Objective To explore clinical significance of C-reactive protein( CRP) and procalcitonin ( PCT) in chronic obstructive pulmonary disease( COPD) with acute exacerbation.Methods Included 120 COPD patients with acute exacerbations,and at the same time,according to the random number table method,120 COPD patients with stable were extracted, all respondents were given corresponding symptomatic support treatment, observation before treatment,after treatment,the 1d,7d,14d patients serum levels of CRP was associated with change PCT level. Results Compared with before treatment, after treatment, the serum levels of CRP of COPD patients with acute exacerbation of at 1d,7d,14d was associated with a decline in PCT level, different time points more statistically significant difference( all P<0.05);Compared with patients with stable,before treatment,after treatment,the 1d,7d serum levels of CRP[(12.32 ±6.59)mg/L,(9.05 ±3.31)mg/L,(7.31 ±2.31)mg/L,(4.45 ±1.54)mg/L]was associated with a high level of PCT[(0.34 ±0.05)μg/L,(0.26 ±0.04)μg/L,(0.18 ±0.04)μg/L,(0.10 ± 0.03)μg/L]were obvious,more statistically significant difference(all P<0.05);But after treatment,serum CRP was associated with differences in the level was no statistical comparison PCT significance ( P >0.05 ) .Conclusion COPD patients with acute exacerbation of serum CRP and early PCT significantly higher level,its level after treatment dropped significantly,joint observation CRP and serum PCT level can reflect COPD acute exacerbation issue of the inflammatory reaction.

Objective To investigate the therapy effect of deanxit combined with large dose of oryzanol in the treatment of post stroke depression(PSD) and anxiety in elderly male.Methods Sixty cases of PSD and anxiety patients were divided into three groups by random number table method with 20 cases in each,deanxit group treated with deanxit,oryzanol group treated with oryzanol,and combination group treated with deanxit and large dose of oryzanol,a total of 4 weeks.Before and after 4 weeks treatment respectively using Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) scores.Results The HAMD and HAMA scores before treatment in three groups had no statistical significance (P ＞ 0.05).Compared with before treatment,HAMD and HAMA scores in three groups after treatment were significantly lower (P＜ 0.01).HAMD scores in combination group were improved better than those in deanxit group and oryzanol group [(12.85 ± 3.69) scores vs.(15.30 ± 3.28),(18.65 ± 3.13) scores](P＜ 0.01),and deanxit group were better than oryzanol group(P＜ 0.01).HAMA scores in deanxit group and combination group were lower than those in oryzanol group [(8.65 ± 3.33),(7.25 ± 3.34) scores vs.(10.65 ± 3.18) scores] (P ＜0.01).Conclusion Deanxit combined with oryzanol is effective in the treatment of PSD and anxiety in elderly male.

Objective To construct the recombinant plasmid of protein CFP10-MPT48-TB8.4 of Mycobacterium tuberculosis and to investigate the diagnosis potential of this fusion protein in tuberculosis serodiagnosis.Methods The recombinant fusion protein CFP10-MPT48-TB8.4 was expressed, and identified by Western blot.The ELSIA based on the purified fusion protein was done,and used for screening in 230 cases of clinical serum samples including pulmonary tuberculosis patients ( n =150 ),pulmonary disease patients other than tuberculosis (n =70) and health controls (n =103 ).The test result was analyzed by Medcale11.5 software.Results The fusion protein CFP10-MPT48-TB8.4 was successfully expressed with a purity over 95％.Specific immunogenicity of the recombinant protein was confirmed by Western blot.The overall sensitivity and specificity obtained of ELISA were 56.7％ (85/150) and 90.8％ ( 157/173 ),respectively.The specificity was 85.7 ％ (60/70) in non-tuberculosis group and 94.2％ (97/103 ) in healthy group,respectively.Conclusion The recombinant protein of CFP10-MPT48-TB8.4 has a high sensitivity and specificity and may be a potential candidate antigen in tuberculosis serodiagnosis.

Objective To evaluate whether sofosbuvir (SOF)-based direct-acting antiviral agents (DAAs) combined with ribavirin (RBV) (combined RBV) can yield benefits to the recipients infected with hepatitis C virus (HCV) genotype 1 (GT1) after liver transplantation through systematic evaluation and Meta-analysis. Methods Multiple databases at home and abroad were systematically searched, the literature screening was conducted according to relevant standards, the quality of literatures was evaluated and data extraction was performed. The literature was divided into two groups according to the recipients with HCV-GT1 hepatitis after liver transplantation who received the treatment combined RBV or SOF-based DAAs alone without RBV (not combined RBV). Meta-analysis of the data was carried out using Rev Man 5.3 and R3.4.3 software. The incidence of sustained virological response 12 weeks (SVR12) after therapy was evaluated. Results A total of 2 195 articles were retrieved, and 6 articles published in English were eventually included according to the inclusion criteria. The Meta-analysis results demonstrated that the incidence of SVR12 did not significantly differ between the combined RBV and not combined RBV groups (P=0.28). However, the incidence of anemia in the combined RBV group was significantly higher than that in the other group (P < 0.01). Both combined RBV and not combined RBV therapies were efficacious in treating HCV-GT1a and HCV-GT1b subtypes after liver transplantation with similar clinical efficacy (P=0.33). The incidence of SVR in HCV-GT1 recipients did not significantly differ after receiving 12- and 24-weeks therapy after liver transplantation (P=0.95). Conclusions When SOF-based DAAs regimen is adopted to treat HCV-GT1 in recipients after liver transplantation, combination with RBV not only fails to improve the virus clearance rate and bring clinical benefits, but also increases the risk of anemia in the recipients.

Objective To study the relationship of two variants( -871A/G and -336A/G) polymorphisms of the DC-SIGN gene with the susceptibility to pulmonary tuberculosis in Chinese population.Methods Two hundred and thirty-seven tuberculosis cases and 244 controls were genotyped by pyrosequencing in this case-control study. The analysis of the relationship of the -871A/G and -336A/G polymorphisms with their susceptibility of pulmonary tuberculosis(PTB) and the relationship of the two variants with their clinical correlation of tuberculosis was performed by chi-square test. Results The genotypic frequencies of A/G + G/G and A/A of - 871, 37.6%, 62.4% respectively in cases, and 43.4%, 56. 6%respectively in controls, had no significant difference in statistics. And the genotypic frequencies of A/G + G/G and A/A of -336, 12. 2% ,87.8% respectively in cases, and 14.3% ,85.7% respectively in controls, had also no statistical difference between two groups. Interestingly, a significant association is disclosed between the promoter variant - 336G allele and fever in patients ( P = 0. 037, OR = 0. 191, 95 % CI:0. 040-0. 907 ). Conclusion The single nucleotide polymorphism of -871A/G and -336A/G in DCSIGN gene promoter might not be associated with the susceptibility to tuberculosis in Chinese. Tuberculosis patients with -336G allele are significantly protected fever.

Postoperative complications of ERCP include pancreatitis,cholangitis,hemorrhage,mechanical damage (such as perforation) of the digestive tract and drug reaction.Since the the complications definition,surgical indications,operation technique,data collection and processing method were inconsistent,there were controversies for the incidences of complications after ERCP and its risk factors for different institutions.This paper discussed the evolution of ERCP risk factors,current situation and prophylaxis of major complications after ERCP and summarized the current research progress in order to provide theoretical help for prevention and prophylaxis of postoperative complications of ERCP.

Objective:To evaluate the effect of different options of preoperative biliary drainage (PBD) on perioperative complications of patients undergoing pancreaticoduodenectomy (PD).Methods:The clinical data of patients undergoing PD for periampullary carcinoma from January 2016 to November 2021 at Third Affiliated Hospital of Naval Medical University (Shanghai Eastern Hepatobiliary Surgery Hospital) were retrospectively analyzed. The 303 patients including 199 males and 104 females, aged (64.2±8.8) years. According to PBD, the patients were divided into two groups: percutaneous transhepatic biliary drainage (PTBD) group ( n=228) and endoscopic retrograde cholangiopancreatography (ERCP) group ( n=75). PBD operation-related complications (including bleeding, biliary leakage, etc.), postoperative complications of PD (including pancreatic fistula, biliary leakage, surgical site infection, etc.) and perioperative complications (PBD operation-related complications + postoperative complications of PD) were compared between the two groups. Univariate and multivariate logistic regression analysis were used to analyze factors influencing perioperative complications of PD. Results:The incidence of PBD operation-related complications in PTBD group was 10.1% (23/228), lower than that in ERCP group 25.3%(19/228), and the difference was statistically significant (χ 2=10.99, P=0.001). The incidence of postoperative complications of PD in PTBD group was 38.2%(87/228), lower than that in ERCP group 69.3%(52/75), the difference was statistically significant (χ 2=22.09, P<0.001). The incidence of total perioperative complications in PTBD group was 44.3% (101/228), lower than that in ERCP group 73.3%(55/75), the difference was statistically significant (χ 2=19.05, P<0.001). Multivariate logistic regression analysis showed that patients with periampullary carcinoma undergoing ERCP biliary drainage and PD had increased risk of surgical site infection ( OR=2.86, 95% CI: 1.59-5.16, P<0.001) and pancreatic fistula ( OR=3.06, 95% CI: 1.21-7.74, P=0.018). Conclusion:ERCP biliary drainage is a risk factor for postoperative pancreatic fistula and surgical site infection in patients with periampullary carcinoma undergoing PD. PTBD should be recommended as the first choice for the patients underwent PD.

Objective To investigate the changes of autophagy in rat lung tissues after acute spinal cord injury (ASCI) and the possible mechanisms.Methods Sixty-three female SD rats were divided into sham operation group (n =21) and spinal cord injury group (n =42),according to the random number table.The modified Allen method with the impact energy of 10 × 25 g · mm at the T10 vertebra was used for preparation of ASCI models.The rats were sacrificed at 6,12,24,48,72 hours,1 and 2 weeks after injury.Lung tissue damage and apoptosis were detected by HE staining and TUNEL method.The changes of autophagy and expressions of LC3-Ⅱ,P62,Beclin-1,interleukin (IL)-17A and Bcl-2 in lung were detected by Western blot and immunofluorescence.Results The pulmonary alveoli maintained normal structure in sham operation group,with no inflammation or pulmonary hemorrhage.Slight lung tissue damages were observed in spinal cord injury group at 12 h postinjury.Alveolar stroma widening,inflammatory infiltration,hemorrhage,and alveolar collapse became ingravescent at 24-72 hours postinjury.Numbers of apoptotic cells in spinal cord injury group were 551.22 ± 135.94,905.11 ±92.64,and 141.78 ± 30.86 respectively at 24,72 hours and 1 week postinjury,and were significantly increased at 24 and 72 hours postinjury,compared with sham operation group (P ＜ 0.05).Expression of LC3-II in spinal cord injury group was increased at 24-72 hours postinjury,compared with sham operation group (P ＜ 0.05).Expression of P62 in spinal cord injury group was up regulated at 24-72 hours postinjury,compared with sham operation group (P ＜ 0.05).Expression of Beclin-1 in spinal cord injury group was increased at 24 h postinjury and then dropped at 48-72 hours,compared with sham operation group (P ＜ 0.05).Expression of IL-17A in spinal cord injury group was increased at 24-48 hours,compared with sham operation group (P ＜ 0.05).Expression of Bcl-2 in spinal cord injury group was increased from 24 hours to 72 hours,compared with sham operation group (P ＜ 0.05).Conclusion Autophagosome formation is increased and accumulated in the lung tissues after ASCI,which might be related to the increased interaction between Beclin-1 and Bcl-2 because of the up regulation of Bcl-2 by IL 17A,ultimately leading to the inhibition of autophagy.