Objective To evaluate Mycobacterium tuberculosis (M. tuberculosis)-specific cellular immunity in individuals with latent or active tuberculosis and human immunodeficiency virus (HIV) coinfection. Methods One hundred HIV-infected individuals in Yunnan Province were enrolled. The enzyme-linked immunospot (ELISPOT) assay using early secreted antigenic target (ESAT)-6 and culture filtrate protein (CFP)-10 was employed to detect M. tuberculosis-specific T cells in the peripheral blood. The absolute number of CD3+ CD4+and CD3+ CD8+ T cells in the peripheral blood from the enrolled subjects were determined by flow cytometry. Data were analyzed using nonparametric Mann-Whitney test. Results The prevalence of latent tuberculosis co-infection in HIV-infected individuals without any clinical evidence of active tuberculosis was 67.6%. The absolute numbers of CD3+ CD4+ (532 × 106/L) and CD3+ CD8+ (473 × 106×/L) T cell in HIV-infected individuals with latent tuberculosis co-infection were similar to those of only HIV-infeeted individuals (406 ×106×/L and 504 × 106/L). While those in HIV-infected individuals with active tuberculosis co-infection were 189 × 106/L and 293 × 106/L, respectively, which were both significantly lower than those in other two groups (U=168. 0,U=163. 0,U= 374. 0,U=147. 0, all P<0. 01). Furthermore, ESAT-6 (31/106 cells) and CFP-10 (82/106 cells) specific spot-forming cells in HIV-infected individuals with active tuberculosis co-infection were significantly less than those in HIV-infected individuals with latent tuberculosis co-infection (92 × 106 cells and 109 × 106 cells, U= 507. 0,U= 529. 5, both P<0. 01). Conclusions The prevalence of latent tuberculosis in HIV-positive individuals without any clinical evidence of active tuberculosis is high in China. Both overall cellular immunity and M. tuberculosis-specific immune response in HIV-positive individuals with active tuberculosis co-infection are severely impaired.

Objective To compare the effect of different flow rate of oxygen inhalation on relieving scapuledynia after laparoscopic cholecystectomy(LC) with carbon dioxide pneumoperitoneum. Methods 100 patients adopted LC were divided into the 2 L/min group (n=50), the 4 Ldmin group (n=50), both re-ceived oxygen inhalation 6 hours after LC. The incidence and degree of scapulodynia and the blood- gas analysis were analyzed. Results The incidence of scapulodynia after LC in the 4 L/min group was signifi-cantly lower than that of 2 L/min group. PaCO2,PaO2 and pH in the 4 L/min group were different from those of the 2 L/min group. Conclusions Increasing flow rate of oxygen inhalation can relieve incidence and degree of scapulodynia after laparoscopic cholecystectomy.

Objective To assess the efficacy and safety of dl-3-butylphthalide on the treatment of acute ischemic stroke. Methods A total of 197 patients who were in the period of 72 hours of first attack of ischemic stroke of internal carotid artery with NIHSS from 5 to 25 scores were enrolled in this multi-center, randomized, double-blind and aspirin-control study. Compound " Dan Shen" was used as a baseline therapy. Results Basical recovery plus significant improvement was seen in 74.7% of the patients in dl-3-butylphthalide group and 60.9% in aspirin group (CMH value 4.0,P=0.047);There was a significant improvement for dl-3-butylphthalide group regarding NIHSS total score, total score difference value and Barthel index on the day 11th and 21st after treatment compared with control group. The main adverse reaction of dl-3-butylphthalide was increased aminotransferase and mainly the slight increase of aspartate aminotransferase, by 4.34% and 0 respectively. Conclusion dl-3-butyiphthalide should be regarded as an effective and safe treatment for ischemic stroke and a treatment without severe side effects.

Objective: To investigate the effect of nucleophosmin 1 (NPM1) mutant A on TGF-β1-induced K562 cell proliferation and AKT phosphorylation. Methods: K562 cells were infected with Ad5-NPM1 to create an NPM1 over-expression cell model. NPM1 levels were determined by ELISA and Western blot analysis. The levels of AKT and P-AKT were determined by Western blot. MTT was used to measure the proliferation of K562 cells. Results: NPM1 protein levels in K562 cells increased in an Ad5-NPM1-MOI-dependent manner. Cell proliferation and NPM1 levels in the supernatant were significantly increased in K562 cells infected with Ad5-NPM1-30 and Ad5-NPM1-100 compared to those infected with Ad5-vector-100 (P<0.01). Treatment with (10 ng/mL) TGF-β1 increased P-AKT levels, but not total AKT levels in K562 cells. TGF-β1-induced phosphorylation of AKT was significantly increased by infection of K562 cells with Ad5-NPM1-100. No significant differences were found in total AKT levels among all groups. TGF-β1 (10 ng/mL) treatment also in-creased the proliferation of K562 cells. TGF-β1-induced K562 cell proliferation was significantly increased by infection with Ad5-NPM1-100 (P<0.01). Conclusions: NPM1 improves TGF-β1-induced cell proliferation by up-regulating AKT phosphorylation levels.

Objective:To explore the efficacy of online pulmonary rehabilitation (PR) management among community-dwelling patients with stable chronic obstructive pulmonary disease (COPD).Methods:This study was a single-center randomized controlled trail with an unblinded design. A total of 130 patients with stable COPD who visited Zhuanqiao Community Health Service Center in Shanghai Minhang District from October 2020 to March 2022 were randomly divided into study group and control group with 65 cases in each group. Both groups received conventional treatment, while patients in study group attended online rehabilitation management, including face-to-face rehabilitation instruction and multiple online guidance. Pulmonary ventilation function including forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1) and percentage of forced expiratory volume in the first second to forced expiratoty volume (FEV 1%pred), modified British Medical Research Council Dyspnea Scale (mMRC), chronic obstructive pulmonary disease assessment test (CAT), score of 6 minutes walking distance (6MWD) and DOSE (dyspnea, degree of airflow obstruction, smoking status, the number of exacerbation) index were measured at baseline and after 8 weeks of rehabilitation, and compared between two groups. Results:The baseline data of the two groups were comparable. After 8 weeks of management, FVC, FEV 1, FEV 1%pred, mMRC, CAT, 6MWD and DOSE index of both groups were improved compared with the baseline level(control group: t=-7.799, -7.581, -9.010, 3.565, 9.887, -16.677, 3.795; study group: t=-12.623, -13.914, -17.644, 7.404, 22.457, -26.826, 7.968; all P<0.05). The FEV 1%pred, CAT and 6MWD in the study group were better than those in the control group ( t=-2.939, 2.277,-2.130, all P<0.05); while there were no significant differences in FVC, FEV 1, mMRC and DOSE index between the two groups( t=-0.162, -1.280, 0.925, 1.939,all P>0.05). Conclusions:The online pulmonary rehabilitation management can better improve lung function, dyspnea symptoms and exercise tolerance of patients with stable COPD, which can be used for rehabilitation training and management of community-dwelling patients.

Objective:To investigate the awareness rate of " 1+ 1+ 1" contracted residents in the outer suburbs of Shanghai on the extended prescription policy of the family doctor contract service, and to analyze the influencing factors.Methods:From March to May, 2021, the cluster random sampling method was used to select one community health service center in Fengxian district, Shanghai, and a smart voice telephone assistant survey was conducted among the contracted residents aged 18 and above in the area, to understand their awareness of the extended prescription policy. χ2 Test was used for single factor analysis on the influence of different factors on the policy awareness of the contracted residents, while a multivariate analysis was performed by binary logistic regression, presenting P<0.05 as statistically significant. Results:A total of 13 495 " 1+ 1+ 1" contracted residents were surveyed via phone calls. Their awareness rate of extended prescription policy was 67.5% (9 115/13 495), while those with higher awareness rates were patients with ≥2 chronic diseases (92.3%), patients with 1 chronic disease (88.5%) and those aged 81 and above (88.4%). Logistic regression analysis showed that age, marital status, the number of chronic diseases and signing duration were all independent factors influencing the awareness of extended prescription policy (all P<0.05), while whether the residents were key population groups presented no significant influence on the awareness of extended prescription policy ( P=0.431). Conclusions:The awareness rate of " 1+ 1+ 1" contracted residents in the outer suburbs of Shanghai to the extended prescription policy needs to be further improved and publicity should also be strengthened to extend the policy benefit coverage.

Objective: To investigate the incidence and risk factors of extraintestinal manifestations (EIMs) in children with inflammatory bowel disease (IBD). Methods: The clinical data of 161 children with IBD was collected from the electronic medical records in the Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine from January 2012 to December 2017. These patients were divided into Crohn′s disease (CD) group and ulcerative colitis (UC) group, accounting for 82.0% (132 cases) and 18.0%(29 cases), respectively. The incidence of EIMs in each group was analyzed. The potential risk factors of EIMs including the IBD phenotype, gender, age, location of the CD lesion, disease activity of CD, and the presence of perianal lesion were analyzed with logistic regression model. Results: Eighty-eight patients (54.7%) had EIMs. The main EIMs were immune-mediated EIMs and growth retardation, accounting for 41.0% (66/161) and 24.2% (39/161), respectively. Aphthous ulcer (39/161, 23.0%) was the most common symptom among immune-mediated EIMs, followed by arthropathy (20/161, 12.4%) and skin lesions (19/161, 11.8%). Forty-three patients (26.7%) had EIMs before being diagnosed as IBD. Fifty-eight (65.9%) patients had only one EIM during the whole course of IBD. By logistic regression analysis, CD (OR=5.536, 95%CI:1.825-16.788) and perianal disease (OR=1.969, 95%CI:1.035-3.746) were the risk factors of immune-mediated EIMs. Meanwhile, CD (OR=11.319, 95%CI: 1.487-86.179), younger than six-year-old at diagnosis (OR=8.556, 95%CI: 3.109-23.545), moderate to severe activity of CD (OR=3.447, 95%CI: 1.196-9.934) and perianal disease (OR=3.361, 95%CI: 1.720-7.793) increased the risk of growth retardation. Conclusions The children with IBD have a high incidence of EIMs, which were more common in CD than in UC. The risk factors of developing EIMs include CD, perianal diseases, younger than six-year-old at diagnosis and moderate to severe activity of CD.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.