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Objective To explore the effects of severe acute respiratory syndrome coronavirus (SARS-CoV) on heart and its conduction system in SARS patients. Methods Six specimens of heart tissue and one specimen of heart condunction system from patients who died from SARS were studied histologically, and by histochemical and in situ hybridization examinations. Results The pathological changes showed that a part of cardiomyocytes manifested slight vacuolar degeneration, atrophy and cytoplasmic lysis, stromal edema, mild mononuclear infiltration, and vasculitis. SARS-CoV was identified within some cardiomyocytes and specialized cardiomyocytes which belonged to the conduction system of the heart by in situ hybridization in combination with Macchiavello's viral inclusion stain. Conclusions The results showed that SARS-CoV could invade not only cardiomyocytes, but also the specialized cells of heart conduction system, thus resulting in mild viral myocarditis-like pathological changes. The results provided the evidence in explaining the clinical manifestations of cardiac dysfunction in patients with SARS.

Objective To explore the significance of cellular apoptosis induced by severe acute respiratory syndrome cronovirus (SARS-CoV) in the pathogenesis of SARS. Methods TdT-mediated biotinylated-dUTP nick end ladelling method (TUNEL), and the double immunochemical staining with cytokeratin and CD3, CD8, CD20 and CD68 monoclonal antibodies were used to study the cellular apoptosis in tissue specimens from six patients who died from SARS. Meanwhile, the expression of Fas, Fas ligand (FasL), P53 and Bcl-2 proteins was detected by immunohistochemical method. Results The number of cellular apoptosis was obviously increased in multiple organs from the six patients died from SARS. The cellular apoptosis occurred predominantly in cytokeratin-positive pneumoncytes, terminal bronchiolar epithelium, CD3 + and CD8 + lymphocytes, as well as a part of CD20 + lymphocytes and CD68 + macrophages. Fas protein was mainly expressed in the infiltrated mononuclear cells, while FasL was chiefly expressed in SARS-CoV target cells, especially in the apoptotic cells. In the lung and immune organs, down-regulation of P53 and Bcl-2 expression was found. Conclusion The occurrence of increased and rapid cell apoptosis induced by SARS-CoV might be the main cause of the injuries to the lung and immune system. That the activated lymphocytes which expressed Fas and FasL attack SARS-CoV target cells might be the underlying mechanism of cell apoptosis in SARS. Down-expression of Bcl-2 and P53 proteins might also participate in cell apoptosis induced by SARS-CoV.

Objective To compare the effect of target controlled infusion (TCI) and man controlled infusion (MCI) of propofol in pain-free endoscopic ultrasonography.Methods Sixty patients undergoing pain-free endoscopic ultrasonography were divided into TCI group and MCI group by random digits table method,each group 30 patients.Operation time,dose of propofol,time to loss consciousness and recovery time were recorded.The level of mean artery pressure (MAP) and heart rate (HR) were recorded before induction (T0),before operation (T1),5 min afteroperafion (T2) and 5 min afterawake (T3).Cases with bucking,aspiration,laryngeal spasm,pulse oxygen saturation (SpO2) lower than 0.90,MAP lower than 50 mmHg (1 mmHg =0.133 kPa) and HR lower than 50 bpm were recorded.Results Dose of propofol was higher in MCI group than that in TCI group,time to loss consciousness was shorter in MCI group than that in TCI group,recovery time was shorter in TCI group than that in MCI group,there was significant difference (P ＜ 0.01).The level of MAP and HR on T1 were significantly lower than those on T0 between two groups (P ＜ 0.05).The level of MAP and HR on T1 in TCI group were signifcantly higher than those in MCI group (P ＜ 0.05).The rate of bucking between two groups had no significant difference (x2 =0.37,P ＞ 0.05).The rate of anoxemia in TCI group was 10.0％ (3/30),in MCI group was 66.7％ (20/30),there was significant difference (x2 =20.38,P ＜ 0.01).The rate ofMAP lower than 50 mmHg in TCI group was 6.7％ (2/30),in MCI group was 30.0％ (9/30),there was significant difference (x2 =5.46,P ＜ 0.05).The rate of HR lower than 50 bpm between two groups had no significant difference (x2 =3.35,P ＞ 0.05).Conclusion Compared with MCI,patients induced by TCI mode are more stable in blood pressure,and more safe.

The body surface area of adult Chinese males was estimated by using paper cast method.56 healthy individuals, aged 18 to 45, coming from thirteen provinces mostly from Hebei and Hubei were used in this study. From the results obtained, the mean body weight, height and surface area were 59.78kg, 168.8 cm and 1.712 m2 respectively. A height-weight equation for estimating body surface area was derived accordingly, i.e. body surface area(m2)= 0.00607H(cm) + 0.0127W(kg)-0.0689. The error of the value calculated from the equation was 0.17% higher than the value actually taken on an average. The percentage of various body regions to the total body surface area was as follows: head, 6.11; trunk (including neck), 29.59; upper arms, 8.09; forearms, 6.41; hands, 4.93; thighs (including buttock), 24.63; calf, 13.29 and feet, 6.95.For convenient use a table for calculation was given.

Objective To explore an epicanthoplasty with good effect and small scar. Methods A V shape incision was designed in medial canthus and the two lines: point A is the top point of medial canthus and point A' is the top point of new medial canthus. The length of line AA' is about 4 to 8 mm according to the medial canthus and th incision is Y shape, and then Y-V epicanthoplasty is raised and enlarged. Results From January 2005 to December 2008, 98 cases were treated with this method to eliminate the medial epicanthal fold of the upper eyelid with simple procedures. Scarring of the medial canthal area had not been a problem with this technique because we designed incisions along the eyelashes and skin-mucosal junctions. By raising the point of new medial canthus to physiological position the angle of medial canthus was enlarged to reveal a lacrimal lake. Conclusion This technique is a simple, easy procedures with no visible scar.

We had previously reported the height-weight formula for the estimation of body surface area of adult Chinese males (this journal 6(2):87, 1984). In this study, by using the same paper cast method, a formula for the adult Chinese females was obtained from the data of 44 healthy subjects (age 18-45) coming from 15 provinces. The mean body weight, height and surface area measured were 52.13?6.22 kg, 159.3?5.18 cm and 1.546?0.105 m2 respectively. The formula thus derived was: body surface area (m2) = 0.00586H (cm) +0.0126W (kg)-0.0461. The value calculated from it was 0.03% less than the value actually measured on an average. The percentage of various body regions to the total body surface area was as follows: head, 6.33; trunk (including neck), 28.27; upper arms, 8.29; forearms, 6.65; hands, 4.52; thighs (including buttocks), 27.40; calves, 12.83 and feet, 6.65.

Periodontitis is a common chronic inflammatory disease. Recent studies have shown that chronic stress (CS) might modulate periodontal disease, but there are few models of CS-induced periodontitis, and the underlying mechanisms are unclear. The present study established a rat model of periodontitis associated with CS induced by nylon thread ligatures. The severity of periodontitis was evaluated in this model by radiographic and pathological examination. The inflammatory reaction indicated by the elevated serum levels of interleukin (IL)-1β, IL-6 and IL-8 was assessed by enzyme-linked immunosorbent assay. Toll-like receptor-4 (TLR4) and glucocorticoid receptor-α (GR-α) expressions were detected by reverse transcriptase-PCR and western blotting. Open-field tests and serum corticosterone were used to evaluate CS. The results showed that CS induced behavioral changes and increased corticosterone levels of the animals with periodontitis. CS stimulation markedly increased alveolar bone loss, periodontal pocket depth and the number of plaques. It also enhanced the inflammatory reaction. These results suggest that CS accelerated the ligature-induced pathological changes associated with periodontitis. Further analysis of the mechanisms involved showed that GR-α expression was significantly downregulated in periodontal tissues of the animals undergoing CS. Blocking GR-α signaling in lipopolysaccharide and corticosteroid-treated human periodontal ligament fibroblast cells in vitro significantly upregulated the expression of p-Akt (protein kinase B) and TLR4, promoted nuclear factor-κB activity and increased levels of IL-1β, IL-6 and IL-8. This research suggests that CS might accelerate the pathological progression of periodontitis by a GR-α signaling-mediated inflammatory response and that this may be a potential therapeutic target for the treatment of periodontal disease, particularly in patients with CS.
Alveolar Bone Loss ; Animals ; Blotting, Western ; Corticosterone ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts ; Humans ; In Vitro Techniques ; Interleukin-6 ; Interleukin-8 ; Interleukins ; Ligation ; Models, Animal ; Nylons ; Periodontal Diseases ; Periodontal Ligament ; Periodontal Pocket ; Periodontitis* ; Phosphotransferases

Immune checkpoint inhibitors(ICIs)have become the most widely used drugs in tumor immunotherapy, with ipilimumab and nivolumab as their representatives.However, the use of immune checkpoint inhibitors has brought about many immune-related adverse events, of which myocarditis is one of the most fatal adverse reactions.The pathogenesis of immune checkpoint inhibitor-associated myocarditis is not fully understood, mainly involving autoimmune T lymphocyte infiltration, regulatory T-cell dysfunction, cytokines, autoantibody production, genetic factors, the gut microbiome, etc.The treatment and management of immune checkpoint inhibitor-associated myocarditis require concerted efforts of multidisciplinary experts.

BACKGROUNDTo explore the clinical and pathological characteristics and pathogenesis of autoimmunohepatitis (AIH).

METHODSThe serum and liver biopsy specimens and clinical data of 26 cases with patients with AIH were analyzed and scored according to the criteria of International autoimmune hepatitis (IAIHG, 1999). The changes of dendritic cells (DC) in the liver tissues were observed with a panel of DC markers (CD-80/B7-1, CD-86/B7-2, CD-1a and HLA-DR) and immunohistochemistry, and the activation of hepatic stellate cells (HSC) and the expression of TGF-alpha were also detected. Liver tissue specimens from 10 patients with chronic viral hepatitis B and C respectively and 5 normal liver specimens were chosen as controls.

RESULTSMean aggregate scores of 26 AIH cases, including 21 cases of type B (80.8%) and 5 cases of type C (19.2%), which were 18.6 +/- 1.4 and 19.1 +/- 2.1 respectively. There were significant differences between the type B and type C in the average age levels of serum ALT and AST, and alpha-Glo (P <0.001 or P< 0.01 or P <0.05). Histological features of all the AIH liver tissues showed the lesions of chronic active hepatitis such as interface hepatitis/piecemeal necrosis (100%), obvious lobular inflammation (type B 95.2%, type C 100%), bridging necrosis (57.1% type B, 80.0% type C, P<0.05), rosetting of liver cells (71.4% type B, 100% type C, P<0.01), central lobular confluent necrosis (33.3% type B, 80.0% type C, P<0.001), predominant plasmacytic infiltration (type B 95.2%, type C 20.0%, P<0.001). The rates of increased and concentrated DC in the portal and lobular areas, especially in the active lesions in type B and type C AIH were 85.7% (18/21) and 5/5 respectively. It was found that DC and lymphocytes surrounded the hepatocytes which partly expressed HLA-DR antigen, while there were no or a few HLA-DR positive hepatocytes in controls. Meanwhile, the number of alpha-SMA positive HSC and the expression of TGF- were obviously increased in AIH liver tissues.

CONCLUSIONSSeveral clinical and pathological features of AIH were identified in this study. As an antigen-presenting cell, DC might play an important role in the pathogenesis of AIH. In China, sub-type B of AIH might be more frequent than sub-type C and there were differences in clinical aspects, serology and pathology between the two types.

Adolescent ; Adult ; Child ; Dendritic Cells ; immunology ; Female ; Hepatitis, Autoimmune ; blood ; pathology ; Humans ; Liver ; pathology ; Male ; Middle Aged