Objective To explore the clinical significance of immunocyte subsets before and after immunosuppressive therapy in the peripheral blood of patients with immune thrombocytopenic purpura (ITP).MethodsThe percentages of immunocyte subsets in the peripheral blood of 35 patients with ITP and 20 healthy controls were detected by flow cytometry,including CD3+,CD4+,CD8+,CD56+,CD19+ lymphocytes and CD4+/CD8+.Results The percentages of CD3+ T lymphocyte (61.58 ± 6.45 ) %,CD4+ T lymphocyte (28.38 ±4.89)% and the ratio of CD4+/CD8+ 0.99 0.22 in patients with ITP were lower than those in healthy controls[( 67.85 ± 4.68 ) %,( 38.00 ± 3.37 ) %,1.54 ± 0.13,all P ＜ 0.05].After immunosuppressive therapy,the percentages of CD3+ T lymphocyte ( 69.41 ± 5.03 ) %,CD4+ T lymphocyte (38.17 ±3.18)% and the ratio of CD4+/CD8+ 1.60 ±0.15 recovered to control levels.The percentages of CD8+ T lymphocyte (29.20 ±4.50)% and CD19+B lymphocyte ( 17.74 ±4.14)% were higher than those in healthy controls[( 24.82 ± 2.93 ) % and ( 12.09 ± 3.51 ) %,all P ＜ 0.05].After the immunosuppressive therapy,the percentages of CD8+ T lymphocyte ( 24.06 ± 3.02 ) % and CD19+ B lymphocyte ( 10.90 ± 3.55 ) %recovered to control levels.There were no significant difference of the percentage of CD56+ lymphocyte among ITP patients ( 15.80 ± 2.85 )%,ITP patients after immunosuppressive therapy ( 15.16 ± 2.77 )% and healthy controls ( 16.36 ± 2.75 ) %.ConclusionThe aberrant immunocyte subsets are involved in the pathogenesis of ITP,and detection of immunocyte subsets might be helpful for the diagnosis and determination of therapeutic outcome of ITP.

Objective To explore the clinical significance of a series of cytokines and peripheral blood immunocyte subsets before and after immunosuppressive therapy in patients with immune thrombocytopenia (ITP).Methods The percentages of immunocyte subsets in the peripheral blood of 20 patients with ITP and 20 healthy controls were detected by flow cytometry,including CD3+,CD4+,CD8+,CD4+/CD8+,CD1~.ELISA was applied to detect the level of serum TNFα,IL-2,IL-6,IL-4,IL-10,IL-11,IL-17,IL-27,transforming growth factor β (TGFβ),thrombopoietin (TPO) of 20 patients with ITP and 20 healthy controls.Results The percentage of CD3+ T lymphocyte,CD4+ T lymphocyte and the ratio of CD4+ / CD8+ T lymphocyte in patients with ITP were lower than those in healthy controls [(62.66 ± 6.58) ％ vs (69.93 ± 4.81) ％,(29.46 ± 5.02) ％ vs (39.08 ± 3.50) ％,0.97 ± 0.35 vs 1.56 ± 0.26,all P ＜ 0.05].After immunosuppressive therapy,the percentage of CD3+ T lymphocyte,CD4+ T lymphocyte and the ratio of CD4+/CD8+ T lymphocyte [(71.49 ±5.16)％,(39.25 ±3.21)％ and 1.56 ±0.28] recovered to the same levels in healthy controls.The percentage of CD8+ T lymphocyte and CD19+ B lymphocyte in patients with ITP were higher than those in the healthy controls [(30.28 ±4.63)％ vs (25.90±3.06)％,(18.92 ± 4.27)％ vs (13.17 ± 3.64)％,all P ＜ 0.05].After treatment of immunosuppressive therapy,the percentage of CD8+ T lymphocyte and CD19+ B lymphocyte [(25.16 ± 3.45) ％ and (11.98 ± 3.68) ％] recovered to the similar levels in healthy controls.The serum levels of IL-4,IL-6,IL-11,IL-17 and TPO in patients with ITP were significantly higher than those in healthy controls.While TGFβ level was significantly decreased.There was no significant difference of IL-27 between ITP patients and healthy controls.After the treatment of immunosuppressive therapy,IL-4,IL-6,IL-11,IL-17,TPO and TGFβ were down-regulated while IL-27 was up-regulated.There was no significant difference of IFNγ,TNFα,IL-2 and IL-10 among ITP patients before or after immunosuppressive therapy and healthy controls.Conclusions The present study suggests that the aberrant immunocyte subsets and cytokines are involved in the pathogenesis of ITP.Hyper-function of Th2 and Th17,dysfunction of Treg cells,up-regulation of IL-27,IL-11,TPO and other factors may contribute to the pathogenesis of ITP.

Objective To analyze the changes and clinical significance of C-reactive protein (CRP)、hemoglobin (Hb) and erythrocyte sedimentation rate (ESR) in different disease stage of multiple myeloma according the international staging system. Method Thirty untreated MM patients with complete clinical records were included in the stndy. The multiple myeloma patients were classified into three groups according to international staging system (ISS).Thirty megaloblastic anemia patients of similar age 、sex、hemoglobin level as the observation group.Resulets The levels of CRP (24.17±9.87 mg/L)、Hb (71.72±13.27 g/L) and ESR (105.94±27.73 mm/h) of stage Ⅲ patients were statistically different with stage Ⅰ ( CRP 8.54±1.97 mg/L; Hb 91.00±9.92g/L; ESR 73.57±20.53mm/h)、Ⅱ patients ( CRP 14.89±5.51 mg/L; Hb 91.29±8.32g/L; ESR 67.00± 15.56 mm/h) separately (P＜0.05).The levels of CRP (19.40±10.17 mg/L) and ESR (91.90±29.70 mm/h) in the MM patients were significantly higher than that in the observation group Ⅰ ( CRP 7.52±1.57mg/L; ESR 20.20±8.04mm/h) (P＜0.05 respectively).CRP and ESR level in MM patients positively correlated with myeloma cell proportion and β2-microglobulin level (P＜0.05), while Hb level negatively correlated with myeloma cell proportion and β2-microglobulin level (P＜0.05),Conclusion The levels of C-reactive protein、hemoglobin and erythrocyte sedimentation rate are closely associated with the development of multiple myeloma. C-reactive protein and hemoglobin are relatively sensitive response to disease than erythrocyte sedimentation rate. There is a clear clinical implication in detecting the patient' s condition for progress and the prognosis.

Objective:To investigate the expression of SHIP1 in the patients with acute myeloid leukemia and its effect on the apoptosis of human leukemia cells.Methods:The expression of SHIP1 in the bone marrow of patients with acute myeloid leukemia was detected by Westem blot.U937 cells was transfected with SHIP1 expression vector (pEGFP-SHIP1 group) and empty vector control (pEGFP group) respectively,U937 cells without transfection were used as the control group.Flow cytometry was used to detect the apoptosis of the cells,the expression of SHIP1,Bcl-2,Bax,Akt,p-Akt were detected by western blot.Results:The expression of SHIP1 in the bone marrow of patients with acute myeloid leukemia was significantly lower than that of the normal human bone marrow SHIP 1 (P＜0.01).The SHIP1 and Bax expressions as well as the apoptotic rate ofpEGFP-SHIP1 group were significantly higher than those of the control group(P＜0.01),while the Bcl-2 and p-Akt expressions were significantly lower than those in the control group(P＜0.01).Conclusions:SH-P1 expression was down regulated in the bone marrow of patients with acute myeloid leukemia.SHIP1 could promote the apoptosis of human leukemia cells via Akt signaling pathway.

With the research progress of pathogenesis of JAK gene in myeloproliferative neoplasms (MPN), more tyrosine kinase inhibitors were developed. MPN quantify scoring system is used to determine the efficacy of tyrosine kinase inhibitors for MPN. The choice of tyrosine kinase inhibitors, tyrosine kinase for the relief of MPN symptom burden, etc, become the topics of the 57th American Society of Hematology (ASH) annual meeting.

Objective To investigate the roles of the chemokine receptor CXCR3 and its ligand I-TAC in the pathogenesis of immune thrombocytopenic purpura (ITP).Methods A total of 48 ITP patients were enrolled in this study:30 with newly diagnosed or relapse ITP and 18 in remission after treatment,and 24 healthy volunteers were as controls.IFNγ and I-TAC in plasma were detected by ELISA.The mRNA expression of CXCR3 in the peripheral blood mononuclear cells (PBMNCs) was determined by quantitative RT-PCR.Results The IFNγ level in the plasma of ITP patients before the treatment was obviously increased than those in the remission group and controls[ (71.45 ± 17.62)ng/L vs (36.94 ±14.86 )ng/L and (25.28 ± 12.85 )ng/L,all P ＜ 0.05 ]and those in the remission group was higher than in the controls ( P ＜ 0.05 ).In contrast,there were no statistic differences of the levels of I-TAC among the three groups[ (455.56 ± 144.70 ) ng/L,( 488.24 ± 164.70 ) ng/L and ( 382.97 ± 167.43 ) ng/L,P ＞0.05 ].Both ITP patients before the treatment and remission groups expressed more CXCR3 mRNA [ 6.76(3.03,37.00),1.76 (0.45,14.18 ) vs 0.12 ( 0.04,0.28 ),P ＜ 0.05 ].After effective therapy,CXCR3mRNA expression decreased,while it was still higher than that in the controls.Conclusions Our data demonstrate that Th1 cytokine (IFNγ) dominance is reflected in ITP.Simultaneously,the CXCR3 + cell may play a role in cell-mediated immunity through chemotaxis in ITP.

Objective To investigate the expression of miR-372 in the plasma of patients with acute my-eloid leukemia(AML)and the possible mechanism to participate in the development of AML. Methods Real-time quantitative PCR was used to detect the level of miR-372 in plasma. Bioinformatics software predicted the pos-sible target genes of miR-372 and dual luciferase reporter assay was performed to validate the prediction. In HL-60 cells,miR-372 was knocked down,and the effects on cell migration and cloning were detected by scratch test and clone formation. Results The level of miR-372 was significantly up-regulated in the plasma of AML patients. ROC analysis showed that miR-372 could distinguish between AML patients and healthy controls. Dual luciferase report-er assay showed that miR-372 could inhibit the activity of PTEN-3'UTR. Inhibition of miR-372 in HL-60 cells can significantly reduce the cell migration rate and clone formation ability. Conclusion In summary,for the first time,we showed novel data that the level of miR-372 was increased in the plasma of AML patients. By targeting the tumor suppressor gene PTEN,miR-372 may become a potential noninvasive biomarker for the screening and di-agnosis of AML.

Objective:The effect of three-dimensional(3D)printed bone-attached guide plate assisted cannulated screw fixation of pelvic fracture is reliable,but extensive soft tissue dissection is still required when installing the guide plate.This study aims to compare the efficacy of posterior pelvic ring fracture fixation with iliosacral screw insertion between the assistance of modified percutaneous patient specific 3D printed guide template and conventional fluoroscopy. Methods:From May,2019 and September 2021,28 patients sustained posterior pelvic ring fractures were randomized into 2 groups:A guide template group,in which the iliosacral screw was inserted for fixation of the posterior pelvic ring fracture with the assistance of modified percutaneous patient specific 3D printed guide template,and a fluoroscopy group,in which the iliosacral screw was inserted under the guidance of conventional fluoroscopy.The operation time,fluoroscopic frequency,intraoperative blood loss,and incision length were recorded for each screw insertion.Fracture reduction was evaluated according to the Matta criteria.The screw position was evaluated according to the modified Gras classification,and the functional outcome was evaluated according to Majeed score.The parameters of both groups were compared,and statistical analysis was performed. Results:All the 28 patients were followed up for 12-24 months.Of them,15 iliosacral screws were inserted in 14 patients in the guide template group,and 14 iliosacral screws were inserted in 14 patients in the fluoroscopy group.The operation time,fluoroscopic frequency,screw deviation,incision length,and blood loss in the guide template group were 20-30(25.8±2.8)min,9-15(12.2±1.9),2-4(2.6±0.7)mm,4-5(4.6±0.5)cm,and 5-10(7.8±1.7)mL,respectively,whereas those in the fluoroscopy group were 30-60(48.1±7.5)min,40-96(64.7±16.3),3-6(4.2±0.9)mm,0.8-1.2(1.0±0.1)cm,and 2-5(3.1±1.3)mL,respectively,and there were statistical significance(all P<0.001).Fracture reduction was evaluated according to the Matta criteria,and all the patients reached excellence and good(P=0.584)in the 2 groups.According to modified Gras classification,there were 12 Grade Ⅰ screws,3 Grade Ⅱ screws,and 0 Grade Ⅲ screws in the guide template group,and 10 Grade Ⅰ screws,3 Grade Ⅱ screws,and 1 Grade Ⅲ screw in the fluoroscopy group,with no statistical significance(P=0.334).The functional outcome was evaluated according to Majeed score at the last follow-up,without significant difference between the guide template group and the fluoroscopy group(P=0.908). Conclusion:Compared with the conventional fluoroscopy,it would cost less operation time,less fluoroscopic frequency and increase more accurate screw insertion to fixate the posterior pelvic ring fracture with the assistance of modified percutaneous patient specific 3D printed guide template.

Objective To study the mechanism of Sanhuang Decotion in the treatment of ulcerative colitis(UC)under Candida albicans colonization in mice based on Dectin-1-Syk-CARD9 signaling pathway.Methods Mice model of UC with fungal colonization were established with dextran sodium sulfate free drinking and C.albicans intragastric administration.Mice were divided into normal control group,model group,sulfasalazine group,fluconazole group,and Sanhuang Decotion low-and high-dosage groups,and receive corresponding drug interventions.General state of mice were observed,and the disease activity index(DAI)score of mice were calculated.The load of C.albicans in intestine was detected,the length of the colon was measured,and pathological scoring of the colon tissue was performed.The ultrastructural changes of colon epithelium were observed under transmission electron microscopy.The contents of TNF-α,IL-6 and IL-12 in serum and colon tissues were detected by ELISA.The mRNA and protein expression of Dectin-1,Syk,CARD9,NF-κBp65 and inflammation factors in intestinal epithelial cells and colon tissues were detected by qPCR,Western blot and immunohistochemistry.Results Compared with the normal control group,the model group mice showed reduced activity,decreased food intake,accompanied by loose stools,significantly increased DAI score,increased load of C.albicans in the intestine,shortened colon length,and increased histopathological score,with widening of gap between colon epithelial cells,cytoplasmic dissolution,mitochondrial swelling;TNF-α,IL-6 and IL-12 in serum and colon tissue increased,the expressions of Dectin-1 and CARD9 mRNA and protein in colon epithelial cells increased,p-Syk,p-NF-κBp65,CARD9,TNF-α,IL-1β,IL-6 protein expression in colon tissue increased(P<0.01,P<0.05).Compared with the model group,the Sanhuang Decotion high-dosage group mice showed a significant decrease in DAI score,decreased intestinal C.albicans load,increased colon length,decreased histopathological score,more complete and orderly arrangement of microvilli in colon epithelial cells,mild mitochondrial swelling,TNF-α,IL-6 and IL-12 in serum and colon tissue decreased,and the mRNA and protein expression of Dectin-1 and CARD9 in colon tissue increased,the expression of p-Syk,p-NF-κBp65,CARD9,TNF-α,IL-1β,IL-6 protein in colon tissue decreased(P<0.01,P<0.05).Conclusion Sanhuang Decotion may exert an anti C.albicans colonization UC effect by inhibiting the Dectin-1-Syk-CARD9 signaling pathway and reducing the release of inflammatory factors.

Objective:To retrospectively summarize the clinical characteristics and treatment of 49 patients with hyperthyroid cardiopath and to explore the diagnosis and treatment methods of hyperthyroid cardiopathy.Methods:A total of 49 patients with hyperthyroid cardiopath(HC group) who were successfully treated and followed up in the Department of Endocrinology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, from January 2016 to December 2021 were collected, and 85 cases of Graves′ disease without heart disease were collected as the control group(GD group). The medical history, laboratory tests, and echocardiographic parameters of the two groups were compared. Differences in thyroid and cardiac indicators before and after treatment in the HC group were summarized, along with the dosage of β-receptor blockers used in treating different types of conditions(atrial fibrillation and heart failure.Results:Patients in the HC group were older and had a longer duration of hyperthyroidism than those in the GD group( P<0.001, P=0.002). There were no significant differences in thyroid hormone levels between the two groups except for reverse triiodothyronine(rT 3). Age and rT 3 were independent risk factors of hyperthyroid cardiopathy. rT 3 level was linearly positively correlated with brain natriuretic peptide, systolic pulmonary artery pressure, left artrium diamete (LAD) and left ventricular end-systolic diameter(LVDs; r=0.352, P<0.001; r=0.392, P=0.019; r=0.202, P=0.029; r=0.242, P=0.028). In patients of HC group, free triiodothyronine(FT 3) level returned to normal range after 2.87(1.63, 5.53) months of treatment with radioiodine(41/49) or antithyroid drugs(8/49), while brain natriuretic peptide, LAD, LVDs, and systolic pulmonary artery pressure declined after 5.00(1.25, 8.00) months of treatment. Non-selective β-receptor blockers were used for both hyperthyroid heart failure and atrial fibrillation, and there was no statistically significant difference in dosage[(86.52±47.83)mg vs(88.67±47.19)mg, P>0.05]. Conclusions:rT 3 may be a biomarker of hyperthyroid cardiopath and indicate the severity of hyperthyroidism. β-receptor blockers are crucial in treating patients with hyperthyroidism who develop atrial fibrillation and heart failure.