Objective To evaluate the clinical features,diagnosis and treatment of metastatic adrenal carcinoma. Methods The data of 11 cases of metastatic adrenal carcinoma who were admitted from December 1993 to March 2003 were reviewed,including 4 cases of lung carcinoma,5 cases of hepatocellular carcinoma,1 case of bile duct carcinoma and 1 case of renal cell carcinoma.The main clinical manifestations were waist pain in 3,fatigue and weight loss in 3,hematuria in 1 and no symptom in 4.All the 11 cases underwent B-ultrasonography and CT scan,of whom 2 underwent positron emission tomography (PET).All patients were treated by surgical operation,including 9 cases by total adrenalectomy,1 case by palliative adrenalectomy and 1 bilateral metastatic case by left-adrenalectomy alone. Results In 5 cases by total adrenalectomy the survival time was 6 to 63 months with a mean of 34 months.Two cases were followed up for 2 to 16 months and 2 cases were lost with follow-up.One case by palliative adrenalectomy survived for 3 months.One bilateral metastatic case by left-adrenalectomy survived for 4 months. Conclusions Ultrasonography and CT are important in the diagnosis of metastatic adrenal carcinoma,and PET is of greater value in clinical practice.Complete adrenalectomy may be the best treatment choice to prolong the survival time.

Objective:To explore the changes and possible mechanisms of circulating Tc 17 cells in patients with colorectal cancer ( CRC) following disease progression .Methods:The peripheral blood were collected from 54 patients with colorectal cancer . the proportions of Tc17 cells in peripheral blood mononuclear cells (PBMCs) and cultured PBMCs treated by IL-1β, IL-6 and TGF-βin different concentrations were determined by flow cytometry;the levels of IL-1β, IL-17A, IL-23 and IL-6 in sera were measured by ELISA.Results:The proportions of Tc17 cells and the levels of IL-1β, IL-17A, IL-23 and IL-6 were significantly higher than those in healthy controls (P<0.05).Compared with early CRC, the proportions of Tc17 cells and the levels of IL-1β, IL-17A in advanced CRC were significantly decreased, but the level of IL-6 was significantly increased (P<0.05).The difference of IL-23 level between early and late groups was not significant (P>0.05).In vitro experiments confirmed that IL-1βor high concentrations of IL-6 and TGF-βcould significantly increase the number of Tc 17 cells in PBMCs.Conclusion: The changes of circulating Tc 17 cells in the progression of colorectal cancer are possibly modulated by IL-1β, IL-23, IL-6 and TGF-β.

Objective To compare ratio of circulating Th17 over Tc17 cells in patients with colorectal polyp (CRP), colorectal adenoma (CRA) and colorectal cancer (CRC),and analyse their relationship. Methods The ratio of circulating Th17 over Tc17 cells in 93 patients(17 CRP, 34 CRA and 42 CRC)and 17 healthy donors were examined by flow cytometry;Serum levels of IL-17A and IL-23 were tested by ELISA. Results The ratio of circulating Th17 over Tc17 cells and the se-rum levels of IL-17A and IL-23 were the lowest in healthy control groups, medium in CRP and CRA groups and the highest in CRC groups (P＜0.05). The proportions of Tc17 cells in CRA groups were significantly higher compared to those in CRP groups,but no statistical significance of proportion of circulating Th17 cells as well as serum levels of IL-17A and IL-23 be-tween CRA and CRP groups was observed (P>0.05). Further analysis showed that there was a positive correlation between proportions of circulating Th17 and Tc17 cells (rs=0.594, P＜0.001). Conclusion The proportions of circulating Th17 and Tc17 cells were positively related and the ratio of Th17 over Tc17 was markedly increased from CRP group or CRA group to CRC group.

Objective To observe the changes of circulating Tc 17 and Treg cells in the patients with colorectal adenoma(CRA)and the patients with colorectal cancer (CRC)and to investigate the correla-tions between them.Methods Peripheral bloods were collected from 63 patients (30 CRA and 33 CRC) and 20 healthy subjects .The proportions of circulating Tc 17 and Treg cells in peripheral blood mononuclear cells ( PBMCs) were detected by flow cytometry .The serum levels of IL-17A and IL-23 were measured by ELISA.Results Compared with healthy controls , the proportions of circulating Tc 17 and Treg cells as well as the serum levels of IL-17 A and IL-23 in CRA and CRC groups were significantly up-regulated ( P<0.05).The proportions of circulating Tc17 cells and the serum levels of IL-17A and IL-23 in CRC group were significantly higher than those in CRA group (P<0.05), but there was no significant difference in the expressions of Treg cells between the two groups .As the disease progressed , the proportions of circulating Tc17 cells and the serum levels of IL-17A and IL-23 in CRAⅠgroup and the early CRC group were respec-tively higher than those in CRAⅡgroup and the advanced CRC group (P<0.05), while the expressions of Treg cells was just the opposite , and no correlation between the expressions of Tc 17 and Treg cells was found (r=-0.227, P=0.073).Conclusion The changes in the percentage of Tc17 cells in peripheral blood are contrary to Treg cells in patients with CRA or CRC as the disease progresses , but there is no correlation be-tween them .

Objective:This study was conducted to investigate the levels of IL-23 and IL-17 in sera and tumor tissues and to ana-lyze their association with clinico-pathological parameters in patients with colorectal cancer (CRC). Methods:A total of 24 healthy sub-jects and 56 patients with CRC were recruited in this study. Enzyme-linked immunosorbent assay was performed to measure the concen-trations of IL-23 and IL-17 in the sera of CRC patients and healthy controls and in cultured normal tissues and tumor tissues from CRC patients. Results:The levels of serum IL-23 and IL-17 were significantly higher in CRC patients than in healthy controls (P<0.01). The supernatant levels of IL-23 and IL-17 in tumor tissues were significantly higher than in normal tissues (P<0.05). Serum IL-17 level was correlated with tumor location, lymph node metastasis, and TNM stage (P<0.05), whereas serum IL-23 level showed no correlation with all clinico-pathological parameters (P>0.05). Tumor supernatant IL-17 level was correlated with tumor differentiation, lymph node metastasis, and TNM stage (P<0.05), whereas tumor supernatant IL-23 level was correlated only with TNM stage (P<0.05). Conclu-sion:IL-23 and IL-17 may be involved in the immuno-pathogenesis of CRC progression.

Objective The visual inspection method were not appropriate to perform a hemolysis evaluation for colored injection like doxorubicin hydrochloride,this article adopted three methods to evaluate the hemolysis test of doxorubicin hydrochloride in vitro and provide reference for clinical drug safety.Methods Using rabbit erythrocytes as experimental object,the durg concentration 4.0 and 2.0 mg/mL was chosen which range of clinical concentration and preclinical safety evaluation concentration,to evaluate the hemolysis test of doxorubicin hydrochloride injection with blood analyzer test,direct colorimetric assay,and indirect colorimetric assay.Results The evaluation results of three different methods were very consistent.The tube's hemolysis rate of 4.0 mg/mL dose was far greater than 5％,which means serious hemolysis;Only 0.1 mL tube of 2.0 mg/mL dose (according to the drug concentration equal to 0.5 mL tube of 0.4 mg/mL drug concentration) without hemolysis occurring,the other tubes' hemolysis rates were far greater than 5％,which means serious hemolysis.Conclusion The hemolysis phenomenon may occur when 2.0 mg/mL dose of doxorubicin hydrochloride solution for iv injection is used in clinic and dilution (final concentration not more than 0.4 mg/mL) is recommended.

We studied Yersinia infection and carriage in shepherd dog on the natural foci of Marmota himalayana plague and investigated the substitution or antagonism relationship among three pathogenic Yersinia in nature,providing a novel approach for prevention and control of plague.Blood sample and rectal swab specimens from shepherd dogs were collected.Rectal swab specimens were detected and isolated for Y.enterocolitican and Y.pseudotuberculosis.IHA was used to measure the positive rate of F1 antibody.Results showed that among 88,94,70 and 64 serum specimens respectively from Akesai,Subei,Sunan,and Tianzhu,IHA positive rates were 31.82％,32.98％,2.86％ and 1.56％ separately.A total of 236 anal swab specimens of shepherd dog were collected,among which one Y.kristensenii strain and 2 non-pathogenic Y.enterocolitica strain were recovered from Akesai and Subei respectively,where plague was violently prevalent in animals.All the results indicate that shepherd dogs in natural foci of M.himalayana plague where plague in animals are prevalent with non-pathogenic Y.enterocolitica,is an evidence of antagonism relationship in three pathogenic Yersinia.

Abstract: Objective To conduct a molecular epidemiological tracing and analysis of Yersinia pestis strains isolated from two human plague outbreaks with unknown sources in Gansu Province, China. The results of this analysis would provide a basis for isolating and controlling the sources of Yersinia pestis. Methods The strains of Yersinia pestis isolated from two human plague outbreaks occurring on December 12, 2017, and September 27, 2019 were genotyped by the different region (DFR) and the clustered regularly interspaced short palindromic repeats (CRISPR). The repeat numbers of the variable number tandem repeat (VNTR) loci in the tested strains of Yersinia pestis were calculated by the multiple variable number tandem repeats analysis (MLVA), and the location of the phylogenetic tree of the tested strains was determined with the method of minimum spanning tree (MST) by the software BioNumerics 6.6. Results The strain of 20171212 lacked DFR01, DFR02, DFR03, DFR04, DFR13, DFR23, and the DFR type was identified as type 8. The space sequence of YPa was a1'-a2-a3-a4-a5-a6-a7-a35, the space sequence of YPb was b1-b2-b3-b4, the space sequence of YPc was c1-c2-c3, the gene cluster of CRISPR was Ca35', the genotype of CRISPR was 26'. MLVA clustering analysis showed that the strain clustered within in the cluster of Yuerhong pasture in Subei County and formed an independent branch. On the other hand, the strain of 20190927 lacked DFR01, DFR13 and DFR23, with the DFR type identified as type 1b. The space sequence of YPa was a1-a2-a3-a4-a5-a6-a7, the space sequence of YPb was b1-b2-b3-b4, the space sequence of YPc was c1-c2-c3, the gene cluster of CRSIPR was Ca7, the genotype of CRSIPR was 22 MLVA clustering analysis showed that the strain was located close to the cluster of Dangjinshan in Akesai County, and relatively distant from the cluster of Yuerhong pasture in Subei County. Conclusions The genotypes of strain 20171212 by DFR and CRISPR were consistent with the main genotypes of Y. pestis from Himalayana Marmota foci in Subei County, which confirmed that the human plague cases were naturally occurring locally. However, the strain gathered the cluster of Yuerhong pasture in Subei County, which indicated that the source of infection was not in Yanchiwan Town, but in the surrounding area of the Yuerhong pasture. The genotypes of strain 20190927 by DFR and CRISPR were in accordance with the main genotype of Y. pestis from Himalayana Marmota foci in Akesai County and were closer to the cluster of Dangjinshan in Aksai County than to

Objective:To understand the plague epidemic characteristics in the natural foci of the Qilian Mountains-A-erh-chin Mountains Himalayan marmot plague in Gansu Province, and to provide scientific basis for innovative prevention and control of the plague in combination with local conditions. Methods:A retrospective study was used to collect the monitoring data of the natural foci of plague in Gansu Province from 2011 to 2018 (from the epidemic surveillance files of the Center for Disease Control and Prevention of Gansu Province and direct network reporting information). Descriptive epidemiological method was used to analyze the plague epidemic characteristics of natural foci of the Qilian Mountains-A-erh-chin Mountains Himalayan marmot plague in Gansu Province from 2011 to 2018, including the distribution of host animals, pathogenic and serological testing of the plague bacteria, and the epidemic characteristics of human plague. Results:From 2011 to 2018, the total average marmot density in the natural foci of the Qilian Mountains-A-erh-chin Mountains Himalayan marmot plague in Gansu Province was 0.21/hm 2, of which Tianzhu County had the highest average marmot density of 0.58/hm 2, and Jiayuguan City had the lowest average marmot density of 0.01/hm 2. A total of 381 strains of Yersinia pestis were isolated in the foci, of which 4 were isolated from human corpses, 298 were host animals, and 79 were infectious vectors. Among them, the top 3 counties (cities) of isolated strains were Aksai County (38.85%, 148 strains), Subei County (31.50%, 120 strains) and Yumen City (16.27%, 62 strains). A total of 6 860 marmot serum, 1 769 dog serum were tested, the F1 antibody positive rates were 2.70% (185/6 860), 8.42% (149/1 769); and the F1 antigen positive rate of 814 animal materials was 4.30% (35/814), respectively. There were 4 times of human plague, 4 cases occurred and 4 cases died; 3 times occurred in Subei County and 1 time in Yumen City. The onset months were July, September, November and December. Active contact with infected animals such as shepherd dogs was the main route of infection, and migrant herders were the key occupation population. Conclusions:The animal epidemic situation in the natural foci of the Qilian Mountains-A-erh-chin Mountains Himalayan marmot plague in Gansu Province is active, and the plague presents different epidemic states in different regions. The prevention and control measures should be taken according to local conditions and guided by classification to strictly prevent the occurrence and transmission of the plague.

Objective:To investigate the infection status of Yersinia in the main host animals of plague in Xiahe and Luqu counties, the Himalayan marmot plague foci of Gansu Province, and to provide a basis for exploring the epidemic status of plague in these foci. Methods:Samples of the ileocecal region and contents, pharyngeal swabs (or tongue roots), and blood of the main host animals of plague in Xiahe County and Luqu County where the plague were active in the 1950s and 1960s were collected from 2014 to 2018. The Yersinia isolation, virulence determination and F1 antibody detection were performed, respectively. Results:Totally 24 strains of Yersinia were detected in 958 samples of ileocecal region and contents with a bacterial detection rate of 2.51%, which were 13 strains of Yersinia enterocolitia (Y.e), 1 strain of Yersinia kristensenii (Y.k), 2 strains of Yersinia frederiksenii/ intermedia (Y.f/i), 6 strains of Yersinia intermedia (Y.i), 1 strain of Yersinia aldouae (Y.a) and 1 strain of Yersinia massiliensis (Y.m). Totally 19 strains of Yersinia were detected in 958 samples of pharyngeal swabs (or tongue roots), and the detection rate was 1.98%, which were 8 strains of Y.e, 1 strain of Yersinia pseudotuberculosis (Y.p), 4 strains of Y.k, 1 strain of Y.f/i, 4 strains of Y.i, and 1 strain of Yersinia ruckeri (Y.r). The virulence types of 21 strains of Y.e were ail -ystA -ystB +yadA -virF -rfbc -, ail -ystA -ystB -yadA -virF -rfbc -, respectively, accounting for 9.52% (2/21) and 90.48% (19/21), none were pathogenic. The results of F1 antibody in 1 079 serum samples were all negative. Conclusions:Yersinia are widely found in the pharynx and intestines of the main host animals of plague in Xiahe and Luqu counties, and the Y.e detected are all non-pathogenic strains. The results of this investigation can provide clues for further study on the preservation of Yersinia pestis in host animals and their living environment.