Chlamydia pneumoniae(Cpn) is one of the most common pathogens causing human respiratory tract infection.They cause acute respiratory tract infection,atherosclerosis and many other diseases. Cpn infection often recur or remain persistent,which may induce Th1-type response.At the same time,antibody-mediated immune and Toll like receptor play an auxiliary role.In this review,the author summarized advances in the immune response to Chlamydia pneumoniae infection.

Cardiopulmonary bypass(CPB) often result systemic inflammatory response syndrome.In addition to lipid lowing effects,statins appears to exhibit pleiotropic effects such as antiinflammatory properties,improvement of endothelial dysfunction and reduction of ischemia-reperfusion injury.In this review,the author summarized advances in these respects.

Objective: Chlamydia pneumoniae is a kind of common pathogenic bacteria in respiratory passage which cause persistent and chronic infection cell mediated immunity results mainly followiny the infection.The infection kinetics and local in vitro-restimulated cell mediated immunity(CMI) responses in the lungs and spleens of Icr mice during Chlamydia pneumoniae(Cpn) primary infection and reinfection will be analyzed in this article.Methods: Icr mice were inoculated intranasally with 105 IFU of Cpn(PT group).The same dose was given in the same way as rechallenge 4 weeks after the primary challenge(ST group).Control groups were inoculated with 0.05 ml PBS.The mice were sacrificed at predetermined days,and the pulmonary mononuclear cells and splenic lymphocytes were isolated and stimulated with Cpn in vitro for 3 days.The proliferative response was measured by MTT;IL-4,IL-10 and IFN-? were detected by ELISA.Results: The PT group showed a weak proliferative response and no secretion of IFN-? in the lungs after Cpn stimulation,while the ST group presented a reinfection characterized by IFN-? production both in the lungs and in the spleens(P

Objective To investigate the clinical value of emergent perspective stent implantation for leftside obstructive colonic cancer.Methods The clinical data of 26 patients with obstructive colonic cancer who received emergent perspective stent implantation at the Affiliated Xuzhou Hospital of Southeast University from October 2011 to February 2014 were retrospectively analyzed.A soft and a hard guidewire and a catheter were applied in the operation.The guidewires were put through the hole of the intestinal tumor,and then the metal stent and the conveyor were guided by the guidewires and were pulled through the hole of the intestinal tumor,finally the stent was released and the conveyor was adjusted to ensure that the stent was at the right position.Patients were followed-up through outpatient examination till 4 weeks after tumor resection.Results Of the 26 patients,9 were with rectal cancer,10 with sigmoid colonic cancer,6 with descending colonic cancer,1 with splenic flexure cancer.The median length of stenosis was 4.6 cm (range,2.0-8.0 cm).The surgery of the 26 patients was successful.The mean operation time was 35.2 minutes (range,15.2-72.0 minutes),and the mean time of stent implantation was 5.6 minutes (range,2.6-26.9 minutes).Patients had watery or loose stool for 4-8 times after stent implantation.Ten hours after the operation,all the patients were given liquid diet.The remission rate of clinical symptoms was 100.0％ (26/26).No colonic perforation was detected during the operation.Two patients were complicated with slight bleeding,and was alleviated by medication.Twenty-six patients received stage Ⅰ tumor resection procedure within 7-10 days after the symptoms of intestinal obstruction were remised.The success rate of surgery was 100.0％ (26/26).No infection and other drainage were detected after tumor resection through follow-up.Conclusion Emergent perspective stent implantation for left-side obstructive colonic cancer is safe and effective.

Objective: Blue dye was one of the methods for sentinel lymph node biopsy in breast cancer, but the success rate was affected by multiple factors. This study was to determine the related factors contributing to the success of sentinel lymph node biopsy in breast cancer using blue dye method. Method:From Jan. 2007 to Aug.2008, sentinel lymph node biopsy was performed by periareolarly injecting 1% methylene blue in 141 breast cancer patients followed by axillary clearance. Pathological diagnosis was performed for all of the lymph nodes by conventional HE staining. Unconditional logistic regression was applied to make both univariate and multiva-riate analysis. Results:Sentinel lymph node was successfully detected in 126 patients. But the biopsy was failed in the 15 patients. The success rate was 89.4% and the false negative rate was 6.82%. Univariate analysis showed that success rate of biopsy was in association with patients' age, body mass index (BMI), tumor size, preoperative axillary node's status, pathological grade as well as ≥4 positive axillary lymph nodes involved. Multivariate analysis indicated that the patients'age (OR=4.587, P=0.024), BMI (OR=4.882, P=0.011) as well as 4 or more of the axillary nodes involved (OR=3.143, P=0.013) were independent predicting factors for the success of sentinel lymph node biopsy. Conclusions:Methylene blue dyeing is a reliable method for sentinel lymph node biopsy. The rate of success is associated with patients' age, BMI as well as the number of metastases in axillary lymph nodes.

Objective To investigate the availability and strategy of breast reconstruction for patients with caesarotomy scar using pedicled TRAM flap.Methods From January 2007 to May 2011,12 cases of breast reconstruction with caesarotomy scar were carried out with pedicled TRAM flaps.All the patients that were classified as the class Ⅱ that was 0.5 or less by score were operated on by using the inverted trapezoid incision,of which the upper edge was 2 or 3 cm down to the umbilicus.Double pedicles were adopted for the patient with the longest vertical scar; single pedicle of the breast contralateral side and the muscle sheath of the breast ipsilateral side were harvested for the rest of the patients.A synthetic mesh was used for the enforcement of the muscle and sheath defect.Results No flap necrosis or abdominal complications were observed.With the follow-up from 3 months to 4 years and 4 months,the overall satisfactory rate was 100 ％.Conclusions The strict patient selection and the operating strategy are the keys to the successful breast reconstruction for patients with caesarotomy scar using pedicled TRAM flap.

OBJECTIVETo investigate the association between serum miRNA-6086 expression level and anal fistula recurrence.

METHODSClinical data and serum samples of 60 patients with anal fistula and mix hemorrhoid identified by pathology undergoing resection in our department from August 2015 to August 2016 were collected. In addition, serum samples of 20 patients matching with fistula group in age, gender and body weight and receiving only hemorroidectomy were collected as control during the same period. Serum miRNA6086 expression level was detected by real-time quantitative RT-PCR method, and the association of serum miRNA6086 expression level with clinicopathologic features was analyzed. Univariate ANOVA test and multivariate logistic regression analysis were performed to analyze the association between serum miRNA6086 expression level and anal fistula recurrence.

RESULTSThe relative expression of serum miRNA6086 in fistula group was 65.85±15.57, which was significantly up-regulated for 4.87 folds of 13.52±7.32 in control group(P<0.05). In fistula group, 24 cases(40%) developed anal fistula recurrence, whose serum miRNA6086 expression was significantly higher compared to 36 cases without recurrence (74.06±12.92 vs. 60.38±14.90, P<0.05). No associations of serum miRNA6086 expression with age, gender, BMI, drug history, acute phase were observed (P>0.05), while association of serum miRNA6086 expression level with the type, number and position of anal fistula was significant (all P<0.05). Univariated analysis indicated that anal fistula type (χ=6.890, P=0.009), anal fistula number (χ=0.554, P<0.001) and serum miRNA6086 expression (χ=11.390, P=0.001) were significantly associated with anal fistula recurrence. Multivariate logistic regression analysis showed that complex anal fistula (OR=4.75, 95%CI: 1.84 to 12.01, P=0.001) and high expression of serum miRNA6086 (OR=3.22, 95%CI:1.31 to 8.22, P=0.011) were independent risk factors of anal fistula recurrence.

CONCLUSIONUp-regulated expression of serum miRNA6086 is associated to the anal fistula type and may be valuable in predicting the prognosis.

Objective The purpose of this study was to evaluate the degree of skin thickening of patients with systemic sclerosis (SSc) by high-frequecy ultrasound,as well as the value of ultrasound.Methods Thirty-one patients with SSc and 31 age-matched and sex-matched healthy control subjects were enrolled.Skin thickness,modified Rodnan skin score (mRss),disease activity index (DA1) and other clinical parameters within and between groups were compared using SPSS 21 software.Student's t test,x2 test or nonparametric testing was performed to compare between groups.The Pearson or Spearman methods were used to test correlation.Sensitivity and specificity of skin thickness detection by high-frequecy ultrasound were evaluated by using receiver operating characteristic (ROC) curve analysis.Results Total thickness of skin (TST) of patientswith SSc were positively correlated to the total mRss (r=0.416,P=0.020) and DAI (r=0.436,P=0.014).The skin thickness of patients with mRss 0,1,2 was higher than CNT [1.45(0.60),1.70(0.30) mm,1.60 (0.30) mm vs 1.30 (0.35) mm,Z=-3.242,-6.577,-5.090,P＜0.01].The cut-off value of TST used as the evaluation of skin change was 7.4 mm by ROC curve analysis,and the sensitivity and specificity of them was 77.40％ and 87.10％ respectively,and patients with thickened skin were more likely to suffer interstitial lung disease (ILD) (16 vs 1,x2=26.004,P=0.014),higher mRss [10(6) vs 4(5),Z=-2.499,P=0.031],DAI [(5.2±2.4) vs (2.3±1.7),t=-3.104,P＜0.01)] and CRP [(8.60 (10.48) mg/L vs 3.52 (4.93) mg/L,Z=-2.276,P=0.038].Conclusion US combined with mRss are helpful to evaluate the changes of skin and disease activity of patients in SSc.US can identify the early and subclinical skin involvement that may precede mRss,providing a more reliable tool for diagnosis,treat efficacy and prediction of organ damage.

Objective:To assess the changes of left ventricular systolic function and global myocardial work in heart failure with preserved ejection fraction (HFpEF) patients by speckle tracking layer-specific strain combined with myocardial work technique and explore the diagnostic value of each parameter for HFpEF.Methods:From December 2019 to December 2020, 38 HFpEF patients (HFpEF group) and 38 healthy individuals with age- and sex-matched (control group) were enrolled consecutively in the Fourth Affiliated Hospital of Harbin Medical University. Conventional ultrasound parameters were collected. Layer-specific strain and myocardial work techniques were used to obtain the global longitudinal strain (GLS) of the left ventricular endocardium, mid-myocardium, and epicardium (GLSendo, GLSmid, GLSepi), global myocardial work index (GWI), global myocardial work efficiency (GWE), global constructive work (GCW), and global wasted work (GWW). The absolute difference of GLS(ΔGLS) between endocardium and epicardium were calculate.All parameters were analyzed statistically. ROC curves were plotted to compare the effectiveness of layer-specific strain and myocardial work parameters in predicting left ventricular systolic function impairment in HFpEF patients.Results:①Left atrial diameter, interventricular septum at end-diastole, left ventricular posterior wall at end-diastole, relative wall thickness, left ventricular mass index, and average early diastolic peak velocity (E)/early diastolic tissue velocity (e′) in HFpEF group were significantly higher compared with control subjects, while late diastolic peak velocity (A), E/A, and e′ were significantly lower (all P<0.05); E, left ventricular end-diastolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic volume, fraction shortening, and left ventricular ejection fraction were not different between HFpEF and control groups (all P>0.05). ②The global longitudinal strain of the left ventricule was highest in the endocardium and lowest in the epicardium. ③Compared with control subjects, HFpEF patients demonstrated significantly decreased GLSendo, GLSmid, GLSepi, ΔGLS, GWI, GWE, GCW and increased GWW (all P<0.01). ④The ROC results showed that the area under the curve of ΔGLS and GWE for predicting left ventricular contractile function impairment in HFpEF group, was 0.884 and 0.882, respectively; The cutoff values were -5.8% and 95%; The sensitivity were 84.2% and 71.1%, and the specificity was 84.2% and 89.5%, respectively. ⑤The ROC curve of combining the two technologies showed that the maximum area under the curve of the ΔGLS in tandem with GWE was 0.944, the sensitivity was 81.6%, and the specificity was 97.4%. Conclusions:Both speckle tracking layer-specific strain and myocardial work techniques can sensitively detect left ventricular myocardial function impairment in HFpEF patients at an early stage. ΔGLS and GWE are more reliable indexes for predicting left ventricular systolic function damage in HFpEF patients. Combining the two techniques can improve the diagnostic performance in HFpEF patients.