Objective To detect the expression of IL-17 in renal transplant recipients by Luminex and evaluate the relationship between the level of serum IL 17 and early acute renal allograft rejection.Methods 38 kidney transplant recipients and healthy controls (HC,healthy volunteers,n =20) were selected in this study from January 2009 to October 2011.All patients were divided into two groups according to their allograft outcome as acute rejection group (ARG,n-18) and non-rejection group (NRG,n=20).The expression of serum IL-17 was detected by Luminex technique in two groups of kidney transplant recipients and HC.To evaluate the correlation between the level of serum IL-17 and early acute renal allograft rejection.Results The mean level of IL-17 in all renal transplant recipients 1.3 ± 1.9 pg/ml at the pre-transplantation was significantly lower than that in HC (6.9± 8.5 pg/ml,t=3.968,P＜0.001).The results highlighted that the level of serum IL-17 in ARG 3.4±5.8 pg/ml was significantly higher than that in NRG (0.5±0.4 pg/ml) on the 7th days post Kidney transplantation (post KTx,t=2.242,P =0.031).Kaplan-Meier survival analysis showed that the probability of rejectionfree survival in the higher levels group of IL-17 on the 7th days post-KTx was significant lower than that in the lower levels group (P＜0.001).The results of receiver operating characteristic curve showed that the sensitivity and specificity of the combined IL-17 to predict acute rejection were 66.67％ and 100％,respectively.Conclusion The serum IL-17 levels in renal transplant recipients on the 4th and 7th post-KTx days can predict early renal transplant rejection.

Objective To investigate the reliability and validity of Simple Facial Grading System (SFGS) in patients with idiopathic facial palsy. Methods 80 patients with idiopathic facial palsy were evaluated with the House-Brackmann (H-B) scale and SFGS before and every 2 weeks after treatment until 12 weeks or recovery. They were assessed by 2 testers before and 2 weeks after treatment. The results were analyzed and compared. Results The Cronbach's α coefficient was 0.93 of SFGS, and 0.74 of H-B scale. The intraclass correlation coefficient (ICC) between testers was 0.84 or higher of SFGS, and 0.77 or higher of H-B scale. The Spearman's rank correlation coefficient between SFGS and H-B scale was 0.73, Kappa coefficients was 0.81 for grade II, 0.74 for grade III, 0.49 for grade IV, 0.66 for grade V, and 0.92 for grade VI. The scores of SFGS and H-B scale positively correlated with the recovery time. Conclusion SFGS is a kind of evaluation for peripheral facial paralysis with satisified reliability and validity, which can be applied to evaluate the severity and outcome during acute stage.

Objective:To explore the feasibility of using multivariate statistical analysis to evaluate the quality of Astmgali radix from different habitats. Methods:The contents of Astragaloside saponinⅠ, Astragalus saponin Ⅱ, Astragaloside Ⅲ and Astragaloside A were determined by UPLC-ELSD. The components of astragalus saponins from different habitats were analyzed by TOPSIS and cluster thermogram.Results:TOPSIS analysis showed that the comprehensive quality of Astmgali radix samples from Shanxi, Gansu and Inner Mongolia was related(were 0.297 3, 0.346 0, 0.322 5), and the whole quality of S13 and S14 from Shanxi and N5 from Inner Mongolia were higher than others. Cluster thermogram showed that Astmgali radix was grouped into three groups according to region, and the quality difference of Astmgali radix was mainly reflected on Astragaloside saponinⅠand Astragalus saponin Ⅱ. Conclusions:The theory of multivariate statistical analysis is perfect, objective and reliable. It can be used as a reference for comprehensive quality evaluation of Traditional Chinese Medicine (TCM), selection of excellent germplasm resources and traceability of origin of TCM.

Objective To investigate the predictive value of urinary exosomal microRNA(miR)-29 c in the clinical outcome of organ-and non-organ-confined bladder urothelial carcinoma(BUC).Methods From January 2017 to March 2022,152 patients with BUC were recruited from the Department of Urology in our hospital as a validation set.In addition,126 non-cancer controls were selected from the physical examination center of our hospital.The expression level of urinary exosomal miR-29c was detected by real-time quantitative PCR.Results In the validation set,urinary exosomal miR-29c level in BUC patients was significantly lower than that in non-cancer control group(P＜0.05),while urinary exosomal miR-17-5p level and miR-590-5p level were not significantly different(P＞0.05).The area under ROC curve of urinary exosomal miR-29c for the diagnosis of BUC was 0.969(95％CI:0.953～0.986),and the corresponding sensitivity and specificity were 92.1％and 90.2％,respectively.In subtype analysis,urinary exosomal miR-29c levels were further reduced in patients with non-organ-confined BUC compared with patients with organ-confined BUC(P=0.009).Overall survival(OS),disease-free survival(DFS)and disease-specific survival(DSS)were longer in the urinary exosomal miR-29c high expression group(P＜0.05).Conclusion Low levels of urinary exosomal miR-29c are an adverse prognostic factor for survival in patients with BUC,and are promising as a predictor of adverse clinical outcomes of organ-and non-organ-confined BUC.

In September 8 th, 2021, a male patient (aged 18 years) with severe destructive injuries of high-voltage electric burns in the head, face, and neck was admitted to General Hospital of Taiyuan Iron Steel (Group) Co., Ltd. Based on the economic theory of flaps, the flap donor site and transplantation method were optimized and evaluated before surgery, and then debridement of head, face, and neck wounds+removal of necrotic skull+free transplantation of super large latissimus dorsi myocutaneous flap+thin intermediate thickness skin graft transplantation from the left thigh was performed. The extra large flap donor site wound was sutured directly. This surgery reduced the adverse consequences of the flap donor site on the premise of ensure of repair effect. After operation, the patient's condition was stable, the flap and skin graft survived well, the repair effect of wound was well, the scar in the flap donor area was relatively mild, and the upper limb had no dysfunction.

Objective To discuss the clinical significance of programmed cell death-1 (PD-1) in neuromyelitis optica spectrum disorder (NMOSD) patients by analyzing PD-1 and programmed death 1-1igand (PD-L1) expressions.Methods Sixteen patients with NMOSD,16 patients with longitudinally extensive transverse myelitis (LETM),13 patients with opticneuritis (ON),20 with other diseases of the central nervous system (OTH) and 16 health controls (CONs) were chosen in our hospital from April 2015 to July 2016;their peripheral blood was separately collected.The PD-1 expression in the CD4+r lymphocytes,and PD-L1 expressions in the CD14+ mononuclear leucocytes and CD19+B lymphocytes of peripheral blood were detected by flow cytometry.ELISA was performed to analyze the levels of soluble PD-1 and soluble PD-L1 in plasma samples.Results The PD-1 level from the peripheral blood of NMOSD patients was significantly higher than that from LETM,ON,and OTH patients and CONs (P＜0.05).The PD-L1 level of NMOSD patients was significantly higher than that of the other 4 groups (P＜0.05).ELISA indicated that levels of soluble PD-1 and soluble PD-L1 in plasma samples from NMOSD patients were significantly higher than those in LETM,ON,and OTH patients and CONs (P＜0.05).Conclusion The PD-1/PD-L1 pathway is an important immune response approach and takes part in the earlier stage of the NMOSD pathological process.

OBJECTIVETo investigate the effects of application of intermittent hemofiltration combined with hemoperfusion (HP) in the early stage of severe burn in the prevention and treatment of sepsis.

METHODSForty severely burned patients, admitted to our burn ward from June 2011 to March 2013, conforming to the study criteria, were divided into conventional treatment group (CT, n=20) and blood purification group (BP, n=20) according to the random number table. Patients in group CT received CT according to the accepted principles of treatment for a severe burn. Patients in group BP received CT and intermittent hemofiltration combined with HP once respectively on post injury day (PID) 3, 5, and 7, spanning 6 to 8 hours for each treatment. On PID 3, 5, 7, 10, and 14, body temperature, heart rate, and respiratory rate were recorded; white blood cell count (WBC), neutrophil granulocytes, blood urea nitrogen (BUN), and creatinine were determined; levels of IL-1, IL-6, TNF-α, and high-mobility group box 1 (HMGB1) in serum were determined by ELISA; level of LPS in serum was determined with the chromogenic substrate limulus amebocyte lysate method; level of procalcitonin (PCT) in serum was determined by double antibody sandwich immune chemiluminescence method. The symptoms and signs of sepsis were observed during the treatment. Data were processed with Fisher's exact test, chi-square test, analysis of variance for repeated measurement, and LSD-t test.

RESULTS(1) Except for that on PID 5, the mean body temperature of patients in group BP was significantly lower than that of group CT at each of the rest time points (with t values from 1.87 to 2.97, P values below 0.05). The heart rate was significantly slower in patients of group BP than in group CT from PID 3 to 14 (with t values from 1.78 to 3.59, P values below 0.05). Except for that on PID 3, the respiratory rate of patients in group BP was significantly slower than that of group CT at each of the rest time points (with t values from 1.93 to 2.85, P values below 0.05). (2) The levels of WBC, neutrophil granulocytes, BUN, and creatinine of patients in group BP were significantly lower than those of group CT (with t values from 1.78 to 4.23, P values below 0.05). (3) Except for that on PID 3, the level of IL-1 of patients in group BP was significantly lower than that of group CT at each of the rest time points (with t values from 1.97 to 4.16, P values below 0.05). Except for that on PID 7, the level of IL-6 of patients in group BP was significantly lower than that of group CT at each of the rest time points (with t values from 2.11 to 6.34, P values below 0.05). The levels of TNF-α and HMGB1 of patients in group BP were significantly lower than those of group CT from PID 3 to 14 (with t values from 1.98 to 5.29, P values below 0.05). (4) On PID 3, 5, 7, 10, and 14, the levels of LPS and PCT of patients in group BP were respectively (0.23 ± 0.07), (0.27 ± 0.09), (0.22 ± 0.06), (0.20 ± 0.08), (0.15 ± 0.07) EU/mL, and (0.44 ± 0.12), (0.67 ± 0.13), (0.74 ± 0.13), (0.64 ± 0.12), (0.71 ± 0.10) ng/mL, and they were lower than those of group CT [(0.37 ± 0.08), (0.45 ± 0.09), (0.56 ± 0.09), (0.48 ± 0.08), (0.40 ± 0.08) EU/mL, and (0.74 ± 0.11), (1.16 ± 0.12), (1.40 ± 0.13), (1.55 ± 0.15), (1.49 ± 0.14) ng/mL, with t values from 1.88 to 3.43, P values below 0.05]. (5) The incidence of sepsis of patients in group BP was obviously lower than that of group CT (χ² = 6.94, P<0.01).

CONCLUSIONSIntermittent hemofiltration combined with HP can effectively improve blood biochemical indexes and vital signs and reduce the occurrence of burn sepsis by decreasing the levels of proinflammatory cytokines, LPS, and PCT.

Biomarkers ; blood ; Burns ; blood ; complications ; immunology ; therapy ; Calcitonin ; Calcitonin Gene-Related Peptide ; Cytokines ; blood ; HMGB1 Protein ; Hemofiltration ; methods ; Hemoperfusion ; methods ; Humans ; Interleukin-1 ; blood ; Interleukin-10 ; blood ; Interleukin-6 ; blood ; Protein Precursors ; Sepsis ; blood ; immunology ; prevention & control ; therapy ; Serum ; Severity of Illness Index ; Treatment Outcome ; Tumor Necrosis Factor-alpha

Objective To explore the immunopathological mechanism for the imbalance between the positive signal mediated by inducible costimulator (ICOS) and the negative signal mediated by programmed death-1 (PD-1) in patients with myasthenia gravis (MG).Methods Eighty-two patients with MG,56 healthy controls (HC) and 20 non-MG (NMG) patients,collected in the First Affiliated Hospital of Suzhou University from February 2014 to December 2016,were chosen to participate in the study.The expression of ICOS and PD-1 on peripheral blood mononuclear cells was detected by immuno-fluorescence staining and flow cytometry.The levels of soluble programmed death-1 (sPD-1),soluble programmed death ligand 1 (sPD-L1),IL-4 and other cytokines were detected by enzyme-linked immunosorbent assay.Results (1) Flow cytometry analysis:The co-expression of PD-1,ICOS on CD4 + T cells from MG group (9.64％ (8.82％)) was higher than in HC (1.81％ (2.10％),Z =-7.389,P ＜0.05) and NMG group (2.86％ (1.49％),Z =-4.636,P ＜ 0.05).The expression of ICOS on CD4 + T cells,ICOS ligand (ICOSL) on CD14+ monocytes and CD19+ B cells were increased in MG group comparing with that of the control groups.The proportion of PD-1 + CD4 + T cells (MG group 16.82％ (10.66％),HC 9.34％ (9.18％),Z =-4.345,P＜0.05;NMG group 7.07％ (3.40％),Z=-4.594,P＜0.05) and PD-1 Ligand (PD-L1) + CD14+ monocytes was higher in MG patients.All of these were detected by flow cytometry.(2) ELISA analysis:Serum sPD-1 expression significantly increased in MG group compared with that in the control groups (MG group (1.87 ± 0.64) ng/ml,NMG group (1.49 ± 0.70) ng/ml,t =2.04,P ＜ 0.05;HC (1.05 ± 0.50)ng/ml,t =2.08,P ＜ 0.05),while for serum sPD-L1,there was no significant difference between MG and control groups.(3) Serum cytokines detection:The expression of IL-4 was increased in MG patients (MG group (61.88 ±5.15) pg/ml,HC (32.03 ±1.84) pg/ml,t=2.50,P＜0.05;NMG group (42.62± 3.31) pg/ml,t =2.34,P ＜0.05),and there was a negative correlation between the expression of sPD-1 and the concentration of IL-4.Conclusions The increased expression of PD-1 + ICOS + CD4 + T cells suggested the subset involved in the pathological progress of MG.sPD-1 might disturb the ligation of PD-1 on T cells and PD-L1 on antigen presenting cells,while the ligation of ICOS and ICOSL passed positive signal,leading to over activity of the subsets and the progression of disease.

【Objective】 To establish a prognostic model of fatty acid metabolism related genes for predicting the prognosis of renal clear cell carcinoma. 【Methods】 The differentially expressed fatty acid metabolism-related genes in renal clear cell carcinoma samples and normal samples in TCGA database were screened by R language software. The Cox proportional hazard regression model was used to select and establish a multigene prognostic model and the prognostic score was calculated. Patients were divided into high-risk group and low-risk group according to the median prognostic score. Kaplan-Meier survival curve was used to analyze the difference in two groups. The clinical pathological factors and prognostic score factors were included in the Cox regression model to analyze the factors affecting the survival of patients with renal clear cell carcinoma. ROC receiver operating curve analysis was used to evaluate the accuracy of the prognostic prediction model. The prognostic model of fatty acid metabolism-related genes and their correlation with clinical factors were analyzed. GSEA enrichment analysis analyzed the differences of gene sets in risk groups. 【Results】 A total of 4 differential genes (CPT1B, HADH, CYP4A11, and ACADSB) were selected to establish a prognostic model for genes related to fatty acid metabolism in renal cell carcinoma. The prognostic risk score (RS) formula is as follows: RS=0.490×CPT1B-0.428×HADH-0.11 × CYP4A11-0.372 × ACADSB. Kaplan-Meier survival analysis confirmed that the overall survival rate of patients with low-risk prognostic score was significantly higher in patients with overall renal clear cell carcinoma, and the difference was statistically significant (P<0.001). Cox regression analysis showed that the prognostic model of genes related to age and fatty acid metabolism is an independent influencing factor for the prognosis of patients with renal clear cell carcinoma (P<0.01). The 5 years’ AUC of the renal clear cell carcinoma ROC curve of the renal cancer fatty acid metabolism related gene model was 0.802. GSEA analysis showed that the difference of 81 gene sets in the low-risk group was statistically significant (P<0.05). 【Conclusion】 The prognostic model of renal cancer fatty acid metabolism-related genes can be used to predict the prognosis of patients with renal clear cell carcinoma, which is conducive to further guide clinical treatment.

Objective:To assess the combination of conventional ultrasound with contrast-enhanced ultrasound(CEUS)in the diagnosis of urothelial carcinoma(UC)of the renal pelvis in elderly patients.Methods:Sixty-seven elderly patients with a histopathologic diagnosis of UC of the renal pelvis and surgically treated at our hospital between April 2015 and March 2023 were retrospectively analyzed.Characteristics of regular preoperative 2D ultrasound, color Doppler flow imaging(CDFI)and CEUS were examined.Results:Of 67 patients, 49(73.13%)were found to have localized lesions in the renal pelvis and renal calyces.Lesions in 53 patients(79.10%)could be clearly identified by conventional ultrasound, with 46(86.79%)being isoechoic or hypoechoic, and 7(13.21%)being hyperechoic.Analysis of tumor blood flow by CDFI found 22 cases(41.51%)with avascular lesions, 21(39.62%)with hypovascular lesions and 10(18.87%)with hypervascular lesions.The average value of the resistance index(RI)was 0.64.Enhancement was seen in 62 lesions(92.54%)by CEUS after injection of SonoVue.Compared with the cortex of the ipsilateral kidney, a slow enhancement pattern was observed in 46(74.19%), 14(22.58%)showed simultaneous enhancement, and 2(3.23%)showed fast enhancement.At peak enhancement, 43 lesions(69.35%)had hypo-enhancement, 10(16.13%)had iso-enhancement, and 9(14.52%)had hyper-enhancement, compared with the cortex.Concerning the homogeneity of enhancement, 16(25.81%)displayed heterogeneous enhancement, with tumor necrosis or hemorrhage, and 46(74.19%)had homogeneous enhancement.When the contrast agent washout rate was assessed, a fast washout pattern was observed in 53(85.48%), synchronous washout in 6(9.68%), and slow washout in 3(4.84%).Conclusions:UC of the renal pelvis mostly shows isoechoic and hypoechoic lesions on conventional ultrasound, avascular or hypo-vascular lesions on CDFI, and slow-in, fast-out and hypo-enhancement on CEUS, compared with the cortex.Conventional ultrasound combined with CEUS can help improve the diagnostic accuracy of UC of the renal pelvis.