Objective: To demonstrate that expression of the CCRSDelta32 protein in PBMCs able to down-regulate surface expression of the HIV-1 coreceptor CCR5 and CXCR4.Methods:CCR5Delta32 gene was amplified from human peripheral blood mononuclear cells(PBMCs)genomic DNA by using PCR, and then cloned into lentiviral vector pLenti6/V5-D-TOPO.Recombinant lentiviral particles were produced by packaging using 293T cells.Human PBMCs were transfected with the constructed recombinant lentiviral particles and the expression of CCR5Delta32 was detected by Western blot.The level of CCR5 and CXCR4 expression on transfected PBMCs was detected by FACS analysis.Results: The recombinant lentiviral vector pLenti-CCR5Delta32 was constructed successfully, and the target protein was expressed in PBMCs.FACS analysis showed that CCR5Delta32 protein expressed in PBMCs was able to down-regulate cell surface expression of CCR5 and CXCR4.Conclusion: This study is expected to be used for the gene therapy on AIDS, which deserves further study.

Objective To statistically analyze data of blood transfusion from General Hospital of Chengdu Military Command,Mianyang field blood station,Deyang field blood station and other military medical institutions from May 12 to June 30,2008 so as to provided certain references for reasonable blood supportability in wartime and disaster.Methods A statistical analysis was done on data of blood collection and supply including self-taken blood and assembled blood,total amount of blood supply as well as the transfusion information of inpatients injured by earthquake in our hospital.Results The amount of self-taken blood was 5 111 U,the amount of assembled blood 3 380 U and the total amount of blood supply 1 0405.5 U.But blood transfusion was 4 090.6 U in 132 patients admitted into General Hospital of Chengdu Military Command.In addition,the crest-time of transfusion appeared at 96 hours after earthquake.Moreover,patients with fractures received the highest rate of blood transfusion and crush syndrome patients received the most blood transfusion and the highest per capita transfusion.Conclusions Blood supportability in earthquake is different from that in wartime and other disasters in aspects of transfusion time,blood types and blood transfusion volume.It is important to analyze the characteristics of transfusion in patients injured by earthquake for national strategy of blood supportability in disasters and for blood supportability in the wartime.

Objective To study the effect of hypertonic sodium chloride in the treatment of patients with traumatic hemorrhagic shock and the effects of NO and neutrophil surface CD 18 on the serum.Methods 120 patients with traumatic hemorrhagic shock were admitted to the hospital from December 2013 to December 2016,and randomly divided into the observation group and the control group.The control group was given nal-oxone injection,while the observation group was given hypertonic Sodium Chloride Solution.The two groups were compared before and after treatment,hemoglobin concentration,total infusion,24 h mortality,recovery time and adverse reactions,and the patients′hemodynamic and NO and CD18 levels were measured on the ser-um.Results After 24 h treatment,the observation group total infusion was(1 203.13 ± 117.82)mL,the re-covery time was(60.73 ± 5.63)min,24 h mortality rate of 5.00% was significantly lower than the control group total infusion(1 672.38 ± 123.64)mL,the recovery time(71.82 ± 6.19)min,24 h death rate 16.67%, hemoglobin concentration(91.24 ± 5.71)g/L higher than that of the control group(79.45 ± 6.18)g/L,the difference was statistically significant(P<0.05).Before treatment,there was no difference in the contents of NO and CD18 between the two groups.After treatment,two groups of patients with serum NO,CD18 content significantly decreased,but the observation group NO(20.27 ± 6.65)mol/L,CD18(41.67 ± 13.24)ng/mL were significantly lower than the control group NO(29.12 ± 8.23)mol/L,CD18(52.64 ± 13.51)ng/mL,the difference were statistically significant(P<0.05).Before treatment,two groups of patients with hemodynam-ic indexes of arterial and venous pressure,no difference in heart rate(P> 0.05);after treatment,the two groups of patients with arterial and venous pressure and heart rate were improved,but the change index of the observation group than in the control group was stable,the difference was statistically significant(P<0.05). The complication rate of the observation group was 10%(6/60),which was significantly lower than that of the control group(15/60),and the difference was statistically significant(P<0.05).Conclusion The infiltra-tion of sodium chloride intravenous infusion could significantly decreased CD 18 and NO levels in the serum of the patients,the patients with stable hemodynamics,reduced the incidence of complications,worthy of clinical reference.

Objective:To explore the risk factors for urinary tract infection (UTI) among type 2 diabetics after an ischemic stroke.Methods:A total of 459 survivors of a first ischemic stroke who had type 2 diabetes were studied retrospectively. The 149 who had contracted a urinary tract infection (32.5%) formed the infections group; the other 310 were the no-infections group. Univariate analysis was applied to the subjects′ ages, sex, type of ischemic stroke, body mass index (BMI), history of coronary heart disease, glycosylated hemoglobin (HbAlc) levels, serum albumin (ALB) levels and serum glucose (GLU) levels. The risk factors for urinary tract infection for such patients were analyzed using binary logistic regression.Results:The univariate analysis showed that gender, age, smoking, drinking, type of ischemic stroke, coronary heart disease, as well as BMI, HbAlc and ALB levels were correlated with UTI. In the binary logistic regression analysis the significant predictors were being female, HbAlc≥6.5%, serum albumin<40g/L, obesity (BMI≥28.0kg/m 2) and the type of ischemic stroke. Conclusions:Ischemic stroke survivors with type 2 diabetes mellitus are at high risk of UTI. Being female and/or obese, a high HbAlc level, a low ALB level, and certain types of ischemic stroke are all risk factors. These findings should provide a basis for the prevention and treatment of UTIs after a stroke.

Objective:To investigate the effect of lateral tibial periosteum distraction on diabetic foot and vasculitis foot.Methods:A retrospective analysis of 13 patients (16 feet) who received lateral tibial periosteal distraction between June 2019 and May 2020 were included in the study. 9 males and 4 females; aged 39-77 years (average 66 years); left foot 7 cases, right foot 9 cases. 5 cases were patients with diabetic foot, 1 case was diabetic foot with arteriosclerosis obliterans, 2 cases were thromboembolic vasculitis, and 5 cases were arteriosclerosis obliterans. The tibial periosteum was dissected and a distraction device was placed. In the 3 patients with foot ulcers, tibial periosteum distraction devices were placed on the severer side. The periosteal distraction began on the third day after surgery, about 0.75 mm/d, the adjustment was done usually in two weeks. Two weeks later, the stretch plate was removed surgically. The followings were evaluated: visual analogue scale (VAS) pain score, foot peripheral oxygen saturation, foot capillary filling test, lower extremity arterial CT angiography (CTA), etc.Results:All 13 patients were followed up for 2-12 weeks, with an average of 3.85 weeks. VAS pain score: the average pain score of 13 patients with preoperative foot pain was 5.31±1.84 (range, 2-9) points, and 2 weeks after surgery, the average value was 2.46±1.39 (range, 1-6) points with statistical significance ( t=6.124, P<0.001) ; peripheral foot oxygen saturation: the average preoperative blood oxygen saturation of 12 patients was 87.83%±14.83% (range, 50%-98%), 1 patient was not detected before surgery, and 2 weeks after operation, the average blood oxygen saturation was 92.33%±7.91% (range, 75%-99%). There was no significant difference between them ( t=1.124, P=0.285). The foot skin temperature of 10 patients was 35.68±0.85 ℃ (range, 34.00-36.60 ℃) before surgery and 36.23±0.46 ℃ (range, 35.50-36.90 ℃) after surgery, and the difference was statistically significant ( t=3.197, P=0.008) . Capillary filling test: 2 weeks after operation, the capillary filling response was significantly improved. All 13 patients had improved CTA of both lower extremity arteries before operation, and 11 patients had CTA taken back after two weeks of operation. Compared with preoperative CTA, new vascular network was found in the operation limb. In addition to 1 patient with thromboangiitis obliterans (mainly suffering from foot pain, no wound symptoms), 2 of 12 patients with heart failure, renal failure and other basic diseases did not heal, and the wounds of the other 10 patients had improved significantly 1 month later. Conclusion:Lateral tibia periosteum distraction can be used to treat chronic ischemic diseases of lower extremities with satisfactory postoperative results.

Objective:To investigate the factors affecting the application of systemic glucocorticoids in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with carbon dioxide (CO 2) retention, and to guide the formulation of a strategy to reduce systemic glucocorticoid exposure. Methods:The AECOPD patients with CO 2 retention admitted to the Ningde Municipal Hospital of Fujian Medical University from January 2017 to December 2019 were enrolled. The general information, past history, times of acute exacerbations within 1 year, pneumonia on admission, causes of COPD, heart failure, blood gas analysis, eosinophil count (EOS), albumin (Alb) and apolipoprotein E (ApoE) levels, exhaled nitric oxide (FeNO) level, inhaled glucocorticoid and non-invasive mechanical ventilation treatment at acute exacerbation were collected. The patients were divided into recommended dosage group (exposure levels in the recommended dosage range, cumulative prednisone dosage ≤ 200 mg) and exceeded group (exposure levels exceeded the recommended dose, cumulative prednisone dosage > 200 mg) according to cumulative systemic glucocorticoid exposure dosage of the patients during hospitalization. The clinical data of patients between the two groups were compared, and possible factors with P < 0.1 in univariate analysis were included in multivariate Logistic regression analysis to screen the related factors of systemic glucocorticoid exposure level in AECOPD patients with CO 2 retention. Results:According to the order of hospitalization, 151 AECOPD patients with CO 2 retention were enrolled, 8 patients were excluded, and 143 patients were enrolled in the analysis. Of the 143 patients, 68 received the recommended dose of systemic glucocorticoid, and 75 received excessive systemic glucocorticoid. Age, percentage of forced expiratory volume in 1 second (FEV1%) at stable phase, frequency of acute exacerbation within 1 year, heart failure ratio, oxygen index (PaO 2/FiO 2), arterial partial pressure of carbon dioxide (PaCO 2), serum EOS and ApoE levels at admission, the ratio of aerosolized inhaled glucocorticoids and non-invasive mechanical ventilation showed statistical differences between the two groups. Multivariate Logistic regression analysis showed that related factors affecting systemic glucocorticoid exposure levels of AECOPD patients with CO 2 retention were FEV1% at stable phase [odds ratio ( OR) = 0.957, 95% confidence interval (95% CI) was 0.921-0.994, P = 0.023], acute exacerbation frequency within 1 year ( OR = 1.530, 95% CI was 1.121-2.088, P = 0.007), heart failure ( OR = 3.022, 95% CI was 1.263-7.231, P = 0.013), PaCO 2 ( OR = 1.062, 95% CI was 1.010-1.115, P = 0.018) and EOS at admission ( OR = 0.103, 95% CI was 0.016-0.684, P = 0.019), aerosolized inhaled glucocorticoids ( OR = 0.337, 95% CI was 0.145-0.783, P = 0.011) and non-invasive mechanical ventilation at acute exacerbation ( OR = 0.422, 95% CI was 0.188-0.948, P = 0.037), of which high FEV1% at stable phase, high EOS at admission, aerosolized inhaled glucocorticoid and non-invasive mechanical ventilation at acute exacerbation were protective factors, while high frequency of acute exacerbation within 1 year, heart failure and high PaCO 2 were risk factors. Conclusions:For AECOPD patients with CO 2 retention, high FEV1% at stable phase, high EOS level at admission, aerosolized inhaled glucocorticoid and non-invasive mechanical ventilation at acute exacerbation can reduce systemic glucocorticoid exposure. In addition, high frequency of acute exacerbation within 1 year, heart failure, and high PaCO 2 can increase systemic glucocorticoid exposure.

Objective:To explore the clinical features, diagnosis, treatment and prognosis of rectal neuroendocrine tumor with lymphatic metastasis.Method:There were 153 case who were diagnosed with RNET, among them, there were 10 patients(6.5%) with lymphatic metastasis in Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science & Technology from January 2012 to December 2020, including 4 males and 6 females, aged from 32 to 71 years old, and the median age was 56.5 years.Results:Of the 10 patients, 3 had tumors < 1 cm in diameter, 4 had 1 to 2 cm, and 3 had > 2 cm. Preoperative CT examination was performed in 10 patients, of which 9 suggested lymphatic metastasis; preoperative MRI examination was performed in 7 patients, of which 6 suggested lymphatic metastasis. All patients were received radical resection, in which Miles operation was performed in 2 cases, Dixon operation in 6 cases, and additional Dixon operation after endoscopic submucosal dissection in 2 cases.All patients were followed up for 51 months (ranged from 14 to 118 months). Nine patients had no recurrence or metastasis, and one patient had abdominal metastasis 40 months after surgery and died after 31 months of comprehensive treatment.Conclusions:Lymphatic metastasis is rare in rectal neuroendocrine tumor. Imaging examination has important reference value for judging the status of lymphatic metastasis. For rectal neuroendocrine tumor with lymphatic metastasis, radical resection is effective.

Objective:To investigate the clinicopathological features and prognosis of patients with gastric gastrointestinal stromal tumor (GIST) combined with digestive tract cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 1 163 patients with gastric GIST who were admitted to the Union Hospital admitted to Tongji Medical College of Huazhong University of Science and Technology from January 2002 to December 2021 were collected. There were 606 males and 557 females, aged 59(range,20?94)years. Of the 1 163 patients, 129 cases with gastric GIST combined with other digestive tract cancer were divided into the combined group, and 1 034 cases with only gastric GIST were divided into the non-combined group. Observation indicators: (1) clinicopathological features of patients; (2) surgical situations and postoperative complications; (3) follow-up and survival of patients; (4) analysis of prognosis associated affecting factors. Follow-up was conducted using outpatient examination, telephone and online interview to detect survival of patients up to January 2022. The overall survival time was defined as the time from surgery to the last tine of follow-up or the outcome events, such as death of patient, loss of follow-up, etc. Measurement data with normal distribution were represented as Mean± SD, and measure-ment data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Com-parison of ordinal data was conducted using the non-parameter Mann-Whitney U test. Kaplan-Meier method was used to draw survival curves and calculate survival rates, and Log-Rank test was used to conduct survival analysis. The COX proportional hazard model was used for univariate and multivariate analyses. Results:(1) Clinicopathological features of patients. Of the 129 patients in the combined group, there were 81 cases combined with gastric cancer, 39 cases combined with esophageal cancer, 8 cases combined with colon cancer and 1 case combined with rectal cancer. Gender (male, female), cases with age ≤60 years or>60 years, cases without or with clinical symp-toms before surgery, cases with tumor diameter of gastric GIST as<2 cm, 2?5 cm, 5?10 cm,>10 cm, cases with mitotic index as <5/50× high power field, 5?10/50× high power field, >10/50× high power field, cases with cell proliferation index of Ki-67 as ≤5% or >5%, cases classified as extremely low risk, low risk, medium risk and high risk of the modified national institutes of health (NIH) risk classification, cases with or without tumor necrosis of the gastric GIST, cases without or with adjuvant imatinib therapy, cases with the expression of DOG-1 detected by immunohistochemical staining as positive or negative, cases with the expression of CD34 as positive or negative were 92, 37, 30, 99, 9, 120, 114, 10, 3, 2, 126, 1, 2, 122, 2, 112, 8, 5, 4, 129, 0, 121, 8, 118, 3, 117, 12 in the combined group, versus 514, 520, 585, 449, 194, 840, 383, 360,201, 90, 799, 155, 80, 851, 143, 337, 308, 192, 197, 960, 74, 769, 265, 850, 80, 990, 44 in the non-combined group, showing significant differences in the above indicators between the two groups ( χ2=21.46, 51.11, 11.06, Z=?10.27, ?5.34, χ2=15.94, Z=?10.61, χ2=9.86, 24.10, 5.52, 6.37, P<0.05). Of the 1 163 patients, there were 12 cases of the combined group suspected diagnosed as gastric GIST before surgery and 1 case of the combined group dia-gnosed as gastric GIST by gastroscopy and pathological examination before surgery. The rest of 1 150 patients were diagnosed as gastric GIST by intraoperative exploration or postoperative pathological examination. (2) Surgical situations and postoperative complications. Of the 129 patients in the combined group, 72 cases underwent open surgery and 57 cases underwent laparoscopic or thoracoscopic surgery including 3 cases converted to open surgery. Of the 1 034 patients in the non-combined group,207 cases underwent endoscopic surgery, 371 cases underwent open surgery, and 456 cases underwent laparoscopic or thoracoscopic surgery including 8 cases converted to open surgery. Incidence of postoperative complications was 10.078%(13/129) in the combined group, versus 2.321%(24/1 034) in the non-combined group, showing a significant difference between the two groups ( χ2=22.40, P<0.05). (3) Follow-up and survival of patients. Of the 1 163 patients, 1 046 cases were followed up for 44(range, 1?220)months, with the postoperative 5-year overall survival rate as 87.2%. The postoperative 5-year overall survival rate was 51.2% in the combined group, versus 91.4% in the non-combined group, showing a significant difference between the two groups ( χ2=169.07, P<0.05). (4) Analysis of prognosis associated affecting factors. Results of univariate analysis showed that gender, age, tumor diameter of gastric GIST as 2?5 cm, 5?10 cm and >10 cm, combined with other digestive tract cancer, mitotic index as >10/50× high power field and tumor necrosis of the gastric GIST were related factors affecting the postoperative 5-year overall survival rate of patients with gastric GIST ( hazard ratio=2.16, 2.27, 0.46, 0.57, 1.75, 7.58, 2.70, 1.80, 95% confidence intervals as 1.52?3.07, 1.60?3.22, 0.29?0.71, 0.34?0.94, 1.11?2.77, 5.29?10.85, 1.67?4.38, 1.08?2.98, P<0.05). Results of multivariate analysis showed that gender, age, tumor diameter of gastric GIST, combined with other digestive tract cancer and mitotic index were independent factors affecting the post-operative 5-year overall survival rate of patients with gastric GIST ( hazard ratio=1.91, 1.82, 2.10, 7.11, 2.75, 95% confidence intervals as 1.33?2.75, 1.27?2.62, 1.14?3.87, 4.58?11.04, 1.50?5.03, P<0.05). Conclusions:The tumor diameter of gastric GIST is short in patients combined with other digestive tract cancer, and the risk grade of modified NIH risk classification is lower. Gender, age, tumor diameter of gastric GIST, combined with other digestive tract cancer and mitotic index are independent factors affecting the postoperative 5-year overall survival rate of patients with gastric GIST.

Objective:To investigate the clinical characteristics and prognosis of duodenal neuroendocrine neoplasms.Methods:The clinical data of 35 patients with duodenal neuroendocrine neoplasms admitted to Union Hospital, Tongji Medical College, Huazhong University of Science & Technology from Jan 2012 to Dec 2021 were retrospectively analyzed. The differences of clinical characteristics between periampullary and non-periampullary duodenal neuroendocrine neoplasms were analyzed. Kaplan-Meier curve was used for survival analysis, and the clinical factors affecting the prognosis were analyzed.Results:Of the 35 patients, 30 underwent tumor resection, 7 (23%) developed different degree of complications after operation and were improved and discharged after intervention. A total of 5 patients died during the follow-up period. Only 1 of 30 patients who underwent tumor resection died 30 months after operation due to disease progression, and the others had no recurrence or metastasis. Univariate analysis showed that tumor size, tumor grade, and tumor location were associated with the prognosis of patients (all P<0.05), and multivariate analysis showed that patients with tumors located.Away from the ampulla had a significantly better prognosis than those located around the duodenal ampulla ( P<0.01). Conclusions:Patients with duodenal neuroendocrine neoplasms have a good prognosis after complete resection; patients with duodenal neuroendocrine neoplasms located around the ampulla of Vater have a relatively poor prognosis compared with those away from the area of ampulla.

【Objective】 To explore the corresponding strategies of blood preparation for placenta previa operation in our hospital according to the situation of blood transfusion during and after operation. 【Methods】 Ninety pregnant women with placenta previa (complete, partial or marginal) undergoing the caesarean operation and blood transfusion in our hospital from January 2011 to September 2020 were selected as the research objects. The corresponding data about intraoperative/postoperative blood loss, blood transfusion and blood preparation were collected, analyzed and compared. 【Results】 There was no significant differences in age between complete and marginal placenta previa(P>0.05), but significant differences in intraoperative/postoperative blood loss and the units of blood transfusion (P<0.05). The blood loss of marginal placenta previa was less (≤1 000 mL) and the units of blood transfusion were mainly 3 (2, 3) U. Complete placenta previa was more likely to cause serious postpartum bleeding (>1 000 mL). The difference between ordering and transfusion units of complete and marginal placenta previa were 0.4 and 0, respectively. When the complete placenta previa was accompanied by placenta increta or placenta percreta, the blood loss was larger (>1 000 mL) and the units of blood transfusion ranged from 4.5 U to 6 U, while the blood loss was generally low (≤1 000 mL) and the units of blood transfusion was concentrated at 3 (2, 4) U without placenta accreta nor implantation.The difference between ordering and transfusion units of complete placenta previa with non-implantation, placenta accreta, placenta increta and placenta percreta were 0.165, 0.33, 0.5 and 1, respectively. 【Conclusion】 For marginal placenta previa, 3U blood is recommended for routine preparation, 3U blood for complete placenta previa with non-implantation or placenta accrete, and 4.5-6U for complete placenta previa with placenta increta or placenta percreta.