Objective To investigate the effect of blockading OX40-OX40L co-stimulatory signaling on the survival time of liver allograft in rat.Methods siRNA-expression vectors were constructed to targeting OX40.3～5 minutes before DA to Lewis orthotopic liver transplantation was performed,5×109 pfu of targeting OX40 siRNA plasmid DNA were diluted in 5 ml of phosphate buffered saline(PBS)and inlected intravenously into recipient Lewis rat over a period of 10 seconds.Serum IL-2 and IFN-γ levels were assayed by ELISA,and mix lymphocyte response(MLR)were tested by 3H-thymidine.Results The survival time of recipients in siRNA treatment group(74.0±9.3)was significantly longer than that in control group[(7.3±0.5)days].In experiment group,the inflammatory cell infihration and liver tissue structure destruction were very slight.The concentration of serum IL-2 was much lower in siRNA treatment group[(46±8.4)pg/ml]than that in control group[(286.5±14.6)pg/ml].Meanwhile,the concentration of serum IFN-γ was much lower in siRNA treatment group [(202.7±14.6)pg/ml]than that in control group[(1682.7±87.9)pg/ml].Conclusion Administration of OX40-siRNA can blockade OX40-OX40L co-stimulatory signaling pathway.hence inhibit the rejection of liver allograft.

Objective To explore the impact of levels of serum IL-17,Leukotriene B4 and IgE on pathogenesis of childhood asthma.Methods Totally 60 children with asthma acute exacerbation ( 29 children with mild asthma,31 children with moderate-severe asthma) were selected as study group,24 healthy children were selected as control group.Serum IL-17 and LTB4 were measured with euryzemLinked immunosorbent assay,serum IgE was determined with enzyme-linked fluoroimmuneassay by pharmacia CAP Sytem,PMN was determined with automatic blood analyser,pulmonary function was measured in the study group.Results ( 1 ) The level of serum IL-17 ( 1.15 ± 0.10 μg/L,2.80 ± 2.30 μg/L,0.83 ± 0.10 μg/L),LTB4 (2.22 ± 1.01 μg/L,8.79 ± 9.36 μg/L,1.94 ± 1.13 μg/L) and IgE( 123.70 ±86.94 μg/L,322.27 ±332.28 μg/L,24.27 ±7.64 μg/L) were significantly different among mild asthma group,moderate-severe asthma group and control group( P ＜ 0.001 ).( 2 )The N％ of mild asthma group,moderate-severe asthma group and study group were( 55.06 ± 1 1.15 ) ％,( 64.44± 11.87)％,(47.96 ± 13.52)％,L％ were(42.20 ± 11.04)％,(33.93 ± 10.02)％,(49.65 ± 13.02)％,and there were significant differences in N％ and L％ between study group and control group( P ＜ 0.05 ).( 3 ) There were significant positive correlations between the serum IL-17 levels and IgE,LTB4 and IgE,IL-17 and LTB4 in asthmatic children( P ＜0.05).(4) There were significant negative correlcations between the level of serum IL-17,LTB4 and FEVI,PEF( P ＜0.001 ).There were significant positive correlations between serum IL-17,LTB4 and N％ (P ＜0.001 ).(5)There were not correlations between the level of serum IgE and FEV1,PEF and N％in asthmatic children( P ＞0.05 ).Conclusion The levels of serum IL-17,LTB4 and IgE participated in pathogenesis on asthmatic children patients.

OBJECTIVE: To investigate the effects of Xuesaitong for injection on microembolic signal (MES) and blood lipid of patients with middle cerebral artery (MCA) atherosclerotic stenosis complicated with MES positive transient ischemic attack (TIA). METHODS: A total of 98 patients with MCA atherosclerotic stenosis complicated with MES positive TIA in the Affiliated Hospital of Chengdu University of TCM during May 2015-May 2016 were divided into routine group and Xuesaitong group according to random numble table, with 49 cases in each group. Routine group received routine treatment. Xuesaitong group was additionally given Xuesaitong for injection (lyophilized) 400 mg intravenously, once a day, for consecutive 15 d, on the basis of routine treatment. The distribution of MES classification and the number of MES were observed in 2 groups before treatment, 15 d after treatment and 3rd and 6th month after treatment. The levels of TG, TC, LDL were observed before treatment and 15 d after treatment. The occurrence of ischemia event and ADR were recorded. RESULTS: Fifteen days after treatment, the distribution of MES classification in 2 groups was significantly better than before treatment; Xuesaitong group was significantly better than routine group, with statistical significance (P＜0. 05). At 3rd and 6th month after treatment, the distribution of MES classification in Xuesaitong group was significantly better than routine group; 6th month after treatment was significantly better than 3rd month after treatment, with statistical significance (P＜0. 05). Fifteen days and the 3rd, 6th month after treatment, the number of MES in 2 groups were significantly lower than before treatment and decreased as time; Xuesaitong group was significantly lower than routine group, with statistical significance (P＜0. 05). Fifteen days after treatment, TG and TC levels of 2 groups were significantly lower than before treatment; Xuesaitong group was significantly lower than routine group, with statistical significance (P＜0. 05); there was no statistical significance in the level of LDL before and after treatment (P＞0. 05). The incidence of ischemic events in routine group at 6th month after treatment was significantly higher than 3rd month after treatment, and the incidence of ischemic events in Xuesaitong group at 3rd and 6th month after treatment was significantly lower than routine group, with statistical significance (P＜0. 05). At 6th month after treatment, the incidence of ADR in 2 groups was significantly lower than 3rd month, with statistical significance (P＜0. 05). CONCLUSIONS: Based on routine treatment, Xuesaitong for injection can reduce the number of MES, reduce the incidence of ischemia events and further improve the level of blood lipid in patients with MCA atherosclerotic stenosis complicated with MES positive TIA without increasing the occurrence of ADR.

Objective:To evaluate the efficacy of salbutamol combined with budesonide suspension nebulization in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure, as well as its impact on inflammation related factors, complement 3a (C3a), C3a receptor (C3aR) levels, and helper T cell 17 (Th17), Th17/regulatory T cell (Treg) levels.Methods:A total of 120 AECOPD patients with respiratory failure admitted to the Jincheng People′s Hospital from March 2017 to March 2022 were selected as the study subjects. They were randomly divided into a control group of 60 cases and an observation group of 60 cases using a simple randomization method. The control group was treated with non-invasive positive pressure ventilation, while the observation group was treated with salbutamol combined with budesonide suspension nebulization on the basis of positive pressure ventilation. Two groups were compared in terms of efficacy, incidence of complications, length of hospital stay, COPD assessment test (CAT) scores, and inflammation related factors [white blood cell count (WBC), tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), interleukin-23 (IL-23) ], differences in complement (C3a, C3aR), peripheral blood Th17/Treg balance factors, vital signs, and blood gas indicators.Resultsl:The total effective rate of the observation group was 93.33%(56/60), significantly higher than the 80.00%(48/60) of the control group, with a statistically significant difference ( P<0.05). After treatment, the levels of inflammation related factors, complement and Th17, Th17/Treg ratio in both groups were significantly lower than before treatment (all P<0.05), and Treg levels were significantly higher than before treatment (all P<0.05). In addition, the levels of inflammation related factors, complement and Th17, Th17/Treg ratio in the observation group were lower than those in the control group (all P<0.05), and Treg levels were higher than those in the control group (all P<0.05). After treatment, the heart rate (HR), respiratory rate (RR), and arterial partial pressure of carbon dioxide (PaCO 2) levels in both groups were significantly lower than those before treatment (all P<0.05), while blood oxygen saturation (SaO 2), partial pressure of oxygen (PaO 2), and pH levels were significantly higher than those before treatment (all P<0.05). The observation group had better lung function, vital signs, and blood gas indicators than the control group (all P<0.05). The hospitalization time in the observation group was significantly shorter than that in the control group ( P<0.05). After treatment, the CAT scores of both groups were significantly lower than those before treatment (all P<0.05), and the CAT scores of the observation group were lower than those of the control group ( P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the observation group [1.67%(1/60)] and the control group [5.00%(3/60)] ( P>0.05). Conclusions:The combination of salbutamol and budesonide suspension nebulization in the treatment of AECOPD with respiratory failure can correct the Th17/Treg imbalance, alleviate inflammatory reactions, improve blood gas indicators, and promote rehabilitation.

Objective:To investigate the clinical value of peripheral blood T lymphocytes in the diagnosis and prognosis of patients with hepatocellular carcinoma (HCC) recurrence after liver transplantation.Methods:The clinical and laboratory data of 50 HCC patients, who received liver transplantation and were followed up in the Liver transplantation Center of Beijing Youan Hospital from January 2014 to December 2016, were retrospectively analyzed. The differences on clinical laboratory indicators and five-year survival were compared between HCC recurrence group ( n=29) and non-recurrence group ( n=21). Spearman correlate analysis was used to analyze the correlation between clinical laboratory indicators and HCC recurrence after liver transplantation. Receiver operator characteristic (ROC) curve was used to analyze the diagnostic value of CD4+T lymphocytes in HCC recurrence after liver transplantation. Kaplan-Meier survival curve was used to compare the survival time of patients with different CD4+T lymphocytes levels post liver transplantation. Results:Compared to non-recurrence group, the level of alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, albumin, lymphocytes, alpha-fetoprotein, protein induced by vitamin K deficiency or antagonist-Ⅱ, CD3+, CD4+and CD8+T lymphocytes were significantly different (all P<0.05). The median recurrence time after liver transplantation was 13.0 (6.0, 24.0) months, and the mortality rate was 100%. The 5-year mortality rate was 0 in the non-recurrence group. During 5-year follow-up, the median survival time of patients in the HCC recurrence group was 18.0 (9.0, 36.0) months, which was significantly lower than that of non-recurrence group [60.0 (60.0, 60.0) months, ( P<0.05)]. Compared with non-recurrence group, the CD3+, CD4+, and CD8+T lymphocytes were significantly lower in the recurrence group (all P<0.05). Spearman correlate analysis showed that HCC recurrence after liver transplantation was negatively correlated with the CD3+, CD8+and CD4+T lymphocytes ( r=-0.43, -0.38, -0.44, all P<0.05). ROC analysis showed that CD4+T lymphocytes at cutoff of≤265.50 cells/μl was valuable for the diagnosis of HCC recurrence after liver transplantation (specificity 100%, sensitivity 48.30%). Survival curve analysis showed that the survival time was significantly lower in the CD4≤265.50 cells/μl group [15.0 (10.0, 36.8) months] than that in the CD4>265.50 cells/μl group [53.0 (19.5, 60.0) months] ( P<0.05). Conclusion:There is a significant negative correlation between CD4+T lymphocytes and HCC recurrence after liver transplantation. CD4+T lymphocytes at cutoff value of≤265.50 cells/μl is valuable for the clinical diagnosis and prognosis evaluation of HCC recurrence after liver transplantation.

Objective:We conducted a real-world multi-center clinical study with a large sample size to comprehensively evaluate the performance of three commercial hepatitis C virus (HCV) core antigen assays. The study aimed to evaluate the performance for their use in HCV infection screening, and to provide clues for further improving the sensitivity and specificity of the assays.Methods:Key performance indicators including the lower limit of detection (LOD), diagnostic sensitivity, and specificity of three HCV antigen assays (the Architect, Laibo, and ChemClin HCV core antigen assays) were evaluated using commercial seroconversion panels reflecting early HCV infection and clinical routine serum samples of outpatients and inpatients from 3 tertiary hospitals from January 2018 to April 2022. Factors that affect the performance indicators were further investigated.Results:The window period for detecting HCV infection with the three antigen assays was equal to or slightly longer than that of the RNA assay, but all are shorter than that of the anti-HCV assay. There was a good linear positive correlation between HCV core antigen and HCV RNA levels in treatment naive patients with hepatitis C ( r=0.90, P<0.01). For the most common genotype 1b strain in China, the LOD of the three HCV assays were equivalent to 531 IU/ml (Architect), 3,698 IU/mL (Laibo), and 4,624 IU/mL (ChemClin) HCV RNA, respectively. Due to the skewed distribution of HCV RNA levels in treatment-naive hepatitis C patients, more than 95% of the patients had viral loads higher than 6 166 IU/ml. Therefore, the three HCV antigens assays still maintained a satisfactory diagnostic sensitivity (94.33%-99.40%). Among 54 immunodeficient patients (leukemia patients) with HCV infection, 9% (5/54) had negative anti-HCV results, while the HCV antigen assays found all these infectors. Through further experiments, we revealed the amino acid polymorphism in the core region of genotype 3 strain impaired the sensitivity of all three HCV antigen assays. In addition, the sensitivity of the two domestic assays was impaired by anti-HCV antibodies in the serum. The specificity of HCV antigen assays for diagnosing hepatitis C is 99.94% to 99.98%. The rheumatoid factors, autoantibodies, and other unknown interference substances can lead to a small number of low level, "false positive" antigen results. Conclusions:HCV core antigen assay may be used as a satisfactory approach of infection screening, especially for the immunodeficient patents. However, the sensitivity and specificity of the assays are influenced by multiple factors, which should be further improved.

Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.

Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.