Objective:To analyze the level of interleukin-36(IL-36) family cytokines in peripheral blood, and explore the regulatory role of recombinant human IL-36α in monocyte function in patients with diabetic kidney disease(DKD).Methods:A total of 41 type 2 diabetes mellitus(T2DM) patients, 36 DKD patients, and 20 controls were consecutively enrolled. Plasma and peripheral blood mononuclear cells(PBMCs) were isolated. Enzyme-linked immunosorbent assay(ELISA) was used to measure plasma levels of IL-36α, IL-36β, IL-36γ, and IL-36 receptor antagonist(IL-36Ra). PBMCs were sorted, and real-time quantitative PCR was performed to detect the mRNA expression of IL-36 receptor subunits in monocytes. Monocytes were stimulated with recombinant IL-36α, and levels of cytotoxic molecules and cytokines in the culture supernatant were measured. Flow cytometry was used to assess the expressions of programmed death receptor-1(PD-1) and cytotoxic T-lymphocyte-associated protein 4(CTLA-4). Co-culture of monocytes with Vero cells was performed to evaluate monocyte cytotoxicity.Results:Plasma levels of IL-36α and IL-36β in the T2DM and DKD groups were significantly higher than those in the control group. The DKD group also showed higher plasma levels of IL-36α compared to the T2DM group( P<0.05). There were no significant differences in IL-36γ and IL-36Ra levels among the three groups( P>0.05). The mRNA expression of IL-36 receptor subunits in monocytes was comparable among the three groups( P>0.05). The DKD group had higher level of tumor necrosis factor-alpha(TNF-α) compared to the control and T2DM groups( P<0.05). The levels of PD-1 and CTLA-4 were lower in the DKD group than those in the control and T2DM groups( P<0.05). The proportion of monocyte-induced Vero cell death was significantly higher in the DKD group compared to the control and T2DM groups( P<0.05). After stimulation with recombinant human IL-36α, monocytes from DKD patients showed a significant increase in the secretion of granzyme B and TNF-α( P<0.05), as well as an increased proportion of monocyte-induced Vero cell death( P=0.024). Conclusion:In DKD patients, elevated IL-36α and granzyme B levels in monocytes enhance monocyte function.

Objective:To observe the expression of interleukin-35(IL-35) in Hashimoto's thyroiditis(HT) patients, and evaluate its regulatory effect on the balance between regulatory T cells(Treg) and T helper 22(Th22) cells.Methods:Forty-two HT patients and eighteen controls were consecutively enrolled. Plasma and peripheral blood mononuclear cells(PBMC) were isolated. Treg were purified. Plasma IL-35 and IL-22 were detected with enzyme-linked immunosorbent assay. Treg and Th22 percentages were measured using flow cytometry. Real-time quantitative PCR was used to assess mRNA levels of forhead box protein 3(FoxP3) and aryl hydrocarbon receptor(AhR). Treg were stimulated with exogenous IL-35, and were co-cultured with autologous PBMC to induce Treg-to-Th22 phenotypic differentiation, evaluating the effect of IL-35 on Treg function and differentiation.Results:There was imbalance between Treg and Th22 cells in HT group. HT group had reduced Treg percentage, plasma IL-35 and FoxP3 mRNA( P<0.001), while had elevated Th22 percentage and AhR mRNA( P<0.001). There was no significant difference in plasma IL-22 level between two groups( P=0.775). The suppressive capacity of Tregs in the HT group was diminished( P=0.013), and secretion levels of IL-35 and IL-10 were lower than those in the control group( P<0.001). The ability of Tregs in the HT group to differentiate into Th22 cells was increased, with higher levels of CCR4, CCR6, CCR10, AhR mRNA, and IL-22 secretion compared to the control group( P<0.01). IL-35 stimulation induced elevation of Treg percentage, FoxP3 mRNA, and IL-35/IL-10 secretion( P<0.05), but did not affect Th22 percentage, AhR mRNA, or IL-22 secretion( P>0.05). IL-35 stimulation enhanced Treg function in HT group, increasing proliferation inhibition and secretion of IL-35 and IL-10( P<0.05). IL-35 stimulation reduced the differentiation of Treg to Th22 phenotype in HT group, with decreased levels of CCR4, CCR6 CCR10, AhR mRNA, and IL-22 secretion( P<0.05). Conclusion:IL-35 enhances the immunosuppression of Tregs in HT patients and inhibits its differentiation into Th22 cells, thus regulating the balance between Tregs and Th22 cells.

OBJECTIVE: To explore changes of humerus torque screw tip distance on stability of proximal humeral internal locking system (PHILOS) by finite element analysis, in order to provide reference for selection of intraoperative plant size. METHODS: The proximal humerus 3D model was constructed based on Synbone artificial bone model in 3D engineering drawing software, and the corresponding 3D model was constructed based on PHILOS bone plate contour. The model was modified to simulate comminuted proximal humerus fracture, and the operation model was simulated after fracture, and the fixed operation model was assembled, the apex distance of humerus moment screw was set as 4, 8, 12 and 16 mm respectively. The axial and torsional loads were applied under the conditions of vertical downward and 20° abduction respectively, and the maximum displacement of humeral head and the peak stress of cortical bone and cancellous bone of humeral head were calculated under the corresponding working conditions, respectively, to evaluate influence of screw tip distance change on the risk of humeral head varus after PHILOS plate fixation. RESULTS: The peak displacement of humerus head did not generally increase with the increase of torque screw tip distance. On the contrary, the peak displacement of humerus head decreased slightly in all working conditions with the gradual increase of torque screw tip distance. At 20° abduction, the maximum displacement of humerus head was significantly higher in all models than that under vertical loading. At the same time, the lengthening of tip distance of torque screw did not lead to significant stress concentration of the humerus head after operation. The peak stress of cancellous bone decreased gradually with the extension of the peak distance of humerus moment screw, while the peak stress of cortical bone increased first and then decreased. When the peak distance was 12 mm, the peak stress of cortical bone was the largest under all working conditions, and then decreased with the further extension of the peak distance. CONCLUSION In the case of a small humeral head interlocking screw tip distance(less than 4 mm), increasing the humeral torque screw tip distance does not lead to a significant loss of stability after PHILOS plate fixation and a significant increase in the risk of postoperative complications.
Humans ; Finite Element Analysis ; Fracture Fixation, Internal/instrumentation* ; Bone Plates ; Bone Screws ; Humerus/surgery* ; Shoulder Fractures/surgery* ; Torque ; Biomechanical Phenomena

ObjectiveTo study the mechanism of Shenling Guchang prescription on blood glucose of gestational diabetes mellitus rats by regulating intestinal flora and short chain fatty acids. MethodThe 30 pregnant rats were randomly selected from 36 pregnant rats which were successfully pregnant. The model rats were fed with high-fat and high-sugar diet for 1 week， and 35 mg·kg^-1 streptozotocin （ STZ ） was given for 3 consecutive days to construct a gestational diabetes model. After successful modeling， the rats were randomly divided into model group， metformin group， Shenling Guchang prescription low-， medium- and high-dose group. The high dose group of Shenling Guchang prescription was given 18 mg·kg^-1， the middle dose group was given 9 mg·kg^-1， the low dose group was given 4.5 mg·kg^-1 drug solution by gavage， the metformin group was given 52.5 mg·kg^-1 drug solution by gavage， the blank group and the model group were given equal volume of normal saline by gavage.At 24 h after the last administration， blood samples were collected from the tail tip of the rats to measure the blood glucose， and blood samples were collected from the abdominal aorta under anesthesia to measure the levels of triglyceride （TG）， total cholesterol （TC）， high density lipoprotein cholesterol （HDL-C） and low density lipoprotein cholesterol （LDL-C）. Lipopolysaccharides （LPS）， interleukin-1β （IL-1β）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α） and insulin （INS） were detected by enzyme-linked immunosorbent assay （ELISA）.The intestinal tissue of rats was taken， and the pathological changes of intestinal tissue were observed by hematoxylin-eosin （HE） staining. Fecal samples were collected from rats， 16S rRNA sequencing was used to detect intestinal flora， and short-chain fatty acids were detected by gas chromatography. ResultCompared with the blank group， the incidence of adverse pregnancy outcomes in the model group was significantly increased （P<0.05）. Compared with the model group， the incidence of adverse pregnancy outcomes in the Shenling Guchang prescription groups and the metformin group was significantly decreased （P<0.05）. Compared with the blank group， the levels of blood glucose， TG， TC， HDL-C， LDL-C， LPS， IL-1β， IL-6 and TNF-α in the model group were significantly increased （P<0.05）， and the intestinal tissues had different degrees of inflammatory changes and mucosal damage. Compared with the model group， the levels of blood glucose， TG， TC， HDL-C， LDL-C， LPS， IL-1β， IL-6 and TNF-α in each group of Shenling Guchang prescription and metformin group were down-regulated （P<0.05）， and intestinal inflammation and intestinal mucosal damage were improved. Compared with the blank group， the functional structure and diversity of intestinal flora in the model group changed （P<0.05）. Compared with the model group， the functional structure and diversity of intestinal flora in the Shenling Guchang prescription groups and the metformin group were reversed， and the trend was close to the blank group （P<0.05）.Compared with the blank group， the abundance of pathogenic bacteria such as Escherichia coli， Enterococcus， Klebsiella， and Dustella in the model group was significantly increased， and the abundance of probiotics such as Prevotella， Prevotella， Akmania， Rombustella， and Lachnospiraceae was decreased （P<0.05）. Compared with the model group， the abundance of pathogenic bacteria such as Escherichia coli， Enterococcus， Klebsiella， and Dustella was decreased （P<0.05）， and the abundance of probiotic bacteria such as Prevotella， Akmanella， Rombustella， and Lachnospira was increased （P<0.05） in the Shenling Guchang prescription groups and the metformin group. Compared with the blank group， the content of short-chain fatty acids in the model group was significantly decreased （P<0.05）. Compared with the model group， the content of short-chain fatty acids in each group of Shenling Guchang prescription and metformin group increased （P<0.05）. Correlation analysis showed that Proteobacteria was positively correlated with inflammatory factors， blood glucose and blood lipid in gestational diabetes mellitus （P<0.05）. ConclusionShenling Guchang prescription has a good regulatory effect on blood glucose， blood lipids and adverse pregnancy outcomes in rats with gestational diabetes mellitus. Its efficacy is comparable to that of metformin sustained-release tablets. Its mechanism may be related to regulating the structure of intestinal flora， increasing the content of short-chain fatty acids， reducing LPS， IL-1β， IL-6， TNF-α， and improving intestinal inflammation.

Objective: To understand the incidence of pneumoconiosis in the non-coal mining industry in Jiangsu Province, and provide reference for the prevention and control of pneumoconiosis in the non-coal mining industry. Methods: The data of 7019 newly diagnosed pneumoconiosis patients in non-coal mining industry in Jiangsu Province from January 1956 to December 2019 were collected through the Jiangsu Province Pneumoconiosis Follow-up Network Report System, including the gender of the pneumoconiosis patients, the name of the employer and the location, the industry classification of the employer, the duration of dust exposure in dust exposure, the name of occupational pneumoconiosis disease, the date of diagnosis of pneumoconiosis, etc. The collected case data of patients with pneumoconiosis were entered into the statistical software, and the characteristics of the patients' diagnosis time, region and industry were analyzed. Results: The number of confirmed pneumoconiosis patients in the non-coal mining industry in Jiangsu Province was mostly in 2007 (395 cases) , concentrated in Wuxi City (40.96%, 2875/7019) and Suzhou City (27.72%, 1946/7019) . The industries to which the patients belonged were mainly non-metallic mining and dressing (60.95%, 4278/7019) , and the most common type of pneumoconiosis was silicosis (96.40%, 6766/7019) . The patients were mainly stageⅠpneumoconiosis (61.33%, 4305/7019) . There were statistically significant differences in the mean age of diagnosis and the average duration of dust exposure among patients with different pneumoconiosis stages (P<0.01) . The differences in the average diagnosis age and the average duration of dust exposure of patients with different types of pneumoconiosis were statistically significant (P<0.05) , the mean age of diagnosis and the average duration of dust exposure of electric welders were the smallest, which were (44.92±7.74) years old and (17.38±10.15) years, respectively. Conclusion: The regional and industry distribution characteristics of new pneumoconiosis patients in the non-coal mining industry in Jiangsu Province are obvious, and attention should be paid to the treatment of pneumoconiosis patients with young diagnosed age and short duration of dust exposure, as well as the personal protection and health protection of front-line workers such as electric welders who are exposed to productive dust in a short period of time.
Adult ; Coal Mining ; Dust ; Humans ; Middle Aged ; Occupational Diseases/epidemiology* ; Occupational Exposure/adverse effects* ; Pneumoconiosis/epidemiology* ; Silicosis/epidemiology*

Objective To compare the sonographic features as well as clinical histopathological features of follicular variant papillary thyroid carcinoma(FVPTC) and conventional papillary thyroid carcinoma (CPTC) in pediatric patients.Methods From Jan.2006 to Dec.2017,26 FVPTC patients and 82 CPTC patients were enrolled in this study.The clinical histopathological findings and the sonographic features were compared between the two groups.FVPTCs and CPTCs were divided into PTC-like and follicular neoplasm(FN)-like based on sonographic characteristics.Results The mean nodule size of FVPTCs was larger than that of conventional PTCs.Extrathyroid invasion and cervical lymph node metastasis did not have significant difference between CPTC and FVPTC patients(53.8％ vs 62.2％ and 76.9％ vs 82.9％,respectively).Multiple nodules(P=0.000)and distant pulmonary metastases(P=0.024) were more frequent in CPTCs than in FVPTCs(P＜0.05).The rate of an ill-defined margin (P=0.000) and calcification (P=0.003)in terms of sonographic features were lower in FVPTCs than conventional PTCs(P＜0.05).A Ⅴ+Ⅵ diagnosis of PTC on FNAC of FVPTCs was less common than that of conventional PTCs (P=0.014).Multifocality(P=0.000),extrathyroidal invasion (P=0.000),and lymph node metastasis (P=0.000) were significantly different between PTC-like FVPTCs and FN-like FVPTCs.Conclusion FVPTC in children and adolescents shows a relatively larger size,more benign sonographic features,and a lower diagnostic rate of PTC by FNAC compared with conventional PTCs in pediatric patients.

Objective: To evaluate renal tissue oxygenation level and its correlation with blood glucose level after hypoglycemic therapy in diabetic patients using BOLD-MRI. Methods Renal BOLD-MRI scans were performed on 23 patients with type 2 diabetes (diabetic group) before and after hypoglycemic therapy and 23 normal controls (control group). R2* values of renal cortex and medulla were measured and statistically analyzed. Results R2* value of renal cortex in diabetic group and control group were lower than that of renal medulla (all P<0.001). R2* value of renal medulla in diabetic group before hypoglycemia was higher than that after hypoglycemia and in control group (both P=0.001), and there was no significant difference of R2* value of renal medulla between diabetic group after hypoglycemia and control group (P=0.941). There was no significant difference in renal cortical R2* value among diabetic group before and after hypoglycemia and control group (P=0.572). R2* value of renal medulla was positively correlated with blood glucose level (r=0.365, P=0.002), while of renal cortex had no correlation with blood glucose level (r=-0.014, P=0.908). Conclusion: Hypoglycemic treatment can help to improve oxygenation of renal medulla in diabetic patients. BOLD-MRI can be used to evaluate changes of renal oxygen content before and after hypoglycemic treatment.

Objective To explore the application and significance of multiple clinical pathway training oriented teaching model in clinical teaching of laboratory diagnostic. Methods Totally 50 medical students enrolled in the Second Military Medical University from September to December in 2015 were divided into experimental group and control group. The course consists of theoretical teaching and experi-mental operation. The pathway group (n=25) were introduced into multiple clinical pathway training oriented teaching method. The theoretical teaching was carried out bysimulation examination application, simulation interpretation and simulation diagnosis and treatment, while the experimental course was carried out by using video teaching combined with actual operation. The control group was taught by traditional teaching method using slide teaching and operation display. The theoretical test including case study and operational skill tests were performed among students in both groups after 10 class hours training . The satisfaction questionnaires were conducted to evaluate the effectiveness and satisfaction of teaching guided by clinical pathway. Differences were compared with independent sample t testing using GraphPad Prism 5.0 statistical software. Results The medical records about professional theoretical test including case study and opera-tional skill test in the pathway group were superior to those in the control group with significant statistical difference (both P<0.05). The records of medical students were (81.84±7.21), (42.00±2.79) in the pathway group and (76.24 ±6.98), (37.00 ±3.71) in the control group. The questionnaire result showed that the pathway group's satisfaction was high, especially with the theoretical knowledge andsceneteaching (higher than 80％). The pathway group believed that multiple clinical pathway training helped to improve learning interest and clinical thinking ability . Conclusions Multiple clinical pathway training oriented teaching model is helpful for the medical students to achieve the basic idea of clinical pathway, improve the profes-sional ability, enhance the interest of learning and the quality of teaching, standardize teaching and promote teaching and learning.

Objective To evaluate the clinical efficacy of nerve-related acupoints electrical stimulation in preventing urinary retention after hemorrhoid surgery. Method Ninety-seven patients were randomized into two groups: the treatment group received nerve-related acupoints electrical stimulation 1 h after Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids, while the control group was taken as a blank control. The incidence of postoperative urinary retention, residual urine volume after the first urination, general urinary condition score, and satisfaction evaluation were compared between the two groups. Result The incidence of postoperative urinary retention and residual urine volume after the first urinary were lower, and the general urination condition and satisfaction evaluation were higher in the treatment group compared to those in the control group. Conclusion Nerve-related acupoints electrical stimulation can prevent and reduce the adverse reactions such as urinary retention after hemorrhoidectomy, and it can effectively protect the bladder function and improve the prognosis.

Purpose To analyze the relationships between glomerular filtration rate (GFR) measured by SPECT and renal parenchyma thickness and enhanced CT value measured by CT, and to explore predictive significance of CT in evaluating renal function of patients with hydronephrosis.Materials and Methods One hundred and fifteen patients diagnosed with unilateral hydronephrosis by ultrasound were retrospectively analyzed. GFR% (GFR percentage of affected kidney to the both kidneys) was measured by SPECT. CT% (percentage of affected renal parenchyma thickness to the both kidneys) and enhanced CT% (percentage of enhanced CT value of affected kidney to the both kidneys) were measured by pre- and post-contrast CT scan. According to GFR, the renal function was divided into mild-to-moderate impairment, severely impairment and non-function. Twenty-five volunteers were recruited as control group. CT%, enhanced CT% and GFR%among the four groups were compared, and the correlation of CT% and enhanced CT%with GFR% was analyzed to evaluated CT in predicting renal function.Results CT%, enhanced CT% and GFR% in mild-to-moderate impairment group was significantly greater than those in severely impairment group and non function group (F=20.24, 7.78 and 329.21,P<0.05). GFR% was positive correlated with CT% (r=0.58,P<0.05) and enhanced CT% (r=0.61,P<0.05). Area under curve (AUC) of CT% were 0.54, 0.79 and 0.83 for mild-to-moderate impairment, severely impairment and non-function, with sensitivity of 92.91%, 93.47%, 65.72%, and specificity of 35.33%, 59.47%, and 88.62%, respectively. AUC of enhanced CT% were 0.79, 0.89 and 0.96 for the three groups, with sensitivity of 97.51%, 80.02%, 97.66%, and specificity of 58.14%, 89.82% and 94.27%, respectively.Conclusion There was high correlation between renal function imaging by SPECT and CT in evaluating renal function of hydroneohrosis patients. Pre- and post-contrast CT scan can be used as complements in predicting renal function, and post-contrast CT with high accuracy.