OBJECTIVE: To investigate the distribution of peripheral blood lymphocytes and natural killer (NK) cells, and its influence on the prognosis of patients with myelodysplastic syndromes (MDS). METHODS: The lymphocytes proportion, absolute lymphocyte counts (ALC), NK cell proportion and absolute NK cell counts (ANKC) as well as the related data of 95 MDS patients diagnosed between 2013 and 2017 analyzed retrospectively. The correlation of ALC and ANKC with prognosis was also analyzed. RESULTS: As compared with low ALC patients, MDS patients with ALC≥0.885×10/L had a higher overall response rate (66.7% vs 35.8%) (P＜0.01). The ALC of effective patients after treatment significatitly increased in compaison of ALC at diagnosis. Multivariate analysis indicated that patients with ALC≥0.885×10/L had long overall survival (OS) time in comparison with patients with low level (16.4 vs 12.4 months) (P＜0.05). The OS time of patients with ANKC≥0.110×10/L was shorter in comparison with patients with low level (10.9 vs 16.3 months) (P＜0.01). Otherwise, blast, cytogenetic risks and treatment response were also independent risk factors of MDS (P＜0.05). Revised International Prognostic Scoring System (IPSS-R) combined with ANKC could improve predictive accuracy of IPSS-R alone (AUC 0.718 vs 0.674) (P＜0.05). CONCLUSION Lymphocytes and NK cells are important for the prognosis evaluation of MDS patients.

Objective: To recover broad-neutralizing monoclonal antibodies (BnAbs) from avian influenza A (H5N1) virus infection cases and investigate their genetic and functional features. Methods: We screened the Abs repertoires of expanded B cells circulating in the peripheral blood of H5N1 patients. The genetic basis, biological functions, and epitopes of the obtained BnAbs were assessed and modeled. Results: Two BnAbs, 2-12D5, and 3-37G7.1, were respectively obtained from two human H5N1 cases on days 12 and 21 after disease onset. Both Abs demonstrated cross-neutralizing and Ab-dependent cellular cytotoxicity (ADCC) activity. Albeit derived from distinct Ab lineages, , V 1-69-D2-15-J 4 (2-12D5) and V 1-2-D3-9-J 5 (3-32G7.1), the BnAbs were directed toward CR6261-like epitopes in the HA stem, and HA I45 in the hydrophobic pocket was the critical residue for their binding. Signature motifs for binding with the HA stem, namely, IFY in V 1-69-encoded Abs and LXYFXW in D3-9-encoded Abs, were also observed in 2-12D5 and 3-32G7.1, respectively. Conclusions Cross-reactive B cells of different germline origins could be activated and re-circulated by avian influenza virus. The HA stem epitopes targeted by the BnAbs, and the two Ab-encoding genes usage implied the VH1-69 and D3-9 are the ideal candidates triggered by influenza virus for vaccine development.

Objective: To investigate the incidence of postoperative pancreatic fistula (POPF) and its risk factors after radical gastrectomy. Methods: The prospective study was conducted. The clinicopathological data of 2 089 patients who underwent radical gastrectomy in 22 medical centers between December 2017 and November 2018 were collected, including 380 in the Zhongshan Hospital of Fudan University, 351 in the Renji Hospital of Shanghai Jiaotong University School of Medicine, 130 in the Ruijin Hospital of Shanghai Jiaotong University School of Medicine, 139 in the Peking University Cancer Hospital, 128 in the Fujian Provincial Cancer Hospital, 114 in the First Hospital Affiliated to Army Medical University, 104 in the First Affiliated Hospital of Nanchang University, 104 in the Affiliated Hospital of Qinghai University, 103 in the Weifang People′s Hospital, 102 in the Fujian Medical University Union Hospital, 99 in the First Affiliated Hospital of Air Force Medical University, 97 in the Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, 60 in the Hangzhou First People′s Hospital Affiliated to Zhejiang University School of Medicine, 48 in the Fudan University Shanghai Cancer Center, 29 in the First Affiliated Hospital of Xi′an Jiaotong University, 26 in the Lishui Municipal Central Hospital, 26 in the Guangdong Provincial People′s Hospital, 23 in the Jiangsu Province Hospital, 13 in the First Affiliated Hospital of Sun Yat-Sen University, 7 in the Second Hospital of Jilin University, 4 in the First Affiliated Hospital of Xinjiang Medical University, 2 in the Beijing Chao-Yang Hospital of Capital Medical University. Observation indicators: (1) the incidence of POPF after radical gastrectomy; (2) treatment of grade B POPF after radical gastrectomy; (3) analysis of clinicopathological data; (4) analysis of surgical data; (5) risk factors for grade B POPF after radical gastrectomy. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using ANOVA. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate analysis was conducted using the t test or chi-square test based on data excluding missing data of clinico-pathological and surgical data. Multivariate analysis was conducted using the Logistic regression model based on factors with P<0.20 in univariate analysis. Results: There were 2 089 patients screened for eligibility, including 1 512 males, 576 females and 1 without sex information, aged (62±11)years. The body mass index (BMI) was (23±3)kg/m². (1) The incidence of POPF after radical gastrectomy: the total incidence rate of POPF in the 2 089 patients was 20.728%(433/2 089). The incidence rates of biochemical fistula, grade B pancreatic fistula, and grade C pancreatic fistula were 19.627%(410/2 089), 1.101%(23/2 089), 0, respectively. (2) Treatment of grade B POPF after radical gastrectomy: 2 of 23 patients with grade B POPF after radical gastrectomy had drainage tube placed for more than 21 days and received anti-infective therapy. Four of 23 patients with grade B POPF after radical gastrectomy had ascites detected by imaging examination, of which 2 received peritoneal drainage guided by ultrasound, 1 received failed puncture drainage, 1 received no puncture drainage, and they were given anti-infective therapy. Eleven of 23 patients with grade B POPF after radical gastrectomy had no ascites detected by imaging examinations, and they were given anti-infective therapy and inhibitors of pancreas secretion for clinical manifestation as fever or elevated white blood cells. Six patients with no typical clinical manifestations were given somatostatin to inhibite pancreas secretion and prolonged duration of abdominal drainage tube placement (with a median time of 7 days). All the 23 patients recovered well after treatment, without reoperation. (3) Analysis of clinicopathological data: for the 2 089 patients, BMI, cases with or without neoadjuvant therapy were (23±3)kg/m^2, 1 487, 160 of patients without pancreatic fistula, (23±3)kg/m^2, 386, 22 of patients with biochemical fistula, and (24±3)kg/m^2, 22, 1 of patents with grade B pancreatic fistula, showing significant differences between the three groups (F=5.787, χ²=8.269, P<0.05). (4) Analysis of surgical data: for the 2 089 patients, cases with open surgery, laparoscopic assisted surgery, totally laparoscopic surgery (surgical method), cases with D₁ lymph lode dissection, D₂ lymph lode dissection, and other lymph lode dissection (range of lymph lode dissection), cases with no omentectomy, partial omentectomy, and total omentectomy (range of omentectomy), cases with no usage of energy facility, usage of CUSA, LigaSure, LigaSure+ CUSA as energy facility, cases with or without biological glue, the number of lymph node dissection were 737, 624, 292, 24, 1 580, 51, 418, 834, 381, 63, 1 530, 23, 16, 1 431, 201, 33±14 of patients without pancreatic fistula, 146, 189, 74, 11, 389, 9, 110, 171, 128, 35, 359, 6, 9, 378, 31, 31±14 of patients with biochemical fistula, and 14, 5, 4, 0, 20, 3, 6, 13, 4, 2, 18, 1, 2, 22, 1, 37±16 of patients with grade B pancreatic fistula, showing significant differences between the three groups (χ²=15.578, 9.397, 15.023, 28.245, 8.359, F=4.945, P<0.05). (5) Risk factors for grade B POPF after radical gastrectomy: results of univariate analysis showed that usage of energy facility was a related factor for grade B POPF after radical gastrectomy (χ²=9.914, P<0.05). Results of multivariate analysis showed that laparoscopic assisted surgery, combined evisceration, application of LigaSure + CUSA, the number of lymph lode dissection were independent factors for for grade B POPF after radical gastrectomy (odds ratio=0.168, 3.922, 9.250, 1.030, 95% confidence interval: 0.036-0.789, 1.031-14.919, 1.036-82.602, 1.001-1.059, P<0.05). Conclusions The incidence of grade B POPF after radical gastrectomy is relatively low. Laparoscopic assisted surgery, combined evisceration, application of LigaSure + CUSA, and the number of lymph lode dissection are independent risk factors for grade B POPF. Trial Registration: This study was registrated at ClinicalTrial.gov in United States with the registration number of NCT03391687.

PURPOSE: Extranodal natural killer/T-cell lymphoma, nasal type (ENKTL) is a rare subtype of non-Hodgkin lymphoma, and asparaginase-based regimens are the best first-line treatments. Data on the role of specific circulating lymphocyte subsets in the progression of ENKTL are limited. The aim of this study was to investigate the clinical correlation and distribution of circulating absolute CD4+ T-cell counts (ACD4Cs) in ENKTL. MATERIALS AND METHODS: We retrospectively searched medical records for 70 newly diagnosed ENKTL patients treated with pegaspargase-based regimens. Comparison of ACD4Cs as a continuous parameter in different groups was calculated. Univariate and multivariate analyses were used to assess prognostic factors for overall survival (OS) and progression-free survival (PFS). RESULTS: Stage III/IV, B symptoms, elevated lactate dehydrogenase, monocytopenia, high-intermediate and high risk International Prognostic Index (IPI) and Korean Prognostic Index (KPI), high risk Prognostic Index of Natural Killer Lymphoma (PINK), and lower lymphocytes were significantly associated with low ACD4C at diagnosis. With a median follow-up time of 32 months, patients who had an ACD4C < 0.30×109/L had a worse OS. Median OS was 11 months and median PFS was 5 months in the low ACD4C cohort. There were significant differences in both OS and PFS between the two cohorts. Moreover, multivariate Cox analysis identified ACD4Cs as an independent predictor for OS and PFS. CONCLUSION: Low ACD4Cs were associated with poorer survival and could act as a negative predictor for ENKTL patients treated with asparaginase-based regimens.
Cell Count* ; Cohort Studies ; Diagnosis ; Disease-Free Survival ; Drug Therapy* ; Follow-Up Studies ; Humans ; L-Lactate Dehydrogenase ; Lymphocyte Subsets ; Lymphocytes ; Lymphoma* ; Lymphoma, Extranodal NK-T-Cell ; Lymphoma, Non-Hodgkin ; Medical Records ; Multivariate Analysis ; Prognosis* ; Retrospective Studies ; T-Lymphocytes

Objective To analyze the application of virtual reality technology and mixed reality techniques in our hospital before and during intraoperative evaluation of complicated congenital heart diseases .Methods Methods Retrospectively ana-lyze the clinical treatment, surgical decision-making, intraoperative and early prognosis of 11 children with complicated congen-ital heart disease assessed by virtual reality technology and mixed reality techniques.The time of operation was 34-121 min, CPB time was 26-101 min, the clamping time of aorta was 18-56 min.There was no operative death.Results All 11cases were assessed by virtual reality technology and mixed reality technology before surgery .Personalized surgical strategies were made based on the evaluation results.All patients had undergone operations successfully.Compared with traditional surgical methods, fewer surgical incisions and shorter operation time were required.And it improved the surgical results.Conclusion Virtual reality technology and mixed reality technology have a great advantage in preoperative and intraoperative evaluation of complex congenital heart diseases.They can optimize surgical strategies, shorten operation time, and reduce surgical trauma. They are worthy of further promotion and application in clinical practice.

Objective To observe changes in the infrared thermogram of Yangming meridian acupoints in patients with idiopathic facial paralysis in acute stage. Method High-performance uncooled infrared focal plane array (M7800 Thermal Imager, LumaSense, USA) was used to detect the infrared thermogram of Yangming meridian acupoints[Kouheliao (LI19), Yingxiang (LI20), Hegu (LI4), Shangyang (LI1), Chengqi (ST1), Sibai (ST2), Juliao (ST3), Dicang (ST4), Daying (ST5), Jiache (ST6), Xiaguan (ST7), Tianshu (ST25), and Zusanli (ST36) ]of 80 patients with idiopathic facial paralysis in acute stage and 75 healthy subjects. The temperature data of the meridian acupoints obtained from the analysis software were statistically processed. Result Compared with the healthy subjects, the temperature differencesΔT of the Hand Yangming Meridian acupoints including Kouheliao, Yingxiang and Hegu, and Foot Yangming Meridian acupoints including Chengqi, Sibai, Juliao, Dicang, Daying, Jiache and Xiaguan were more significant in the patients with idiopathic facial paralysis in acute stage, and the differences were statistically significant (P<0.05); the temperature differences ΔT of the Hand Yangming Meridian acupoint Shangyang, and the Foot Yangming Meridian acupoints including Tianshu and Zusanli in the facial paralysis patients showed insignificant differences compared with those in the healthy subjects (P>0.05). Conclusion There are changes in the infrared thermogram at Yangming meridian acupoints located on face (Kouheliao, Yingxiang, Shangyang, Chengqi, Sibai, Juliao, Dicang, Daying, Jiache and Xiaguan) and the distant acupoint Hegu in idiopathic facial paralysis patients in acute stage, while Shangyang, Tianshu and Zusanli do not present the above phenomenon, indicating the specificity of acupoint effect from the perspective of infrared.

Objective To verify the application value of urinary iodine creatinine ratio in urinary iodine examination under different ways of collecting urine samples.Methods Totally 20 healthy adults were recruited and the urine samples were collected as each time random urine within 1 day,the 24 hour urine and morning urine within 5 successive days,respectively.Urinary iodine concentration and creatinine concentration in all urine specimens were determined.The coefficient of variation of urine iodine creatinine concentration ratio in each group was calculated.Paired t test was used to compare the urine iodine creatinine concentration ratio of 24 hour urine with the urine iodine creatinine concentration ratio of random urine and that of morning urine,respectively.Results The coefficient of variation of urinary iodine concentration values of random urine,morning urine and 24 hour urine samples within 1 d were 12.5％-57.4％,5.4％-26.0％,3.4％-16.6％,respectively,and the corresponding coefficient of variation of urinary iodine concentration The main distribution is around 30％,12％,and 8％.The coefficients of variation for random urine iodine creatinine concentration ratio within one day were 11.6％-36.1％,while most of the coefficients of variation were around 23％.In contrast,the coefficients of variation of morning urine and 24 hour urine within 5 days were 3.9％-16.8％ and 4.3％-12.7％ and most of them were at about 10％ and 7％.The difference of urinary iodine/creatinine concentration ratio between random urine,morning urine and 24 h urine sample was statistically significant (F =4.002,P ＜ 0.05).And the urine iodine creatinine concentration ratio of random urine were significantly different compared with that of 24 hour urine (P ＜ 0.05).On the other hand,there was also significant difference for the urine iodine creatinine concentration ratio of morning urine compared with that of 24 hour urine (P ＜ 0.05).Conclusions After adjusted with urinary iodine creatinine concentration ratio,the effect of urine concentration and dilution on urinary iodine concentration has reduced.The significance of two kinds of urine retention methods for random urine and morning urine in urine iodine detection is enhanced.But it's still not good enough to replace 24 hour urine.

Objective To explore the effects of electroacupuncture at Baihui (DU20) and Shenting (GV24) on Alzheimer's disease, and possible mechanism for it.Methods A total of 24 eight-month-old APP/PS1 male mice were randomly divided into model group (n = 8), electroacupuncture group (n = 8) and non-acupoint group (n = 8), and other eight wild-type mice were as wild-type group.The electroacupuncture group accepted electroacupuncture at Baihui and Shenting, while the non-acupoint group accepted electroacupuncture at bilateral subcostal non-acupoint area, and the wild-type group and the model group accepted the same grasping and fixing, for 28 days. Then they assessed with Morris water maze test. The levels of β-amyloid protein (Aβ) and β-site amyloid precursor protein cleaving enzyme 1 (BACE1) in cerebral cortex were detected with immunohistochemistry and immunofluorescence respectively, and the level of BACE1 m RNA with RT-PCR.Results Compared with the model group, the escape latency decreased in the electroacupuncture group (P ＜ 0.001), and the times crossing platforms increased (P ＜ 0.001), while the expression of BACE1 and Aβ decreased (P ＜ 0.001).Conclusion Electroacupuncture may improve the learning-memory ability by inhibiting the expression of BACE1 in the cerebral cortex of APP/PS1 mice to decreasing the level of Aβ.

Objective To identify the risk factors of ventilator-associated pneumonia (VAP) in infants after surgical correction for tetralogy of Fallot (TOF).Methods This study performed at Guangdong general hospital in China,130 infants (less than 12 months,mechanical ventilation time≥48 h) undergoing surgical correction for TOF were included between January 2013 and December 2017.Ventilator-associated pneumonia was defined according to the CDC/NHSN definitions guidelines issued in 2008.T test or Wilcoxon rank sum test was used in univariate analysis,and the variables with P ＜ 0.05 in the univariate analysis were added to a multiple logistic regression to identify the risk factors of VAP in infants after surgical correction for Tetralogy of Fallot.The area under the receiver operating characteristic (ROC) curve was calculated as a measure of accuracy.Results A total of 130 infants were included,however,VAP was found in 34 (26.2％) infants.The single variables significantly associated with a risk of VAP were:pre-operative hypoxic,pre-operative pneumonia,pre-operative mechanical ventilation support,prolonged cardiopulmonary bypass time,reintubation,pulmonary atelectasis,pleural effusion hydrothorax,prolonged mechanical ventilation support time,low cardiac output and transfusion of erythrocyte concentrate or fresh frozen plasma.Multiple logistic regression analysis showed prolonged cardiopulmonary bypass time (OR =1.02),reintubation (OR =16.111),pulmonary atelectasis (OR =8.133),low cardiac output (OR =7.649) and prolonged mechanical ventilation support time (OR =1.014) were independent risk factors for VAP in infants after TOF surgical correction.The area under the curve demonstrates the accuracy of the model.Conclusion The occurrence rate of VAP was high and risk factors for VAP after TOF surgical correction were complex.These results can be used to prevent and reduce the occurrence of VAP.

T cells play an important role in atherosclerosis (AS) besides monocytes and macrophages .The T helper cell type 1 (Th1) affect AS via strong apoptotic effect ,other T cell subgroups are also involved in occurrence and development of AS ,such as Th2 and Th17. The interaction between regulatory T cells (Tregs) and Th2 related cy—tokines can inhibit AS development .However ,mechanism of T cells in AS is still not clear .The present article made a review on role of T cells in AS and their possible guidance for research and treatment of AS .