Objective To investigate the prognostic value of CD 4+CD25+/high CD127 low/-and CD14+HLA-DRlow/-for evaluating the severity of acute pancreatitis .Methods The percentages of CD4+CD25+/highCD127low/-and CD14+HLA-DRlow/-and the CD64 index were measured by flow cytometry in pa-tients with acute pancreatitis ( including 43 cases of mild acute pancreatitis and 24 cases of severe acute pan-creatitis).Moreover, the levels of C-reactive protein (CRP), acute physiology and chronic health evaluationⅡ( APACHEⅡ) score and CT severity index ( CTSI ) were detected for a correlation analysis .Results The percentages of CD4+CD25+/highCD127low/-and CD14+HLA-DRlow/-and the CD64 index in patients with severe and mild acute pancreatitis were significantly higher than those in healthy subjects .Patients with se-vere acute pancreatitis showed higher percentages of CD 14+HLA-DRlow/-than patients with mild acute pan-creatitis.With the disease progression, the CD64 index and the levels of CD4+CD25+/highCD127low/-, CD14+HLA-DRlow/-and CRP were significantly dropped after an initial increase in patients with mild acute pancrea -titis, while these indexes were continuously elevated in patients with severe acute pancreatitis .The percent-age of CD14+HLA-DRlow/-was positively correlated with CD64 index, CRP level, APACHEⅡ score and CTSI.Conclusion CD14+HLA-DRlow/-level was closely related to the severity of acute pancreatitis , which could be used as immune parameter for the estimation of the clinical severity of acute pancreatitis .

Objective: To evaluate the effects and partly mechanism of Qileng decoction(QLD,芪棱汤) resisting focal cerebral ischemia/reperfusion(I/R) injury in rats by apoptosis and signal transduction pathway.Methods: The rats were randomly divided into three groups including sham operation group,normal saline(NS) control group and QLD group.The model of focal cerebral I/R injury was induced by using modified thread embolizing in rats.Rats were evaluated by neurologic function score at 2 hours after ischemia and 2,4,6,12,24 and 48 hours after cerebral reperfusion,and the pathological changes of nerve cells and mitochondria ultrastructure at pallium and hippocampus CA1 region were observed at 24 hours after reperfusion.Immunohistochemical method was performed to examine the expression of cytochrome C(cyt C) and caspase-9 at different time points after reperfusion.Apoptosis of nerve cells in ischemic penumbra(IP) was also characterized by terminal deoxynucleotidyl-transferase mediated dUTP-biotin nick end labeling(TUNEL) method.Results: Compared with NS control group,neurologic function scores at different reperfusion time points were improved and the pathological changes were ameliorated at 24 hours after cerebral I/R in QLD group.Mitochondria hydropsia was alleviated,mitochondrial cristae fragmentation and granulum basale shedding were diminished,and mitochondrial basical morphology was retained.Meanwhile,apoptosis index(AI) was decreased and the expressions of cyt C and caspase-9 were reduced in IP in QLD group.Conclusion: QLD intervenes in mitochondria mediated and caspase-9 dependent apoptopic pathway.QLD lowers AI and plays a role of protecting nerve by maintaining mitochondrial basical form,stabilizing mitochondrial membrane and inhibiting the release of cyt C and activation of caspase-9.The above actions are possibly some parts of mechanisms of QLD resisting focal cerebral I/R injury.

Objective To investigate the prognostic value of regulatory B cells (Bregs) in patients with acute pancreatitis .Methods Flow cytometry analysis was performed to detected the percentages of CD19+IL-10+and CD19+CD24hiCD27hi Bregs in peripheral blood samples collected from patients with acute pancreatitis (36 cases with mild acute pancreatitis and 15 cases with severe acute pancreatitis ) as well as the surface costimulatory molecules including CD80 and CD86 on CD19+CD24hiCD27hi Bregs.Their correlations with lymphocytes and C-reactive protein ( CRP) were further analyzed .Results The numbers of lympho-cytes, CD19+lymphocytes, CD19+IL-10+and CD19+CD24hi CD27hi Bregs in peripheral blood samples col-lected from patients with severe and mild acute pancreatitis as well as the mean fluorescence intensities ( MFI) of CD80 and CD86 were significantly lower than those from healthy subjects .Compared with patients with mild acute pancreatitis , the numbers of lymphocytes and CD 19+lymphocytes , the absolute numbers of CD19+IL-10+and CD19+CD24hiCD27hi Bregs as well as the mean fluorescence intensities (MFI) of CD80 and CD86 in patients with severe acute pancreatitis were significantly decreased .The percentages of CD19+IL-10+and CD19+CD24hiCD27hi Bregs in patients with mild acute pancreatitis were significantly increased af-ter an initial drop , but in patients with severe acute pancreatitis those values were continuously decreased along with the disease progression .The percentage of CD19+IL-10+Bregs was positively correlated with the percentage of CD19+CD24hiCD27hi Bregs and the absolute number of CD19+lymphocytes, but was negatively correlated with CRP .Conclusion The abnormal number and function of CD 19+IL-10+and CD19+CD24 hi CD27hi Bregs might be one of the important reasons causing immune dysfunction in patients with acute pan -creatitis.

Objective To explore the correlation between volumetric capnography(VCap)and traditional pulmonary function in chronic obstructive pulmonary disease(COPD),so as to assess whether VCap can be used as alternative indicators for the evaluation of COPD severity when some of the elderly COPD patients do not accomplish the traditional pulmonary function tests.Methods 960 patients admitted to Fujian Geriatric Hospital from June 2008 to June 2015 and undergoing pulmonary function tests were included in the study.They were divided into 2 groups of the COPD group(640 cases)and the control group(320 cases).The pulmonary function of COPD group was divided into 4 subgroups(Ⅰ~Ⅳ).All persons received tests of traditional pulmonary function and VCap.The correlations between VCap and traditional pulmonary function indexes and between VCap and COPD severity were observed.Results The differences in Vm25-50/VT,Vm50-75/VT,dC/dV3,SR23 of VCap between the 4 subgroups(COPDⅠ~COPDⅣ)and control group were statistically significant(all P<0.05),while the difference in dC/dV2 of VCap between the 4 subgroups(COPDⅠ~COPDⅣ)and control group was not statistically significant(t=-0.22,-0.43,0.26 and 0.64,all P>0.05).The difference in CO2 max between the COPD Ⅲ group(severe or more severe group)and control group was statistically significant(t=6.91 and 4.65,all P<0.05).The difference in VD-B/VT and VD-F/VT of VCap between the COPD(Ⅱ~Ⅳ)group(from moderate to very severe group)and control group were statistically significant(all P<0.05).CO2 max,VD-B/VT,VD-F/VT,Vm25-50/VT,Vm50-75/VT,dC/dV3,SR23 of VCap showed correlation with traditional pulmonary function.The correlation between dC/dV3 and the seven traditional pulmonary function indexes seen above was statistically significant(|r|>0.555,P<0.05).The specificity of Vm25-50/VT of VCap for the diagnosis of COPD was best,but its sensitivity was poor than other indexes of VCap.The indexes with both high sensitivity and high specificity were Vm50-75/VT and dC/dV3.Conclusions When the patients with COPD manifest the mild airflow limited,Vm25-50/VT,Vm50-75/VT,dC/dV3 and SR23 of VCap are gradually increased with abnormal VCap figures when the illness progressed.The CO2max of VCap might be one of the indexes for assessing the severity of severe or more severe COPD.

BACKGROUND:The safety and efficacy of paclitaxel-eluting stents (Taxus DES) has been proved by international researchers in clinic investigations.Based on further inclusion criteria,the incidence of in-stent restenosis is still lower than that of bare-metal stent.OBJECTIVE:TO observe restenosis of Taxus DES and the effect on local vessels through applying the follow up of coronary angiography and to investigate the biocompatibility of stent and host.DESIGN:Following-up observation.SETTING:Department of Cardiology,General Hospital of Chinese PLA.PARTICIPANTS:A total of 297 patients who had undergone coronary Taxus DES implantation for coronary artery disease were selected from Cardiovascular Department of General Hospital of Chinese PLA from May 2003 to May 2005.There were 265 males and 32 females and their ages ranged from 36 to 76 years.All patients provided informed consent,and the experiment had got confirmed consent from local ethic committee.METHODS:All patients were implanted Taxus DES and received the follow up within 6 and 12 months.In addition,at 6 months after operation,coronary angiography was used to measure the reference vessel diameter (RVD) and the minimal lumen diameter(MLD),calculate diameter restenosis rate and observe late loss.MAIN OUTCOME MEASURES:Coronary angiography at 6 months after Taxus DES implantation and biocompatibility of stent and host.RESULTS:①Quantitative angiographic analysis(QCA):Angiographic follow-up showed that the late loss of in-stent was significantly higher than that of pro-in-lesion and dis-in-lesion(P＜0.05).②Coronary angiography in-stent restenosis:In 134 angiographic follow-up patients,a total of 14 patients experienced restenosis,and the incidence was 10.4%(14/134).The patterns of restenosis were diffuse in-stent in 7 patients and the rate of revascularization was 6.7%.③Stent aneurysm:Angiographic evidence of aneurysm was observed in one patient among follow-up cases,and the rate of which was 0.75% (1/134).④Clinic follow-up major adverse cardiac events(MACE):Among 297 patients,one patient was attracted sudden death 5 months after intervention (0.34%; 1/297),and one patient was suffered subacute thrombosis 5 days after stent implant (0.34%;1/297),and late thrombosis occurred in 2 patients.The general rate of MACE was 1.35%.CONCLUSION:①The late loss of Taxus DES mainly takes place in in-stent.The patterns of restenosis of Taxus DES are in majority of diffuse in-stent,and the incidence of MACE is low.②Taxus DES possibly results aneurysm in local vessels.The follow up indicates that Taxus DES has a good biocompatibility to patients.

Objective:To optimize the water extraction and alcohol precipitation technology of Xuanfei Zhike granule .Methods:Orthogonal test was used to investigate the effects of adding water , decocting time and boiling time on the water extraction , and the effects of relative density , alcohol precipitation concentration and alcohol precipitation time on the alcohol precipitation technology by taking comprehensive score including the amount of hesperidin , the amount of tectoridin and the yield of dry cream as the indices .Re-sults:The preferred water extraction technology was as follows: added 10 times water and extracted 1.5 h firstly, and then added 8 times water and extracted twice with 0.5 h for each.The preferred alcohol precipitation technology was as follows:concentrated the wa-ter extraction to a relative density of 1.05 (measured at 60℃), slowly added 95％ethanol to 80％alcohol solution and stored 18 h at low temperature .Conclusion:The optimal water extraction and alcohol precipitation technology is stable and feasible , which can pro-vide reference for the standardized production of Xuanfei Zhike granule .

Objective:To study the effect of atractylodes lactideⅠ,Ⅱand Ⅲ on the expression of cytokines by inducing M1 type macrophage model. Methods:Apoptotic macrophages were induced by sodium thioglycolate, and then the rat peritoneal inflammatory macrophages were purified by a differential adherence method. The expression of macrophage marker antigen (ED1) was identified by flow cytometry macrophages. Tumor necrosis factor ( TNF-α) , proinflammatory cytokines ( IL-1β) and interleukin-6 ( IL-6 ) were measured by ELISA in vitro. The levels of expression of arginase 1, inducible nitric oxide synthase (iNOS), inflammatory cytokines (IL-1β) chemokine (CCL22) and transforming growth factor (TGF-β) in inflammatory macrophages were determined by RT-PCR. Results:As for the purification of cultured rat inflammatory macrophage expressing ED1, atractylenolideⅠand Ⅲ could reduce the ex-pression levels of iNOS and IL-1βand increase the expression levels of arginase1 CCL22 and TGF-β. The release of inflammatory fac-tor IL-1β decreased, and the release levels of TGF-β and chemokines CCL22 were promoted(P<0. 05). Atropine lactoneⅠ and Ⅲ had significant inhibitory effects on TNF-α, IL-1β and IL-6 in macrophages(P<0. 05). Conclusion: Atractylodes lactone Ⅰand Ⅲ with anti-inflammatory activity can promote the expression of cytokines in inflammatory macrophages, while the change induced by at-ractylaxanthin Ⅱ is not obvious.

Objective:To analyze the relationship of fractional exhaled nitric oxide(FeNO)levels with eosinophils(EOS), C-reactive protein(CRP), procalcitonin(PCT)levels in elderly patients with asthma-chronic obstructive pulmonary disease overlap(ACO).Methods:A retrospective study was conducted.According to the inclusion criteria, 60 elderly patients with ACO admitted in Fujian Geriatric Hospital from May 2016 to May 2019 were enrolled in the ACO group.During the same period, 60 patients with bronchial asthma were included in the asthma group, 60 patients with chronic obstructive pulmonary disease(COPD)were recruited in the COPD group, and 60 people taking health examination were included in the health group.Levels of FeNO, EOS, CRP and PCT were detected and compared between the groups.Correlations of FeNO levels with EOS and inflammatory factors were analyzed by the Spearman correlation.Results:The group with asthma alone showed the highest levels of FeNO, followed by the ACO group, the COPD group and the healthy group( F=970.235, P=0.000). The ACO group had the highest levels of EOS, CRP and PCT, followed by the COPD group, the asthma group and the healthy group( F=103.74, 76.648 and 57.042, P=0.000). Spearman bivariate correlation analysis showed that FeNO levels were positively correlated with levels of EOS, CRP and PCT in the asthma, COPD and ACO groups(the asthma group: r=0.646, 0.326 and 0.497, P=0.000, 0.014 and 0.000; the COPD group: r=0.398, 0.613 and 0.432, P=0.009, 0.000 and 0.001 the ACO group: r=0.654, 0.573 and 0.516, P=0.000, 0.000 and 0.000). Conclusions:High levels of FeNO are found in elderly patients with ACO.Levels of FeNO are positively correlated with EOS, CRP and PCT levels in peripheral blood, and can be used as a sensitive index for airway hyperinflammatory responses.

OBJECTIVE To evaluate the quality of guidelines/consensus on therapeutic drug monitoring （TDM） of anti-tumor necrosis factor-α （TNF-α） in patients with inflammatory bowel disease （IBD） in China and globally. METHODS PubMed， Embase， CNKI， Wanfang data， VIP， and release websites of guidelines/consensus in China and globally were searched to collect guidelines/expert consensus on TDM with anti-TNF-α for IBD patients. The search period was from database establishment to June 2023. After two investigators independently screened the literature and extracted the data， the methodological quality of the included guidelines/consensuses was evaluated using the Appraisal of Guidelines for Research and Evaluation Ⅱ. The main recommendations of the included guidelines/consensuses were summarized. RESULTS A total of 9 articles were included， 3 were guidelines and 6 were expert consensus. The standardized percentages of the 9 guidelines/consensus in the 6 dimensions （scope and aims， participants， rigor of formulation， clarity of expression， application， and editorial independence） were 90.43%， 41.98%， 52.55%， 85.49%， 19.00%， and 76.85%， respectively. Eight guidelines/consensus had a recommendation of grade B and one consensus of grade C. The main recommendations involve TDM application scenarios， threshold ranges， strategy adjustments， detection methods， and interpretation of results. Most guidelines/consensus recommend passive TDM for non-responders. It is recommended to set the TDM concentration range according to the expected treatment results and make strategy adjustments in combination with the disease condition and TDM results. Additionally， the same test method is recommended for the same patient. Some guidelines/consensus hold that no differences were noted in the interpretation of results between biosimilar and original drug. CONCLUSIONS The overall quality of the included guidelines/consensus was fair， with relatively consistent recommendation. Clinicians need to understand the characteristics and limitations of TDM with this class of drugs， and interpret and apply results of TDM in combination with specific clinical treatment goals.