Objective To investigate the relationship between the helper T cell 17 (TH 17)/ Regulatory T cells (Treg cells) balance in peripheral blood with acute graft-versus-host reaction (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT),as well as the impact of anti-thymocyte immunoglobulin (ATG) on helper T cells in peripheral blood.Method Seventyeight hematologic patients underwent allo-HSCT,conditioning with or without ATG.Ten healthy volunteers severed as a control group.The helper T and regulatory T cells in peripheral blood were detected by flow cytometry.Enzyme-linked irnmunosorbent assay (ELISA) was used to detect serum concentrations of interleukin(IL)-17,IL-21,IL22,IL23,γ interferon (IFN-γ),and transforming growth factor β1 (TGF-β1).Result The percentage of Treg cells,TH17 cells and ratio of TH17/Treg cells in patients without aGVHD showed no significant difference from the healthy controls (P＞ 0.05).As compared with control group and non aGVHD group,the ratio of Treg cells was increased,the percentage of TH 17 cells,and TH 17/Treg cells were significantly increased in 1-2-degree aGVHD group (P＜0.01).With increased degree of aGVHD,the difference as above was more significant in 3-4-degree aGVHD recipients (P＜0.01).In aGVHD group,the IL-17,IL-23,IL-21 and IFN-γ concentrations were higher than the healthy group (P＜0.01) and non-aGVHD group (P＜0.05).Serum TGF-β1 level in aGVHD group was significantly decreased as compared with healthy group and non-GVHD group (P＜0.05),while IL-22 concentrations showed no statistically significant difference among three groups (P＞0.05).In anti-thymocyte immunoglobulin (ATG) pretreatment group,the absolute count of peripheral blood lymphocytes was less than in healthy control group (P＜0.01).In ATG group,the absolute counts of TH1 cells,TH17 cells,CD3+ CD4+ cells and non-TH1/17 cells were less than in non-ATG group (P =0.0000),while the absolute counts of lymphocytes,CD3+ CD4-cells,and TH 1/17 cells were less than in non-ATG group,but there was significant difference (P＞0.05).Conclusion The balance of TH 17/Treg cells and related cytokines were closely associated with aGVHD after allo-HSCT,and ATG influences the reconstruction of TH 17 and Th1 cells at early stage.

Objective To establish a mice model of diffuse large B-cell lymphoma (DLBCL) that was treated with adoptive immunity of Th17 cells cultured in vitro,and to analyze the relationship between IL-17 and MHC Ⅱ expression and their relation with tumor growth.Methods The CD4+CD62L+ T cells purified by MACS were stimulated under cytokine conditions including anti-CD3,anti-CD28,TGF-β and IL-6 in vitro,and SUDHL-4 cells were cultured and inoculated the SCID mice to establish DLBCL mice models.The mice were divided into Th17 cells immunity group (30 mice) and control group (20 mice).Th17 cells were injected to mice to get the adoptive immunity in immunity group,and 0.9 ％ NaCl in control group.The half mice were terminated at median disease onset time and median survival time,respectively.ELISA was used to detect IL-17 expression,and immunohistochemistry was applied to detect MHC Ⅱ expression in the tumor tissues.Results The median disease onset time of DLBCL mice model was 8 d,and median survival time was 28 d.The IL-17 and MHC Ⅱ expression levels in Th17 cells immunity group [(11.93±0.56) pg/ml,(69.13t0.36) ％] were higher than those in control group [(9.82±0.26) pg/ml,(42.59±0.12) ％] (both P＜ 0.000 1).Along with the progress of DLBCL,IL-17 and MHC Ⅱ expression levels were decreased [(9.53±0.18) pg/ml,(54.63±0.45) ％,both P ＜ 0.000 1].There was a significantly positive correlation between IL-17 and MHC Ⅱ (r=0.89,P=0.000).Conclusions The expression level of MHC Ⅱ can be used as a factor to judge the disease situation of DLBCL,and combination detection of the expression of both IL-17 and MHC Ⅱ will provide more reference values for judgment of the disease situation and the progress of DLBCL.

Objective To analyze the characteristics of concurrent pattern elements of the patients with phlegm or non-phlegm pattern in metabolic syndrome, explore the correlation between different disease locations as well as complicated diseases and physicochemical parameters in patients with metabolic syndrome, and to provide a theoretical basis for the early detection, diagnosis and treatment of the disease. Methods The 2005 International Diabetes Federation diagnostic criteria and pattern element differentiation method were used to select 334 patients of metabolic syndrome with phlegm pattern and 288 patients of metabolic syndrome with non-phlegm pattern into this study. Physical and chemical parameters and TCM four diagnostic data were entered and analyzed with SPSS 20.0 to explore characteristics of concurrent pattern elements of phlegm and non-phlegm patterns in patients with metabolic syndrome,and to explore the correlation between different locations as well as complicated diseases and physicochemical parameters in patients of metabolic syndrome. Results 1.Disease locations of liver, spleen, kidney, lung,gallbladder, stomach distributed in phlegm group were more frequent than those in non-phlegm group;the percentage of patients with dampness, fever, qi stagnation, blood stasis, qi deficiency, yin deficiency,yang deficiency and blood deficiency were higher than those in non-phlegm group. 2.In male patients with phlegm pattern, the frequency of disease location in the liver was lower than that in the spleen and stomach,while the female patients had opposite distribution. The age of the liver and spleen groups were less than the age in the kidney group among patients with phlegm pattern. 3. In phlegm-pattern patients,the frequency of blood deficiency pattern among male patients was lower than that of qi deficiency,yin deficiency and yang deficiency patterns, while the frequency of females was higher than those of the three groups. The levels of uric acid (UA) and creatinine (Cr) in yang-deficiency pattern group were higher than those in blood deficiency pattern group. Cr levels in yin deficiency pattern group were also higher than those in blood deficiency pattern group. Conclusions Disease locations of phlegm pattern group in metabolic syndrome were: liver, spleen, kidney, lung, gallbladder, stomach and miscellaneous diseases were dampness,heat,qi stagnation, blood stasis, qi deficiency, yin deficiency, yang deficiency, and blood deficiency; Non-phlegm pattern group presented no concurrent pattern element characteristics. Disease locations were in the stomach in the male while they were changed to the liver in the female. Concurrent pattern elements was blood deficiency in patients of phlegm pattern in metabolic syndrome. In addition, the order of disease location of metabolic syndrome patients with phlegm pattern was spleen,liver and kidney. There was a correlation between yin-yang disharmony and levels of UA and Cr.

Objective To study the accuracy and safety of oral mucosal exfoliated cell specimens used in the bedside rapid detection of MTHFR C677T genotype by using the fluorescent probe method.Methods The outpatients and inpatients with hypertension visited and admitted in the department of cardiovascular medicine of this hospital from January 2019 to September 2020 were selected.The plasma homocysteine (Hcy) level in all patients was detected in the laboratory,a total of 482 hypertensive patients with Hcy≥10 μmol/L were se-lected,and the oral mucosal cells and whole blood sample were collected in all patients,and the genotypes of the above specimens were detected by the oral mucosal exfoliative cell fluorescent probe method and whole blood sample contrast reagents.If the two test results were inconsistent,the "gold standard" Sanger sequen-cing method was used to detect the whole blood sample for the final determination of MTHFR C677T geno-type.The coincidence rate was compared between the two detection methods,and the probability of adverse e-vents during the samples collection was observed and recorded.The accuracy and safety of fluorescence probe method for detecting MTHFR C677T genotype in the patients with oral mucosa exfoliation was evaluated.Re-sults The oral mucosal exfoliated cell samples and whole blood samples from 482 hypertensive patients were successfully collected,and no obvious adverse reactions occurred during the sampling process.The incidence rate of total mutation of MTHFR C677T gene detected by the fluorescence probe method and contrast reagent all were 73.23％ (353/482),the coincidence rate of homozygous wild type (CC type) in MTHFR C677T gene detected by the two methods was 100.00％ (95％CI:97.11-100.00),which of heterozygous mutant type (CT type) was 99.14％ (95％CI:96.91-99.76),which of homozygous mutant type (TT type) was 99.17％(95％CI:95.47-99.85),the total coincident rate of MTHFR C677T genotype was 99.38％ (95％CI:98.19-99.79)and the detection results consistency Kappa value was 0.9902.Conclusion The detection of MTHFR C677T gene mutation in oral mucosal exfoliated cells by fluorescent probe method is simple with less invasion,moreover which is rapid,safe and accurate.

OBJECTIVES: Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding. The purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation (RCA) combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis (IHD) treatment. METHODS: Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments, and were randomly divided into RCA group and saline flushing group. In the RCA group, 0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber. The sodium citrate was stopped after 3 h of dialysis, which was changed to sequential dialysis without anticoagulant. The hazard ratios for coagulation were according to baseline. RESULTS: A total of 159 patients and 208 sessions were enrolled, including RCA group (80 patients, 110 sessions) and saline flushing group (79 patients, 98 sessions). The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group (3.64% vs. 20.41%, P<0.001). The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group ((238.34±9.33) min vs. (221.73±34.10) min, P<0.001). The urea clearance index (Kt/V) in the RCA group was similar to that in the saline flushing group with no statistically significant difference (1.12±0.34 vs. 1.08±0.34, P=0.41). CONCLUSIONS Compared with saline flushing, the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.
Humans ; Citric Acid/adverse effects* ; Prospective Studies ; Sodium Citrate ; Hemorrhage/chemically induced* ; Citrates/adverse effects* ; Anticoagulants/adverse effects* ; Renal Dialysis/adverse effects*