P<0.05) and the median OS time was higher in PD-1 negative group than that in positive group (29.8 months vs 17.6 months,χ2=8.293, P<0.05). Conclusion There are high expression levels of PD-L1 and PD-1 in peripheral T-cell lymphoma, which is closely related with the elevated LDH in peripheral blood, poor response rate and shorter OS. Therefore, the expression levels of PD-L1 and PD-1 can be used as factors of worse effect of chemotherapy and poor prognosis.

Coordinated care delivery is faced with various challenges to carry out in China,which are major decisions to make for decision makers,including how to push forward,how to deliver resources, services and patients to primary institutions,and how to ease the difficulties and affordability of seeing doctors.Based on analysis of roadblocks in coordinated care delivery in China,the authors provided near-term and long-term policy recommendations on the system,including how to build a scientific and reasonable healthcare delivery system,coordinated care delivery by stages,building incentives and constraint mechanisms,and enhancing public awareness and patient-doctor education.

Concept of coordinated care delivery is clearly defined,before a comparative analysis is made between such a concept and the integrated care delivery concept which is popular overseas and similar.On such basis,a theory framework is established for building and implementing such care delivery in line with the integrated theory of care delivery systems.Coordinated care delivery system now in place in China aims at rationally delivering medical resources,services and patients to primary institutions,by means of efficiently distributing resources and service systems and integrating care delivery flows,thus offering patients with cost effective and appropriate services and optimizing the care delivery system.

Objective To identify the risk factors for surgical site infections after operation of laparoscopic cholecystectomy (LC), so as to provide warning signs for preventing such incidents. Methods The data of 4042 LC patients from January 2003 to December 2015 were analyzed retrospectively. The risk factors for surgical site infections were identified among demographic data, preoperative patients′history, and operative data using multivariate Logistic regression analysis. Results Surgical site infections after LC was seen in 7.2% (291/4042) of the patients. Multivariate analysis identified the following parameters as risk factors for surgical site infections: additional surgical procedure ( OR 4.011, 95%CI 2.149-7.486), age over 55 years (OR 2.398, 95%CI 1.777-3.235), conversion to open procedure (OR 2.647, 95%CI 1.935-3.621), postoperative hematoma (OR 1.910, 95%CI 1.192-3.060), duration of operation >60 min (OR 2.493, 95%CI 1.710-3.635), cystic stump insufficiency (OR 12.451, 95%CI 4.169-37.189), gallbladder perforation (OR 6.161, 95%CI 2.365-16.047), gallbladder empyema (OR 1.704, 95%CI 1.080-2.689), and surgical revision (OR 15.725, 95%CI 10.439-23.686). Surgical site infections were associated with a significantly prolonged hospital stay (P<0.01), higher postoperative mortality (P<0.01), and increased rate of surgical revision (P<0.01). Conclusions Additional surgical procedure is identified as a strong risk factor for surgical site infections after LC. Furthermore, operation time >60 min, age >55 years, conversion to open procedure, cystic stump insufficiency, postoperative hematoma, gallbladder perforation, gallbladder empyema, or surgical revision were identified as specific risk factors for surgical site infections after LC.