Objective To investigate the status of Chlamydia trachomatis(CT) infection in pregnant women in Wuxi ,and to ex‐plore the relationship between CT and abortion .Methods A total of 3 199 cases of pregnant women visiting this hospital from Jan‐uary 2013 to December 2014 were enrolled in this study and divided into the missed abortion group(2 633 cases) ,incomplete abor‐tion group(265 cases) ,the inevitable abortion group(137 cases) ,threatened abortion group(104 cases) and control group(60 cases , all women undergoing induced abortion) .The CT infection was detected by using the fluorescent quantitative polymerase chain reac‐tion(FQ‐PCR) .Results The positive rate of CT in missed abortion group ,incomplete abortion group ,the inevitable abortion group and threatened abortion group were 5 .62% ,4 .53% ,5 .11% and 4 .81% ,respectively ,all were higher than that in the control group (3 .33% ) ,without statistically significant differences (P>0 .05) .The positive rate of CT in women in 16- <21 years old age group and 21- <26 years old age group was higher than that in other age groups ,which was 7 .06% and 6 .20% respectively .However , there were no statistically significant differences in positive rate of CT between these age groups (P>0 .05) .Conclusion The posi‐tive rate in women undergoing spontaneous abortion is higher than that in women undergoing induced abortion ,and young women has a higher infection rate of CT .

More than half of patients with hepatocellular carcinoma (HCC) have multiple lesions in the liver at the time when they attend the hospital, and there are limited treatment methods with poor efficacy for multifocal HCC in clinical practice. The high degree of tumor heterogeneity in multifocal HCC is the leading cause of treatment failure. More and more studies use multi-omics sequencing to explore the heterogeneity between different lesions at the genetic and transcriptional levels, including tumor clonal evolution, gene mutations, copy number variations, structural variations, RNA expression, and tumor immune microenvironment. Drug target distribution shaped by clonal evolution and the characteristics of immune microenvironment can accurately predict the response to targeted drugs and immunotherapy in patients with multifocal HCC. Therefore, a comprehensive and accurate assessment of the heterogeneity of multifocal HCC based on a multi-omics study is of vital importance in the implementation of precise treatment.

Objective To analyze the X-ray,CT and MRI findings of giant cell tumor in the thoracic vertebrae,in order to improve its diagnostic accuracy.Methods X-ray,CT and MRI findings of 9 cases of pathologically proved giant cell tumor were analyzed retrospectively. X-ray examination was performed in 7 cases,CT in 6 cases,and MRI in 7 cases.Results Of the 9 cases with thoracic vertebrae giant cell tumors,8 involved a single vertebra while 1 case involved the left ninth posterior segment of rib simultaneously.On X-rays studies, 6 cases of bone destruction were dispensability,and 1 case was osteolysis.Three cases of vertebral destructive margin were clear. The body of vertebra was flattened in 3 cases.Pore-vertebral soft tissue masses were found in 4 cases.On CT examinations,5 cases of bone destruction were dispensability,and 1 case was osteolysis.3 cases of vertebral margin were clear with partial sclerotic rim. 4 cases of vertebral body had shade of bone-cristae.There were soft tissue masses around vertebrae in 5 cases,with vertebrae accessory,dural sac and the spinal cord involved to varying degrees.On MRI studies,hypointense were showed in 5 cases while isointense in 2 cases on T1 WI;On T2 WI,isointense was showed in 1 case,hyperintense in 4 cases,and mixed-intense in 2 cases.Conclusion Giant cell tumor in the thoracic vertebrae is uncommon.Full understanding X-ray,CT,MRI characteristics is useful to improve the diagnosis, guide clinical surgical treatment and forecast prognosis.

ObjectiveTo investigate the value of combined determination of hepatitis C virus (HCV) genotype, the alpha-fetoprotein variant AFP-L3, and P53 antibody in HCV-related hepatocellular carcinoma (HCV-HCC). MethodsA total of 84 patients with HCV-HCC who were diagnosed in our hospital from January 2016 to December 2019 were enrolled as HCV-HCC group, and 84 patients with benign liver diseases (hepatitis C and HCV liver cirrhosis) were enrolled as control group. The PCR-reverse dot blot hybridization technique was used to determine HCV genotype, ELISA was used to measure P53 antibody, and electrochemical luminescence was used to measure AFP-L3. The t-test and the Kruskal-Wallis H test were used for comparison between two groups; the chi-square test was used for comparison of categorical data between two groups. The logistic regression analysis and the receiver operating characteristic (ROC) curve were used to compare the value of each index in the diagnosis of HCV-HCC. ResultsCompared with the control group, the HCV-HCC group had a significantly higher proportion of patients with HCV 1b genotype or AFP-L3 and a significantly higher level of P53 antibody (χ2=5714, Z=-9.27, Z=-9.92, all P＜0.05). The logistic regression analysis showed that HCV genotype, AFP-L3, and P53 antibody had significant effects on HCV-HCC (all P＜0.05). The above indices were fitted to establish a model of Logit(Y)=-3.881+0031XAFP-L3(%)+0.043XP53+1218XHCV genotype, in which Y was the positive probability value of combined determination. In the screening of HCV-HCC, Y had a significantly larger area under the ROC curve than HCV genotype (0.945 vs 0.758, Z=6.17, P＜0001), AFP-L3 (0.945 vs 0.863, Z=3.97, P＜0.001), and P53 antibody (0.945 vs 0.887, Z=3.07, P=0.002). Y had higher AUC (0.945), sensitivity (90.90%), specificity (94.00%), positive predictive value (93.80%), negative predictive value (9116%), and diagnostic accuracy (92.44%) than each index alone. ConclusionHCV 1b genotype, AFP-L3, and P53 antibody level are associated with the risk of HCV-HCC, and the combined determination of the three indices has important clinical significance in the early diagnosis of HCV-HCC.

Objective To investigate the pressure changes of cuff in the tapered-cuff endotracheal tubes and the frequency of cuff pressure monitoring in patient with trachea intubation. Methods From December 2016 to October 2017, 80 patients with oral tracheal intubation in the emergency department were divided into group A (n =25) and group B (n =23) according to the principle of randomized control. Group A with odd number was treated and tapered-cuff endotracheal tubes and group B with ever number and cylindrical-cuff endotracheal tubes. Continuous cuff pressure monitoring device was used to continuously monitor the cuff pressure. The two groups were compared in terms of time for keeping the normal cuff pressure and cuff pressure (average pressure, maximum pressure and minimum pressure). Results The total time for keeping the normal cuff pressure in group A was significantly shorter than that in group B (P＜0.05). The average cuff pressure in group A was smaller than that of group B (P＜0.05). The maximum pressure in group A is larger than that in group B and the maximum cuff pressure in group A was smaller than that of group B (P＜0.05). Conclusion Compared with the cylindrical cuff catheter, the tapered-cuff tube can maintain the normal pressure for a shorter period and easily produce needed pressure. It is a need to enhance the monitoring of cuff pressure to ensure good airway closure and reduce artificial airway complications.

Objective:To investigate the etiologic characteristics,as well as the sensitivity of bacteria to antibiotics,in ventila-tor-associated pneumonia(VAP)in Department of Critical Care Medicine,so as to provide evidence for empirical antimicrobial treatment.Methods:The bacterial infection,as well as the sensitivity of bacteria to antibiotics,in 32 VAP cases in Department of Critical Care Medicine in The Third Hospital,Soochow University from Jan 2012 to Dec 2013 were retrospectively analyzed. Results:A total of 110 strains of bacteria were found from 32 VAP cases,including 48 gram negative bacilli(43.6%),43 gram positive cocci(39.1%)and 19 fungi(17.3%).Gram negative bacilli mainly consisted of Baumanii and Klebsiella,Pseudomonas aeruginosa and Escherichia coli.Gram positive cocci mainly consisted of Enterococci and Staphylococcus aureus,Staphylococcus epidermidis and Staphylococcus haemolyticus.Fungi mainly consisted of Candida albicans.Drug sensitive test results showed that Baumanii,Klebsiella and Escherichia coli were more sensitive to carbapenems than to other antibiotics and no Enterococci and Staphylococci was found resistant to vancomycin and linezolid.Conclusions:More VAP patients in Department of Critical Care Medicine were infected by gram negative bacilli.In clinical,empirical antimicrobial treatment should be selected reasonably according to the bacterial etiology and the sensitivity of bacteria to antibiotics,so as to control the infection in Department of Critical Care Medicine and reduce the emergence of drug resistant bacteria.

A purified polysaccharide with a galactose backbone(SPR-1,Mw 3,622 Da)was isolated from processed Polygonati Rhizoma with black beans(PRWB)and characterized its chemical properties.The backbone of SPR-1 consisted of[(4)-β-D-Galp-(1]9→ 4,6)-β-D-Galp-(1 → 4)-α-D-GalpA-(1 → 4)-α-D-GalpA-(1 →4)-α-D-Glcp-(1 → 4,6)-α-D-Glcp-(1 → 4)-α/β-D-Glcp,with a branch chain of R1:β-D-Galp-(1 → 3)-β-D-Galp-(1 → connected to the →4,6)-β-D-Galp-(1 → via O-6,and a branch chain of R2:α-D-Glcp-(1 →6)-α-D-Glcp-(1 → connected to the →4,6)-α-D-Glcp-(1 → via O-6.Immunomodulatory assays showed that the SPR-1 significantly activated macrophages,and increased secretion of NO and cytokines(i.e.,IL-1β and TNF-α),as well as promoted the phagocytic activities of cells.Furthermore,isothermal titration calorimetry(ITC)analysis and molecular docking results indicated high-affinity binding between SPR-1 and MD2 with the equilibrium dissociation constant(KD)of 18.8 μM.It was suggested that SPR-1 activated the immune response through Toll-like receptor 4(TLR4)signaling and downstream responses.Our research demon-strated that the SPR-1 has a promising candidate from PRWB for the TLR4 agonist to induce immune response,and also provided an easily accessible way that can be used for PR deep processing.

[摘 要] 目的：探讨鼠尾草酸（CA）通过调节CXC基序趋化因子受体7（CXCR7）/CXC基序趋化因子配体（CXCL12）轴对胃癌AGS细胞增殖、迁移和侵袭的影响。方法：用不同浓度（0、5、10、20、40、80 µg/mL））的CA处理胃癌AGS细胞，采用CCK-8法筛选合适的CA浓度；将AGS细胞分为对照组（未经处理的AGS细胞）、CA组（20 µg/mL CA处理）、CA+siCXCR7组（转染siCXCR7+20 µg/mL CA处理）、CA+siNC组（转染siNC+20 µg/mL CA处理）、CA+vectorNC组（转染vectorNC+20 µg/mL CA处理）、CA+vectorCXCR7组（转染vectorCXCR7+20 µg/mL CA处理），采用CCK-8法检测AGS细胞增殖的变化，qPCR法检测细胞中CXCR7、CXCL12 mRNA表达水平的变化，Transwell实验检测细胞侵袭能力的变化，划痕实验检测细胞迁移能力的变化，WB法检测周期蛋白D1、Bcl-2、CXCR7、CXCL12、MMP-2蛋白表达的变化。结果：不同浓度CA均可抑制AGS细胞存活率，且浓度为20 µg/mL时，细胞存活率接近50%，故选择20 µg/mL CA用于后续研究。与对照组相比，CA组增殖率、侵袭数、迁移率、周期蛋白D1、MMP-2、Bcl-2、CXCR7、CXCL12 mRNA及蛋白表达显著降低（均P<0.05）；与CA+siNC组相比，CA+siCXCR7组增殖率、侵袭数、迁移率、周期蛋白D1、MMP-2、Bcl-2、CXCR7、CXCL12 mRNA及蛋白表达显著降低（均P<0.05）；与CA+vectorNC组相比，CA+vectorCXCR7组增殖率、侵袭数、迁移率、周期蛋白D1、MMP-2、Bcl-2、CXCR7、CXCL12 mRNA及蛋白表达显著增加（均P<0.05）。结论：CA可抑制AGS细胞增殖、迁移和侵袭，其机制可能与抑制CXCR7/CXCL12轴有关。

Objective: The Four Medical Tantras is a classic work of Tibetan medicine, in which drug treatment is one of the four main treatment methods, and prescriptions are the main form of clinical drug use. The study on the medication rules of The Four Medical Tantras has positive significance for the clinical medication research of Tibetan medicine. Method: Prescriptions recorded in Secret Medical Code and Follow-up Medical Code from The Four Medical Tantras were collected, the prescription database was constructed by Visual FoxPro 9.0, combined the dual perspectives of the " fifteen categories" (skabs bco lnga) of Tibetan medical diseases and the " eighteen practices" (lag len bco brgyad) of treatment, and Gephi 0.9.2 complex network was used to analyze its medication rules. Result: The Four Medical Tantras contained 2 695 Tibetan medicine prescriptions, average number of drugs in each prescription was 6.6, prescription composed of ≤ 7 drugs accounted for 69.2%of the total prescription. There were 1 002 kinds of medicines involved in the total prescription, of which 156 was the nodal degrees of Chebulae Fructus, Bambusae Concretio Silicea, Carthami Flos, Piperis Longi Fructus and Zingiberis Rhizoma and so on; followed by 91 nodal degrees of butter (mar), sugar, barley sweetener (sbang ma), honey and brown sugar and so on, which were Tibetan medicinal and edible medicines. According to the classification of diseases in the fifteen categories, there were 495 prescriptions for traumatology (mtshon rma), 323 for fever (tsha ba), 278 for toxics and 197 for three factors diseases. According to the treatment method of eighteen practices, 162 powder, 77 decoction, 84 laxative (bxhal) and others were used. Association rule analysis found that edge weights of Borneolum Syntheticum, Bambusae Concretio Silicea, Carthami Flos, Santali Albi Lignum and other cold medicines were 59, edge weights of pomegranate seeds, Piperis Longi Fructus, Cinnamomi Cortex, Amomi Fructus Rotundus and other warm medicines were 45. Conclusion: The Four Medical Tantras has some characteristics, including the medication rules of elliptic philosophy with cool-warm medicinal properties as the dual core, elimination-diarrhea (zhi-sbyong) as medication methods, weight of rlung-mkhris pa-bad kan as medication dialectical thinking and so on. Among them, the clinical application of butter, barley sweetener, sugar and other special delivery agents of Tibetan medicine is prominent. The prominent clinical application of special Tibetan medicines embodies the philosophy of Tibetan culture with the emphasis on overall balance. It has the multi-dimensional medication rule of " diet plus medicine, medicine plus therapy", and has positive significance for revealing the research on medication rules of Tibetan medicine.