Objective To investigate the cellular immunologic response of TH 17/Treg cells in the peripheral blood of pelvic tuberculosis patients and explore their roles in the pathogenesis of pelvic tuberculosis.Methods The intracellular flow cytometry was performed to evaluate the expressions of TH 17 and Treg cells in 46 pelvic tuberculosis patients and 25 healthy controls in childbearing age.Twenty-eight of the 46 pelvic tuberculosis patients were followed up to monitor the variation of the TH17/Treg cells after 3 months and 6 months of anti-tuberculosis treatment.Results The percentage of TH 17 cells in the peripheral blood of pelvic tuberculosis patients was (3.26 ± 1.30) ％ which was significantly lower than that of healthy controls [(4.92 ± 1.71) ％,P ＜ 0.01].The percentage of Treg cells in the patients was (5.18 ± 1.53) ％ which was significantly higher than that of healthy controls [(3.26 ± 1.10) ％,P ＜ 0.01].The percentage of TH17 cells in the pelvic tuberculosis patients after 6 months of treatment was (4.67 ± 1.75) ％ which was significantly higher than that in the patients before treatment and after 3 months treatment [(3.26 ± 1.30) ％,P ＜ 0.01 and (3.70 ± 1.06) ％,P ＜0.01,respectively].The percentage of Treg cells in pelvic tuberculosis patient after 6 months of treatment was (3.93 ±0.94)％ which was significantly lower than that in the patients before treatment and after 3 months of treatment [(5.18 ± 1.53)％,P ＜0.01 and (4.94 ± 1.51) ％,P ＜ 0.01,respectively].The percentage of Treg cells in the patients after 6 months of treatment was still significantly higher than that of controls (P ＜ 0.05).The TH 17/Treg ratio before treatment was significantly lower than that of healthy controls (P ＜ 0.01),and the TH 17/Treg ratio was increased after 3 months of treatment but it did not show significant difference compared with that before treatment.The TH 17/Treg ratio after 6 months of treatment (1.18 ± 0.34) ％ was significantly increased in contrast to those after 3 months of treatment and before treatment [(0.77 ± 0.21) ％,P ＜ 0.01 and (0.55 ± 0.13) ％,P ＜ 0.01,respectively].The TH 17/Treg ratio could not rise to the normal level even after 6 months of treatment.Conclusion Both the TH 17 and Treg cells may involve in the immunologic responses of pelvic tuberculosis patients and the imbalance of TH1T/Treg cells may remain persistently.

Objective To evaluate the diagnostic value of two tuberculosis-specific IFN-γ release assays in latent tuberculosis infection among HIV-infected individuals. Methods The levels of tuberculosis antigen-specific IFN-γin 102 HIV patients from AIDS Outpatient Clinic of Shenzhen Third People's Hospital were detected by in-house tuberculosis-specific IFN-γ ELISpot assay and commercial T-SPOT TB kit, and tuberculin skin test (TST) were done at the same time. There were 66 males and 36 females,and the average age was 35. Results Seventeen HIV infected patients were positive in both IFN-γ ELISpot and T-SPOT TB methods, the sensitivity, specificity positive predictive value(PPV), negative predictive value(NPV) and compliance rates of ELISpot were 94. 4% ,94. 0% ,77. 3% ,98. 8% and 94. 1% ,respectively. Three patients were positive in both IFN-γELISpot and T-SPOT TB methods, the sensitivity, specificity, PPV, NPV and compliance rates of TST were 16. 7%, 98. 8%, 75.0%, 84. 7% and 84. 3%, respectively. The average number of spots using three kinds of antigen ESAT-6, Pool A,Pool B obtained were 26. 89 ±5. 77,18. 96 ±4. 75 and 14. 51 ± 3.77, respectively. Only ESAT-6 and Pool B have a statistically significant difference (H=7.557,P = 0.022 9), no significant difference was shown between other groups. There was no significant difference between the positive rate and the CD4+ T cellls number(x2 =0. 860 8 ,P =0. 650 2) ,as the same as the T-SPOT TB (x2 = 1. 396 4, P = 0. 497 5 ). Conclusions The performance of this in-house tuberculosis-specific IFN-γ ELISPot assay was comparable to T-SPOT assay in diagnosis of latent tuberculosis infection, and the sensitivity and specificity of both these two assays were all much higher than TST. They canbe recommended in diagnosing latent tuberculosis infection in HIV infected patients.

Objective To study bacterial conditions in amniotic cavity of the third trimester and the delivery. Methods Patients underwent cesarean section due to various reasons were randomly enrolled in the study. Ten ml aqua amnii taken from using aspesis were cultured and the bacteria were identified and tested for drug sensitivity. All patients were not treated with antibiotics before and during operation,conventional antibiotics treatnent was used after operation. The patients were divided into 3 groups based on their status: 34 cases of premature rupture of membrane ( PROM ), thirty-four cases of labor without PROM, and 27 cases of pregnancy without PROM. The positive rate, species , distribution and drug sensitivity of bacteria in the 3 groups were analyzed. Results The positive rate was 61.8% (21/34) in PROM ,52. 9% ( 18/34 ) in labor without PROM,11.1% (3/27)in pregnancy without PROM. The positive rates were significantly different among the 3 groups (x2 = 17.29 ,P =0.000). However, there was no significant difference between the labor without PROM group and the pregnancy without PROM group ( x2 = 0.541 , P = 0.462 ). Staphylococcus epidermidis was the most common isolated bacteria, following by staphylococcus aureas, streptococcus, colon bacillus, and pseudomonas. There were no significant differences of bacterial species between labor without PROM and pregnancy without PROM( x2 = 11.9,P =0.535 ). The relative higher positive rate in the labor without PROM and PROM indicated that they were important inducement of bacteria infection. There were no significant difference on positive rate and bacteria species distribution between the PROM and labor without PROM group,which suggested that up-bound along vagina to amniotic cavity was the most common route of infection. Sensitive antibiotics should be given to the patients of PROM and labor without PROM targeted at staphylococcus,streptococcus, colon bacillus and monad. Antibiotics such as Cephems, Penicillins and Clindamycin were sensitive to various bacteria and safe to both mother and baby, thus were recommended. Quinupristin, Vancomycin,Furantoin, Fusidic ,Teicoplanin, Amikacin and Meropenem were also sensitive to various bacteria, but due to their side effects and the principle of ladder antibiotics using, they were recommended as second line antibiotics. Conclutions Up-bound along vagina to amniotic cavity is the most common route of infection. For rupture of membrane and labor without PROM patients, antibiotics should be given, and strict aseptic technique,washing cavity and incision, using antibiotics after operation are necessary to prevent infection.

Objective:To systematically analyse the blood coagulation features of coronavirus disease 2019 (COVID-19) patients.Methods:An electronic search in PubMed, Scopus, Web of Science, EMbase, and CNKI to collect studies related to the blood coagulation features of COVID-19 patients from 1 January 2020 to 1 May 2020. Two reviewers independently screened literatures, extracted data and assessed the risk of bias of included studies. Then, the platelet count, D-dimer value, prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen of patients with different types of diseases were analyzed by using Stata12.0 software.Results:Thirty-nine retrospective studies involving 6 994 COVID-19 patients were included. The results of meta-analysis showed that:(1) compared with severe group, the platelet count (Weighted mean difference; WMD=20.11, 95% CI 11.53 to 28.69, P<0.001) and APTT (WMD=1.30, 95%CI 0.31 to 2.30, P=0.01) were found to be higher while D-dimer (WMD=-0.41, 95%CI-0.58 to-0.24, P<0.001), fibrinogen (WMD=-0.58, 95% CI-0.76 to-0.39, P<0.001) and PT (WMD=-0.51, 95%CI-0.92 to-0.10, P<0.001) were lower in mild group; the platelet count (WMD=-14.75, 95% CI-29.73 to-0.23, P=0.044) was found to be lower while D-dimer (WMD=1.06, 95% CI 0.65 to 1.47, P<0.001) was found to be higher in critical ill patients. (2)Compared with the survival group, the patients in death group displayed elevated levels of D-dimer (WMD=6.86, 95% CI 4.15 to 9.57, P<0.001) and PT (WMD=1.37, 95% CI 0.73 to 2.02, P<0.001) while platelet count (WMD=-36.40, 95% CI-63.23 to-9.58, P=0.008) remained low. Conclusion:Coagulation dysfunction was common in severe, critical ill and dead COVID-19 patients. Platelet count, D-dimer and PT levels were associated with the severity of the disease, and thus could be used as early warning indicators for the deterioration of the disease during hospitalization.

ObjectiveTo evaluate the IL-17 expression in HIV/tuberculosis-coinfected patients and its role in the pathogenesis of this coinfection.MethodsFifty-four HIV infected patients were divided into three groups:simple HIV infected group,HIV with latent tuberculosis infection (HIV+ LTBI) group and HIV coinfected with active tuberculosis (HIV+ ATB) group.The whole blood intracellular cytokine staining was performed and samples were then detected by BD FACSCanto.The expressions of CD4+ IL-17+ T cells and CD4+ IFNγ+ T cells were analyzed using FACSDiva software.Comparison between groups was done by independent sample t test.ResultsThe CD4+ T cell count and viral load among these three groups were comparable.There were no significant difference of the expression of CD4+ IL-17+ T cells between simple HIV infected group and HIV+ LTBI group (1.40 ± 1.01) ％ vs (1.29±0.86) ％,(t=0.336,P＞0.05),but both of these two groups were much higher than HIV+ATB group (t=3.680,t=2.516,P＜0.05).There were no significant differences of the expression of CD4+ IFNγ+ T cells among these three groups [(32.8±24.0)％ vs (40.3±1 21.9) ％ vs (46.1±31.2)％,(t=-0.939,t=-1.602,t=-0.646,P＞0.05)].ConclusionThe Th17 response is down-regulated in HIV/tuberculosis-coinfected patients,which may play an important antitubercular role in the pathogenesis of coinfection.

Objective: To investigate the associations between single nucleotide polymorphisms of UDP glucuronosyltransferase Family 1 Member A1 ( UGT1A1 ) with non alcoholic fatty liver disease (NAFLD) and levels of serum lipids in Beijing children, and to provide scientific evidence for the study of genetic mechanism. Methods: In total, 1 027 children aged 7-18 years were recruited from two primary schools and three middle schools from Haidian district of Beijing, who were randomly assigned to case group ( n =162) and control group ( n =865). General condition and medical history were collected by trained field health workers. Height, weight and liver ultrasound were examined. Additionally, fasting venous blood were collected to detect serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and alanine aminotransferase (ALT). The single nucleotide polymorphisms (SNPs) of UGT1A1 were genotyped. Binary logistic regression and multiple linear regression were applied to analyze the associations between three SNPs of UGT1A1 and NAFLD, ALT and levels of serum lipids. Results: The SNP rs 10929303 (C>T) of UGT1A1 was negatively associated with NAFLD( OR=0.51, 95%CI=0.32- 0.83 , P =0.01), while the SNP rs 4148323 (G>A) was negatively associated with the serum level of TC ( B=-0.10, 95%CI=-0.19- -0.02 , P =0.02); in addition, results were consistent regardless of whether the TC level was measured using a categorical variable or continuous variable. Conclusion The SNP rs 10929303 of UGT1A1 is associated with NAFLD, and the SNP rs 4148323 of UGT1A1 is associated with TC levels in Beijing children.

Objective To assess the validity of a newly developed in-house ELISPOT IFN-γ release assay (IGRA) for the detection of latent tuberculosis infection among HIV infected individuals. Methods In-house ELISPOT assay were performed, together with a tuberculin skin test in 205 health controls and 110 HIV infected individuals , who had no signs of active tuberculosis at time of enrolment . Results Using the ELISPOT assay, positivity rates for the 205 health controls, 110 HIV infected individuals and 47 AIDS patients on highly active antiretrovial therapy (HAART) were 7. 3% , 24.5% , 29. 8% , respectively. These results indicated that the positive rates obtained from HIV infected individuals (include patient on HAART) was significantly higher than health controls( P ＜ 0.001). We found no significant correlation between the CD4 cell count and positivity of ELISPOT assay (P ＞0.05 ). The proportion of subjects with a positive response to ELISPOT assay were higher than the proportion of tuberculin skin test(TST) responders(P＜0.0001) in HIV infected individuals. Conclusion Our study indicates that IGRA using M. tuberculosis specific antigens are likely to retain their validity for the diagnosis of LTBI among HIV positive individuals.

Objective To explore the immune response of T helper cells 17 in patients with hepatitis B virus (HBV) and the relation with Th1,Th2 and Treg cells.Methods The percentages of Th17 cells were detected by intracellular cytokine staining with flow cytometry.Using Realtime PCR method,we assayed the mRNA expression of IL-17,T-bet,GATA-3 and FoxP3 in 58 HBV patients and 40 healthy controls in our research.Results Compared with control group (3.56％ ± 1.26％),the percentage of Th17 cells in the peripheral blood of HBV group (4.72％ ± 1.80％) was higher (P ＜0.001).The mRNA of IL-17 expression of the HBV group (4 ±0.49) was higher than in healthy control group (1.19 ±0.19,P ＜ 0.0001).The mRNA of T-bet expression of the HBV group (2.27 ± 0.24) was higher than in healthy control group (1.10 ± 0.13,P ＜ 0.05).The mRNA of GATA-3 expression of the HBV group (2.29 ± 0.16) was higher than in healthy control group (1.10 ± 0.10,P ＜ 0.0001).The mRNA of FoxP3 expression of the HBV group (2.03 ±0.15) was higher than in healthy control group ((1.05 ±0.10,P ＜ 0.0001).Conclusions The Th17 cells participated in immune response of the hepatitis B virus infection patients,and there has certain adjustment relations among Th1,Th2 and Treg cells.

Objective: To study the role of rs 12145833 polymorphism of SDCCAG 8 gene in the intervention of childhood obesity, so as to provide scientific basis for formulating personalized intervention measures based on genetic background in children with obesity. Methods: From September 2018 to June 2019, a total of 393 children aged 8-10 years in Beijing were enrolled in a cluster randomized controlled trial. Eight schools were randomly allocated into intervention group and control group at a ratio of 1∶1. Saliva DNA samples were collected to detect rs 12145833 polymorphism of SDCCAG 8 gene. The intervention group received a comprehensive intervention, while the control group received usual practice. Intervention measures included diet improvement, sports, school amd family sport. The obesity related indicators were measured at baseline and after the end of intervention 1 academic year. Multiple linear regression and Logistic regression were used to analyze the interaction between genes and intervention on obesity indicators. Results: In the intervention group, children with TT genotype of rs 12145833 of the SDCCAG 8 gene had less increase in systolic( β=4.56, 95%CI=1.84-7.28, P <0.01) and diastolic blood pressure( β=2.59, 95%CI=0.45-4.73, P <0.05) than those with GT and GG genotypes. In the control group, the systolic blood pressure of children with TT genotype increased more than those with GT and GG genotype( β=-2.86, 95%CI=-5.63--0.83, P <0.05). There was an interaction between rs 12145833 polymorphism of SDCCAG 8 gene and intervention on systolic blood pressure, diastolic blood pressure and body fat percentage in children( P <0.05). Conclusion Children with TT genotype of rs 12145833 in the SDCCAG 8 gene are more sensitive to obesity intervention than those with GG and GT genotypes, especially in the improvement of systolic blood pressure, diastolic blood pressure and body fat percentage. Further trials to study the role of rs 12145833 polymorphism of SDCCAG 8 gene in the intervention of childhood obesity among different ethnic populations are needed.

Objective:To evaluate the role of volume management guided by extravascular lung water index(EVLWI) in improving the clinical outcomes and cardiac function for patients with cardiogenic shock.Methods:This study was a single-center, prospective cohort study. Patients with cardiogenic shock admitted to the Department of Cardiovascular Medicine, Shanghai East Hospital from July 2022 to December 2023 were enrolled. Patients were matched 1∶1 by propensity score and divided into EVLWI group and control group. In the control group, the volume management strategy was determined by the attending physician based mainly on conventional factors, including clinical features, biochemical assessments, and certain blood pressure measurements. In EVLWI group, the volume management plan was formulated by integrating conventional factors with EVLWI derived from pulse index continuous cardiac output (PiCCO) monitoring. Baseline clinical data, in-hospital treatment, and hemodynamic data were collected. Major adverse cardiovascular events and cardiac function related parameters were compared at 30 d after treatment between the two groups. Baseline EVLWI levels were compared between the non-survivors and the survivors in the EVLWI group. The receiver operating characteristic curve was plotted to assess the accuracy of baseline EVLWI and central venous pressure in predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, and subgroup analysis was performed according to ischemic/non-ischemic etiology and with/without use of inotropic drugs. Kaplan-Meier curve was used for survival analysis, with log-rank tests comparing all-cause mortality, cardiac death, and readmission rate for heart failure at 30 d after treatment.Results:A total of 200 patients with cardiogenic shock were enrolled, aged (71.35±12.82) years, 144(72%) males, EVLWI group and control group 100 patients each. Compared with the control group, EVLWI group had lower all-cause mortality (16%(16/100) vs. 42%(42/100), log-rank P<0.01), cardiac death (14%(14/100) vs. 34%(34/100), log-rank P<0.01), and readmission rate for heart failure (4%(4/100) vs. 12%(12/100), log-rank P=0.03) at 30 d after treatment. Subgroup analysis showed that EVLWI-guided volume management was associated with lower all-cause mortality at 30 d after treatment in patients with cardiogenic shock of ischemic or non-ischemic etiology and with or without inotropic drugs (all P<0.05). In EVLWI group, baseline EVLWI levels were higher in non-survivors than those in survivors [(15.99±6.47) ml/kg vs.(9.75±2.55) ml/kg, P<0.01]. The baseline EVLWI could predicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock, with an area under the receiver operating characteristic curve of 0.84 (95% CI: 0.75-0.94, P<0.01), while the baseline central venous pressure had no predicting value ( AUC=0.54, 95% CI: 0.40-0.69, P=0.60). The optimal cutoff value of EVLWI in pridicting all-cause mortality at 30 d after treatment in patients with cardiogenic shock was >10.3 ml/kg. With the optimization of hemodynamic parameters, left ventricular ejection fraction was improved in EVLWI group, and serum levels of N-terminal pro-brain natriuretic peptide, creatinine, alanine aminotransferase and lactic acid were decreased (all P<0.05). Conclusion:EVLWI-guided volume management exerts a beneficial effect on therapeutic decision-making and improves clinical outcomes and cardiac function in patients with cardiogenic shock.