Objective To quantitatively assess the left ventricular systolic and diastolic function in the elderly patients with dilated cardiomyopathy (DCM) by using Doppler tissue imaging (DTI) and to explore its clinical value. Methods A total of 20 normal controls and 22 old patients with DCM were enrolled in the study. The left ventricular end-diastolic diameter (LVEDd), left atrial diameter (LAD) and left ventricle ejection fraction(LVEF) were obtained by routine echocardiogram. And the systolic and early diastolic peak velocity (Vs and Ve) were detected by quantitative tissue velocity imaging (QTVI) and the mean value was accounted. The systolic mitral valve displacements (MVD) in 6 sites were determined by tissue tracking technique and the mean value was calculated. Results The LVEDd and LAD were significantly higher in DCM group than in normal group [LVEDd: (67.56±10.27) mm vs. (43.36±4.20) mm; LAD: (49.91± 6.27) mm vs. (32.00+4.53) mm, t=10.229 and 10.359, both P<0.01]. And the LVEF, Vs and MVD were lower in DCM group than in normal group [LVEF: (26.50 ± 8.25)% vs. (64.00 + 4.72)%; Vs:(5.14+1.30) cm/s vs. (8.89+1.87) cm/s; MVD:4.82+1.85 vs. 10.23± 1.95, t=18.502, 7.716 and 8.143, all P< 0.01].The Vs and MVD were significantly positively correlated with LVEF (r=0.78 and 0.89, both P<0.01). Conclusions DTI can quantitatively assess global and regional left ventricular systolic and diastolic function of elderly patients with DCM, and provide the reliable information for the judgment of pathogenetic condition.

Posterior urethral valves(PUV) is the most common cause of lower tract obstruction in boys.With the understanding of the prognostic factors of PUV in depth,PUVs can have a profound effect on the function of bladder and upper urinary tract though valves are completely resected.The treatments of PUV include prenatal intervention,the antenatal vesicoamniotic shunt and fetal cystoscopy can be considered in selected patients with oligohydramnios.But the role of antenatal intervention is unclear.The gold standard for postnatal treatment of PUV is valve ablation.Vesicostomy is reserved primarily for the children with PUV whose urethra cannot accommodate an endoscope, as well as have severe urinary tract infections.Circumcision should be encouraged as a prophylactic measure for children with PUV who should have high rate of urinary tract infection.Vesicoureteral reflux is very common in PUV patients, and life-long monitoring of these patients is mandatory, as bladder dysfunction and valve bladder may be found during follow-up.These factors contribute toward the devolution of a bladder into dysfunction status are high voiding pressures and increased residual urine.Medication and clean intermittent catheterization are two main interventions, for the children who difficult to treat, an appendicovesicostomy utilizing the Mitrofanoff principle presents an useful option.Renal transplantation is an alternative for patients with PUV who progress to end-stage renal disease.Bladder dysfunction plays an important role in the development of PUV and urodynamic examination can be used to assess the function of the bladder to achieve timely and effective intervention.

To identify adulterants from medicinal plants of Bletilla H. G. Reichenbach, the suitable candidate DNA barcoding of Bletilla was evaluated. In this study, the internal transcribed spacer (ITS) of nuclear ribosomal DNA, the LFY homologous gene intron 2 and chloroplast ycfl gene were amplified and sequenced from forty-one samples. The intra-specific and inter-specific divergences of Bletilla were calculated, and the identification efficiency was assessed using Barcoding Gap, NJ tree by K2P distance and BLAST1 method. The result showed the intra-specific divergence of nrDNA ITS and ycJfl (0.022-0.106 and 0.017-0.106) were obviously higher than the inter-specific divergence (0-0.012 and 0-0.015), and four species of Bletilla were also accurately distinguished in NJ trees. Whereas, there was no Barcoding Gap on LFY homologous gene intron 2, thus it cannot effectively identify species of Bletilla. Using NJ tree of nrDNA ITS and ycfl gene, powdery medicine and the adulterants of Bletilla were successfully unidentified. In conclusion, nrDNA ITS and ycfl can be used as a potential DNA barcoding to identify the medicinal plants in Bletilla and its adulterants. There were only three basic differences on nrDNA ITS between "Jujing baiji" and Bletilla striata of Lu'an in Anhui province, and two basic differences in ycfl. Based on morphological and molecular data, "Jujing baiji" could be recognized as the species of Bletilla striata.

To make sure the role of flagellin as mucosal adjuvants and the protective effect of streptococcus pneumonia infection when combined with DnaJ protein.Methods:Recombinant plasmid pET-28 ( a)/flagella was transferred to E.coli BL21(DE3).Over-expression of flagella was induced by IPTG and purification for animal study.All the C57BL/6 mice were randomly divided into three groups ,then respectively intranasally given the mixture of flagellin and DnaJ protein ( experimental group ) , DnaJ protein( control group 1 ) and the mixture of GST and DnaJ protein ( control group 2 ).The serum IgG and its subtype , cytokines secreted by mice spleen cells were detected by ELISA.At last all the C57BL/6 mice were intranasally immunized with Streptococcus pneumoniaD39.The protective effect by survival times were evaluated.Results: The mice of experimental group could secrete high level of serum IgG and cytokines IFN-γ,IL-4 and IL-17A.What more,the survival rate of mice in experimental group was 60%,a significant statistical difference with the control group.Conclusion:The flagellin as an adjuvant can reinforce the immune response of DnaJ protein and have better protection of resistance D 39 infection.We suggest that flagellin can be used as protein vaccine adjuvants.

In this study ,a wild type Salmonella typhimurium (S .typhimurium) strain was isolated and identified in Hong Kong (S129) ,then the asdA gene was knocked out and replaced with kanamycin resistant gene in a Salmonella typhi-murium strain S129 using the λ RED-mediated recombination method .The constructed mutant asdAΔS129 was validated by culturing in the presence or absence of 2 ,6-diaminopimelic acid (DAP) growth in vitro and evaluating its virulence in BALB/c mice challenge assay .Therefore ,this study has demonstrated that an asdA mutant Salmonella typhimurium has been success-fully constructed .

Objective:To investigate the application of the decision-oriented context-input-process-product (CIPP) model combined with integrated teaching in standardized training of medical oncology.Methods:A total of 98 standardized training residents who participated in standardized training in Department of Oncology, Jiangsu Cancer Hospital, were enrolled as subjects, and they were divided into control group and observation group using a simple random number table, with 49 residents in each group. The residents in the control group received routine teaching, and those in the observation group received CIPP model combined with integrated teaching. The two groups were compared in terms of department examination score and assessment of subjective learning effect, and the observation group was assessed in terms of critical thinking ability before and after training. SPSS 22.0 was used for the t-test. Results:Compared with the control group, the observation group had significant increases in theoretical examination score ( t=2.95, P=0.004), practical operation score ( t=17.04, P<0.001), and total score ( t=3.55, P=0.001). After training, the observation group had significant increases in the scores of each dimension of critical thinking ability and the total score of critical thinking ability ( t=2.89, 3.55, 3.37, 3.20, 3.13, 2.67, 3.06, 3.13; P=0.005, 0.001, 0.001, 0.002, 0.002, 0.009, 0.003, 0.002). The observation group had significantly higher assessment scores of subjective learning effect than the control group ( t=3.46, 3.56, 2.83, 2.85, 2.57, 3.07; P=0.001, 0.001, 0.006, 0.005, 0.012, 0.003). Conclusion:The CIPP model combined with integrated teaching can improve the department examination score and critical thinking ability of standardized training residents in medical oncology, with good assessment results of subjective learning effect.

AIM:To explore the synergistic sensitization effect of human umbilical cord mesenchymal stem cell culture supernatant(hUMSC-CM)combined with temozolomide(TMZ)on various glioma cell lines,and to elucidate the underlying mechanisms.METHODS:The hUMSC-CM was harvested using two different serum deprivation tech-niques at 24 and 48 h,and was converted into freeze-dried powder,which was then given to rat malignant glioma cell line RG-2,human astrocytoma cell line U251 and human glioblastoma cell line LN-428 at 5 concentrations(0,1,3,6 and 9 g/L).The effectiveness and sensitivity of hUMSC-CM for inhibiting growth of glioma cells at 24,48 and 72 h were as-sessed using CCK-8 assay.Hematoxylin-eosin(HE)staining combined with CCK-8 assay was employed to evaluate the chemotherapy sensitivity of glioma cells after 48 h of treatment with TMZ at 6 concentrations(0,25,50,100,200 and 400 μmol/L).Two concentrations(3 and 9 g/L)of hUMSC-CM and 3 concentrations(50,100 and 200 μmol/L)of TMZ were chosen for concurrent treatment of glioma cells to assess the proliferation and pathological alterations.TUNEL staining was utilized to detect apoptosis.Flow cytometry was utilized to analyze cell cycle modifications.The expression alterations of apoptosis-inducing proteins,cleaved caspase-3,cleaved caspase-8 and cleaved PARP1,as well as autophagy-inducing proteins beclin-1 and LC3,were examined using Western blot to investigate the synergistic sensitization mechanism of hUMSC-CM combined with TMZ in vitro.RESULTS:The susceptibility of glioma cell lines to hUMSC-CM and TMZ varied,with RG-2 showing the highest sensitivity,followed by U251,and then LN-428.The inhibitory effect of hUMSC-CM(3 and 9 g/L)and TMZ(50,100 and 200 μmol/L)combined treatment on glioma cells was significantly greater than that that of single-agent treatments(P＜0.05),demonstrating a dose-and concentration-dependent enhancement.Notably,the combination of 9 g/L hUMSC-CM(C9)with 50 μmol/L TMZ(T50)effectively suppressed glioma cell growth.CCK-8 as-say indicated a significant reduction of cell viability in C9+T50 group compared with either C9 or T50 alone(P＜0.05).HE staining and TUNEL staining revealed pronounced morphological changes and significant apoptotic features in glioma cells treated with C9+T50.Flow cytometric analysis confirmed that C9+T50 induced cell cycle arrest in glioma cells.Fur-thermore,compared with control group,the levels of cleaved caspase-3,cleaved caspase-8,cleaved PARP1,beclin-1,and LC3-Ⅱ/LC3-Ⅰ were significantly elevated in the C9+T50-treated glioma cells(P＜0.01).CONCLUSION:(1)The concomitant administration of hUMSC-CM and TMZ exerts a broad inhibitory effect on glioma cells,with a synergistic sen-sitization observed across different cell lines.(2)The enhancement of glioma cell sensitivity to TMZ by hUMSC-CM may be attributed to the modulation of caspase-8/caspase-3/PARP1 signaling pathway and the induction of both apoptosis and autophagy in glioma cells.

Objective To investigate the timing and scheme of surgical treatment for the concomitant ureteropelvic junction obstruction(UPJO) and congenital abnormalities of the kidney.Methods The clinical data of 155 patients with concomitant UPJO and congenital abnormalities of the kidney from January 2006 to January 2016 was retrospectively analyzed.There were 107 males and 48 females,who aged 6 months to 16 years and 6 months.The average time was 5 years and 9 months old when they received operation.There were 8 cases less than 1 year old.There were 93 cases of UPJO on the left side,54 cases on the right side,and 8 cases on both sides.There were 33 cases with duplication of kidney,19 cases with solitary kidney,and 6 cases with renal dysplasia,6 cases with renal ectopia,12 cases with polycystic kidney disease,and 41 cases with dysplasia;2 cases with renal malrotation.There were 100 cases with symptoms such as fever,abdominal pain,vomiting.5 cases had received Anderson-Hynes pyeloplasty in other hospitals,2 cases received nephrectomy with symptoms did not relieve.4 cases were treated with nephrostomy in other hospital.Children with the repeated clinical symptoms,or renal function decreased significantly,or hydronephrosis progressive to the anteroposterior diameter of more than 30 mm received surgical treatment.Results There were 140 cases received Anderson-Hynes pyeloplasty,and 8 cases received nephrectomy with 5 cases were UPJO side and 3 cases were only abnormalities of the kidney without UPJO.All patients received IVP or ultrasonography postoperative 3-6 months,which showed hydronephrosis improved or no obvious change,and 4 cases were improved obviously.The IVP results showed that 5 patients with renal dysplasia together with UPJO had the renal function improved.There were 128 cases followed up for 12 to 106 months,with an average of 64.5 months.All patients had no clinical symptoms.83 cases were reexamined by IVP or ultrasonography,and hydronephrosis was getting better or no change.Conclusions The patients with concomitant UPJO and congenital abnormalities of the kidney don't need surgery in advance.The best choice for those patients is Anderson-Hynes pyeloplasty.The indication of nephrectomy should be considered carefully.

OBJECTIVE To provide a reference for the early diagnosis， drug treatment and medication monitoring for patients with Lemierre’s syndrome. METHODS The doctors confirmed the diagnosis of the patient as having Lemierre’s syndrome based on the patient’s condition and the results of metagenomic next-generation sequencing （mNGS）， and the clinical pharmacists participated in the treatment process of the patient. During the treatment process， the clinical pharmacists suggested using piperacillin sodium and tazobactam sodium combined with metronidazole for anti-infective treatment against Fusobacterium necrophorum infection； clinical pharmacists recommend anticoagulant treatment with Enoxaparin sodium injection for left internal jugular vein thrombophlebitis. RESULTS The doctors accepted the suggestion of the clinical pharmacists， and the patient’s condition improved after treatment and was allowed to be discharged with medication. CONCLUSIONS By interpreting the results of mNGS， combined with the patient’s condition， the clinical pharmacists assist doctors in formulating individualized anti-infective and anticoagulant plans for the patient and provide medication monitoring， ensuring the safety and effectiveness of the patient’s medication.

CD226 is an activated receptor on the surface of natural killer (NK) cells. It competes with TIGIT and CD96 to bind to ligands such as CD155 on the surface of tumor cells and mediates the killing function of NK cells. Although TIGIT and CD96 have other binding ligands in the tumor microenvironment, they compete to bind CD115 ligands with higher affinity and inhibit the activity of NK cells, which allows tumor cells to evade killing. Therefore, studying the expression patterns of these three NK cell surface receptors in different tumors and monitoring their binding ability with ligands will help us to explore new tumor treatment strategies. This article reviews the role and mechanism of CD226, TIGIT, CD96 and other NK cell receptor molecules in regulating NK cell function in anti-tumor immune response.
Ligands ; Receptors, Immunologic ; Receptors, Natural Killer Cell ; Killer Cells, Natural ; Antigens, CD