Objective To investigate the change of T helper 17 cells (Th17) in the peripheral blood mononuclear cell (PBMC) in patients with liver cystic echinococcosis. Methods Fifty-six subjects were divided into three groups: healthy controls (HD, n = 20), patients with cystic echinococcosis (CE, n= 18) and patients with cystic echinococcosis combined with bile fistula (BF,n= 18). The frequency of Th17 cells in CD4+ T lymphocytes was detected by flow cytometry. Th17-related cytokines including interleukin (IL)-17 and IL-23 were measured by enzyme-linked immunosorbent assay (ELISA). The data were analyzed by t test and Pearson correlation analysis.Results The frequency of Th17 in the peripheral blood was significantly lower in CE group compared to BF group and HD group [(0. 23±0. 11)% vs (0. 76±0.43)% vs (0.52±0.50)%; t=2. 225 and4. 077 respectively, both P＜0.05), while there was no statistical difference between BF group and HD group (t=1. 931, P＞0.05). The levels IL-17 and IL-23 were (12.1±3.7) ng/L and (84.4±46.0) ng/L respectively in CE group, which were lower than those in BF group [(15.5±4.1) ng/L and (138.6±37. 9) ng/L, respectively; t=2. 515 and 3. 649 respectively, both P＜0.05] and those in HD group [(14.8±4.4) ng/L and (138.1±48. 7) ng/L, respectively; t=2. 401 and 3. 706 respectively,both P ＜0.05], while there was no statistical difference between BF group and HD group (t=0. 534,P ＞0.05). Serum concentrations of IL-17 were all positively correlated with the concentrations of IL23 in these three groups (r=0. 657, P＜0.05). Conclusion The frequeny of Th17 cells in PBMC and the serum concentrations of IL-17, IL-23 are significantly reduced in patients with cystic echinococcosis.

Objective To explore the expression of TLR2,4,7 mRNA on peripheral blood mono-nuclear cells (PBMCs) in patients with chronic cystic echinococcosis(CE) infection, and the level of serum IL-10. Methods The expression level of TLR2,4,7 mRNA on peripheral blood mononuclear were tested in 42 chronic CE cases and 28 normal controls (NC) by real-time fluorescent quantitative reverse transcription polymerase chain reaction (FQ-RT-PCR) method. GAPDH was selected as the internal control. The level of serum IL-10 was determined in ELISA. The subjects were determined by t test. The correlations between TLR2, TLR4, TLR7 and IL-10 were determined by differences of expression of TLR2, TLR4, TLR7 on PBMCs and serum IL-10 in two groups of study linear correlation test. Results The expressions of TLR2, TLR4,TLR7 mRNA in chronic CE group were higher than those of in NC group. Compared with the NC group, the expressions of TLR2, TLR4 and TLR7 mRNA increased more than 7.3-, 3.6-, 3.6-fold, respectively. In chronic CE group, TLR2, TLR4 and TLR7 mRNA expressions were 1.0729 ±0.4006, 5.0976 ±1.6682, 0. 6481 ±0. 2574, respectively. TLR2, TLR4 and TLR7 mRNA expressions were 0. 1468 ± 0.0435, 1.4067 ±0. 3279, 0. 1804 ±0. 0568 in NC group, respectively. Compared with NC group, the differences of TLR2 and TLR4 mRNA expression were significant (P = 0.0287, 0. 033), while the expression of TLR7 mRNA was not difference (P =0.0862). Moreover, in chronic CE group, the level of serum IL-10 was higher than that of in NC group. In chronic CE group and NC group, the level of serum IL-10 was (17.6770±1.6298) pg/ml, (9.4898 ±0.7049) pg/ml. Compared with NC group, there was significant difference in chronic group (P<0.01). Significant positive correlation between TLR2 and TLR4 was found in chronic CE group, r = 0. 1135, P =0.036. Others were not correlations. Conclusion In the development of chronic CE, TLR2 and TLR4 participate in this progression. As the receptors of antigen of cystic echinococcus, TLR2 and TLR4 can regulate the immune response through interacting with different antigens from cystic echinococcus. Meanwhile, under the participation of TLR2, TLR4 and increased serum IL-10, they will approach to Th2 immune reaction, which play an important role in chronic CE that can induce immune evasion.

Objective:To explore the quality improvement in the organization structure and management model of the integrated community child health services.Methods:This was a qualitative study, including two parts: cause analysis and service improvement suggestions. In the analysis part the data mining was conducted to identify valuable patterns and relationships in the comprehensive child health services. Semi-structured interviews were conducted with 12 relevant department heads and health workers of the comprehensive child health service team at Gumei Community Health Service Center in December 2023, and the causes of the key problems were explored. In the service improvement part, focus group discussions were held to propose suggestions, then improvement measures were formulated to address the identified problems.Results:Through data mining and semi-structured interviews, the key problems were identified: information isolation among multiple departments and lack of coordination mechanism in the comprehensive child health service team. A team organizational structure based on the "three definite" principle was established. The organizational structure should include the pediatric family doctor team, general practitioner management team and departments of pediatrics, maternal and child health care, immunization and child rehabilitation; the management model should include a cross-department resource and information sharing mechanism, the pediatric family doctor model, optimization and integration of physical space, and enhancement of publicity activities for the comprehensive child health services.Conclusion:Based on the analysis in Gumei health service center, this study identified key problems in community integrated child health services, and proposes the quality improvement measure in the organizational structure and management model of the service team.