Objective To evaluate the protective effectiveness of MPT64 and ESAT6 DNA vaccines against M. tuberculosis. Methods BALB/c mice were randomly divided into 14 groups and subjected to following treatments respectively, i.e. immunized with. ESAT6 (25?g)+MPT64 (25?g)(A), ESAT6(100?g)+IFN-?(100?g) (B), ESAT6 (75?g)+MPT64 (25?g)(C), ESAT6(100?g)+IL-12(100?g) (D), MPT64(100?g)+IL-12(100?g) (E), ESAT6 (25?g)+MPT64 (75?g)(F), MPT64 (100?g)(G), Pvax1 (H),ESAT6 (100?g)(I), ESAT6 (100?g)+MPT64 (100?g)(J), ESAT6 (50?g)+MPT64 (50?g)(K), MPT64(100?g)+IFN-?(100?g)(L), BCG(M ), and saline(N). Then they were infected with M. tuberculosis H37Rv via intravenous route. The pathological changes in the lung, liver, and spleen were observed after the infection. Results Eight weeks after the inoculation, there were only alveolar exudation and capillary hyperemia in the lung lesions in the mice of group N. In the mice of group M and J, main pathological changes included tuberculous granulomas consisting of numerous lymphocytes, macrophages, epithelioid cells and Langhans giant cells, and moderate hyperplasia in alveolar walls. The lung lesions of the other groups were similar, and both hyperplasia and exudate were found (A, B, C, D, E, G, H, I, K, L). No necrosis was found in all the above groups. There were hyperemia, dense lymphocytes infiltration in the portal area, and tuberculous granuloma in the liver in all the groups. No difference was found among all the groups. The pathological changes in spleen induced hyperplasia and fusion of splenic lymph nodule. The reactions in group M and J were stronger than that of the other groups. Conclusions MPT64 and ESAT6 DNA vaccines from M.tuberculosis could enhance immunity against M. tuberculosis, either they were used in combination with different dosages or with IL-12 or IFN-?. The vaccine used in group J showed the strongest effect in enhancing immunity, almost reaching that of combined use of BCG, IFN-? and IL-12.

Objective To investigate the protective effect of crocin on oxidative stress cell model of PC 12 cell and the effect of crocin on PI3K/Akt signal pathway,as well as further explore the mechanism of protective effect on model cells.Methods Cells were divided into control group,model group,crocin group and VE group.The cell survival rate was detected by MTT method,and the expression of mRNA and protein of PI3K/Akt were detected by RT-PCR and Western blot.Results With the crocin concentration in 0.625 μM and 5 μM,the cell survival rate increased in a dose-dependent manner.The average optical density rate of PI3K and Akt mRNA were 0.435±0.044 and 0.375 ± 0.034,and the PI3K and Akt protein were 0.378± 0.038 and 0.386± 0.043 of crocin group.Compared with the model group,the expression levels of PI3K/Akt increased in crocin group (P＜0.05).Conclusion These results indicate that the antioxidant and antiapoptosis effects of crocin are induced via increasing expression of PI3K and pAkt.

It is an important teaching task how to make respiratory disease specialists to accept the standardization training of pulmonary function. However, the theory of pulmonary function is comparatively abstract and the training time is short, but the task is heavy. In order to explore a set of feasible training mode, the pulmonary function laboratory of Zhongshan Hospital affiliated to Fudan University carries out various forms of training, such as compiling textbooks, establishing case database, using multimedia teach-ing, arranging one-to-one guided teaching, and training the ability of doctor-patient communication.

Purpose To compare the CT features of hepatic metastases of gastro-entero-pancreatic adenocarcinomas with and without neuroendocrine differentiation [NED(+) and NED(-)] and to explore the value of CT features in differentiation of the two groups.Material and Methods From January 2009 to December 2015,abdominal CT scans of 17 pathologically proved cases of NED(+) gastro-entero-pancreatic adenocarcinomas with hepatic metastases and 34 pathologically proved cases of NED(-) hepatic metastases with sex,age and primary site matched were retrospectively reviewed.CT features including hepatic metastases number,size,distribution,shape and enhancement were assessed,as well as presence of lymphadenopathy or ascites.Differences of CT features between the two groups were analyzed.Results Compared with NED(-) group,hepatic metastases of NED(+) group more frequently demonstrated a peripheral enhancement on artery phase (94.1％ vs.44.1％,P＜0.05),and more washout on portal venous phase (41.2％ vs.5.9％,P＜0.05),while hepatic metastases of NED(--) group showed more plateau type (91.2％ vs.58.8％).There was no significant difference of other findings between the two groups (P＞0.05).Logistic regression revealed that enhancement area in hepatic artery phase and enhancement changes in portal venous phase were independent factors for differential diagnosis (P＜0.05).The area under the ROC curve of combining the two features was 0.811 (P＜0.05).Conclusion There are some different CT enhancement features between NED(+) and NED(-) hepatic metastases of gastro-entero-pancreatic adenocarcinomas,which are helpful in differential diagnosis.

Objective To explore the characteristics and survival of connective tissue disease (CTD) patients with both of pulmonary arterial hypertension (PAH) arnd interstitial lung disease (ILD),and to compare with CTD patients with isolated PAH.Methods All adult CTD patients who visited one of the three referral centers in China with a diagnosis of PAH confirmed by right heart catheterization from July 2006 to May 2011 were enrolled.They were then divided into two groups (ILD with and without-ILD group) based on chest CT and then the comparison of baseline characteristics and survival at the endpoint of follow up were made between the two groups.T test,Mann-Whitney U test,x2 test,Kaplan-Meier survival analysis and Cox regression analysis were used for statistical analyses.Results One hundred and twenty-six patients were recruited into the study.Patients with ILD (n=27) were older than those without ILD (n=99).Lung function results including FVC [(75±18)％ vs (83±13)％,t=2.212,P=0.037] and DLCO [(54±22)％ vs (68±20)％,t=2.392,P=0.019] in ILD group were significantly wose than those without-ILD group.Although some important hemodynamic parameters such as mean pulmonary arterial pressure and pulmonary vascular resistance were better in the ILD group than the without-ILD group,Kaplan-Meier analysis showed that the short term survival of ILD group was significantly worse than that of the without-ILD group (72.7％ versus 94.7％ at 1 year and 63.6％ versus 81.1％ at 3 year,P=0.047).In ILD group,Cox regression analysis showed that SvO2 was the only independent factor for the short term survival [HR=0.19,95％CI (0.04,0.83),P=0.027],and Kaplan-Meier analysis showed patients with SvO2＜60％ had significantly lower short term survival than patients with SvO2 ≥60％ (1 and 2 year survival were 60.0％ and 40.0％ versus 92.9％ and 77.4％ respectively,P=0.002).Conclusion Patients with both PAH and ILD is a special subtype in CTD.Although with the superiority of hemodynamics,these patients have significantly worse survival than CTD patients with isolated PAH.Low SvO2 is the independent risk factor for the short term mortality in patients of CTD complicated by both PAH and ILD.More attention should be paid to these patients and the management strategy should be investigated further.

Objective:To investigate the study on the diagnostic value of multimodal ultrasound technique for the lesion of extensor carpi ulnaris(ECU)tendon in patients with rheumatoid arthritis(RA).Methods:A total of 175 RA patients who were confirmed by the department of rheumatology of Yantaishan Hospital of Yantai city from December 2021 to January 2023 were selected,and them were included into the RA group.Other 50 patients without RA but with clinical symptoms of wrist were included into the non-RA group,and 50 healthy volunteers were included into the healthy control group.All subjects underwent routine ultrasound and shear wave elastography(SWE)examination on wrist,and then,the characteristics of ultrasound images of wrists and the blood flow distribution of ECU power Doppler ultrasonography(PDUS)were recorded.SWE was used to measure ECU to obtain elastic modulus index(EI)and velocity modulus index(VI).The differences between three groups were compared,and the receiver operating characteristic(ROC)value of RA patients were drawn,so as to confirm the area under curve(AUC)value and optimize cutoff value.Results:There were significant differences in EI and VI of the ECU tendon among three groups(F=61.15,61.28,P<0.05),respectively.The optimal cut-off values of EI and VI were respectively 319.35 kPa and 10.55 m/s in RA patients.In RA patients,age and disease course had significant influences on EI(r=0.19,0.21,P<0.05),and age,disease course,ultrasound score of wrist joint,and grade of power Doppler ultrasonography PDUS of the ECU tendon(ECUPDUS)had significant influences on VI(r=0.19,0.15,-0.16,-0.17,P<0.05).Conclusion:SWE is able to quantitatively and non-invasively assess the stiffness information of the ECU tendon in RA patients.After the supplement of gray-scale ultrasound and PDUS,multimodal ultrasound technique can clearly judge the correlation of the lesions of ECU tendon of RA patients.

Objective: To explore the feasibility of curettage combined with fenestration for jaw classic ameloblastoma treatment and to provide a basis for improving the treatment of classic ameloblastoma. Methods: Twenty-two patients with jaw classic ameloblastoma admitted to Liuzhou People’s Hospital from 2016 to 2019 were selected. They were treated by curettage combined with fenestration. Monthly follow-up visits were conducted after surgery, and orthopantomography was performed for reexamination to observe the recovery of bone and whether there was recurrence. Results : Tumors were completely scraped off in 22 patients, no pathological fracture occurred, and no wound infection occurred after surgery. After 1 to 3 years of follow-up, 19 patients showed excellent bone recovery in the original tumor area, and no recurrence was observed. Three patients relapsed and underwent a second curettage combined with fenestration, and the bone at the original tumor site recovered well. During the 12-month follow-up, no tumor recurrence was observed. After the second curettage combined with open surgery, the bone at the original tumor site recovered well. Eight patients underwent dental implants to repair dentition defects one year after surgery. Conclusion Curettage combined with fenestration is a convenient and effective treatment for jaw classic ameloblastoma.

Objective:To investigate how pelvic incidence (PI) would change during the follow-up in degenerative scoliosis (DS) patients who underwent second sacralalar-iliac (S 2AI) fixation and identify the possible factors associated with the changes in PI. Methods:The DS patients who underwent long fusion to pelvis with S 2AI fixation with a minimum follow-up of two years between November 2014 to January 2017 were retrospectively reviewed in this study. The following sagittal radiographic parameters were measured, including pelvic incidence (PI), lumbar lordosis (LL), pelvic tilt (PT), PI minus LL (PI-LL), and sagittal vertical axis (SVA) at pre-operation, post-operation and 2-year follow-up. Patients were divided into two groups at immediate post-operation: PI decreased less than 5° or increased (Group PI stabilization); PI decreased larger than 5° (Group PI activity). Descriptive statistics were calculated for all patients in the form of mean value and standard deviation (SD). Comparisons of means between variables were performed using an unpaired Student's t test. Pearson correlation coefficienttest was performed to determine the correlations between all radiographic variables. Inter- and intra-observer reliability was assessed using intraclass correlation coefficient (ICC). The internal consistency of the measurements was characterized as excellent ( ICC≥0.9), good (0.7≤ ICC<0.9), acceptable (0.6< ICC≤0.7), poor (0.5≤ ICC<0.6), or unpredictable ( ICC<0.5). Results:There were no significant differences in terms of age, sex, radiographic measurements and scores of SRS-22 between twogroups preoperatively ( P>0.05). 80 DS patients with a mean age of 55.3±16.2 years were enrolled in this study with a mean follow-up period of 34.6±8.7 months. At post-operation, 39 patients (38.8%) were in group PI stabilization whose PI decreased from 45.7°±11.4° to 45.3°±11.2° with no significant difference; while the other 41 (61.2%) were in group PI activity whose PI significantly decreased from 51.6°±14.5° to 40.9°±14.0°. At the last follow-up, 24 patients (49%) in group PI activity had PI returned with an increase of larger than 5°; while the other 25 (51%) showed no increase with a mean ΔPI change of -4.2°. Subgroup comparison revealed that ΔPI, post-operation PI, post-operation PT and age were significantly different between the two subgroups. Pre-operation PI, post-operation PI, post-operation PT, post-operation PI-LL were significantly correlated with ΔPI at the last follow-up. Logistic regression analysis showed that post-operation PI was the associated factor ( OR=0.87, P=0.024). Conclusion:PI decreased in more than half of DS patients after spinal surgery using S 2AI screws, while returned among 48% of them during 2-year follow-up. Lower pre-operation PI, post-operation PI and PT were strongly associated with the return of PI.

Objective:To investigate the correlations between cosmetic and radiographic parameters in patients with congenital scoliosis (CS) with vertebral segmentation failureand the clinical implication of cosmetic parameters.Methods:A total of 27 CS patients were retrospectively reviewed. Anteroposterior and lateral radiographs of the entire spine was taken. Simultaneously, photos were taken from the back in natural standing position and standing forward bending position. Seven cosmetic parameters were measured on the photographs: shoulder area index 1 (SAI1), shoulder area index 2 (SAI2), lumbar area index (LAI), shoulder angle (α 1), axilla angle (α 2), right and left waist angle difference (RLWAD) and hump index. Also, seven radiographic parameterswere measured on the radiographs: radiographic shoulder height difference (RSHD), T 1 tilt, first rib angle (FRA), clavicle angle (CA), clavicle-rib cage intersection (CRCI), clavicle chest cage angle difference (CCAD) and Cobb's angle. The correlation between cosmetic parameters and radiographic parameters was analyzed by Pearson correlation coefficient. Results:Of the 27 patients, 4 were males and 23 were females, with a mean of age 14.0±2.6 years (range 11-18 years). The apical vertebra ranged from T 5 to T 11. LAI was significantly correlatedwith CCAD, but correlation coefficient was only -0.44. The range of correlation coefficientsbetween SAI1 and all radiographic parameters was -0.17 to 0.53, and the range of correlation coefficients between SAI2 and all radiographic parameters was -0.16 to 0.53. However, all correlation coefficients were less than 0.56. Conclusion:Radiographic parameters cannot reflect cosmetic appearances of CS patients with vertebral segmentation failures accurately. More attention should be paid to cosmetic parameters in the evaluation of patients' appearances.

Objective:To analyze the radiographic improvements after Halo-gravity traction in severe kyphoscoliosis patientswith type III spinal cord on preoperative apex MRI, and to assess the clinical outcomes and surgical safety of Halo-gravity traction in this cohort.Methods:A total of 47 severe thoracic kyphoscoliosis patients with type III spinal cord on preoperative apex MRI who underwent preoperative Halo-gravity traction followed by one-stage posterior spinal fusion from February 2019 to June 2021 in the Nanjing Drum Tower Hospital were retrospectively analyzed. There were 18 males and 29 females with an average age of 22.5±12.8 years (range, 9-60 years). The average duration of traction was 7.4±3.9 weeks (range, 4-16 weeks). Radiographic parameters were measured including the coronal Cobb angle, distance between C 7 plumb line and center sacral vertical line (C 7PL-CSVL), sagittalglobal kyphosis (GK) and sagittal vertical axis (SVA) atpre-traction, post-traction and post-operation, respectively. The traction correction rate was measured as "traction degree before traction-traction degree after traction)/traction degree before traction" and the surgical correction rate was represented as "traction degree before traction-postoperative degree)/ traction degree before traction". The Frankel scoring system was used for the evaluation of neurological status at pre-traction, post-traction and post-operation. Results:All of 47 patients underwent the Halo-gravity traction and posterior spinal correction surgery. The C 7PL-CSVL was 35.7±16.9 mm at initial visit. At post-operation, C 7PL-CSVL was improved to 22.0±13.7 mm ( t=13.75, P<0.001), and the improvement rate was 39.9%±15.5%. The GK was 110.9°±22.1° at initial visit, which was improved to 84.1°±19.9° ( t=8.84, P<0.001) after Halo-gravity traction with an average correction of 23.7%±8.9%. At post-operation, GK was improved to 65.3°±19.3° ( t=10.63, P<0.001), and the improvement rate were 40.1%±20.7%. The SVA was 43.8±19.5 mm at initial visit. At post-operation, SVA was improved to 21.1±14.9 mm ( t=10.32, P<0.001), and the improvement rate were 53.1%±27.0%. A total of 14 patients showed neurological deficits of lower limbs at pre-traction, of which 8 patients had significant neurological improvement after Halo gravity traction; 3 patients had significant neurological improvement after surgery, and the remaining 3 patients had no significant neurological improvement during treatment. No new neurological deficits were observed after Halo-gravity traction or surgery. Conclusion:For severe kyphoscoliosis patients with type III spinal cord on preoperative apex MRI, the Halo-gravity traction could effectively correct the deformity, improve neurological function, enhance the tolerance of spinal cord to surgery and reduce the risk of intraoperative iatrogenic neurological deficit.