OBJECTIVE: To study the level and clinical value of Th17 cell subset in the peripheral blood of the patients with aplastic anemia (AA). METHODS: Eighty-five patients with aplastic anemia in our hospital from May 2017 to February 2018 were selected. Among them, 51 patients with poor curative effect were enrolled in group A. and the 34 patients with good curative effect were enrolled in group B, the 35 healthy persons were selected as controls. The levels of serum IL-17, IL-6, IL-4 and IFN-β were analyzed by ELISA; the levels of peripheral blood Th17 cell subset were analyzed by flow cytometry; the expression levels of RORγt and STAT3 mRNA in lymphocytes were analyzed by RT-PCR; the expression levels of RORγt and STAT3 protein in lymphocytes were analyzed by Western blot. RESULTS: There was no significant difference in sex, age, WBC count and complications between group A and group B (P＞0.05). Non-severe aplastic anemia (NSAA) in group B accounted for 23 cases, and the NSAA ratio (23/34) was significantly higher than that in group A (20/51) (P＜0.05). The Hb level (86.25±7.9 g/L) and Plt count (54.7 ± 6.3×10/L) in group B were significantly higher than those in group A (P＜0.05). ELISA showed that the levels of IL-17 and IL-6 in group A were significantly higher than those in control group (P＜0.05); the levels of IL-17 and IL-6 in group B were significantly lower than those in group A (P＜0.05); the levels of IL-4 and IFN-β in group A were significantly lower than those in control group (P＜0.05); the levels of IL-4 and IFN-βin group B were significantly higher than those in group A (P＜0.05). Flow cytometry showed that the proportion of Th17 cells in peripheral blood of group A was higher than that of group B (P＜0.05). RT-PCR showed that the levels of RORγt and STAT3 mRNA in group A were significantly higher than those in control group (P＜0.05), and the mRNA levels of RORγt and STAT3 in group B were significantly lower than those in group A (P＜0.05). Western blot showed that the protein levels of RORγt and STAT3 in group A were significantly higher than those in control group (P＜0.05), and the protein levels of RORγt and STAT3 in group B were significantly lower than those in group A (P＜0.05). CONCLUSION The Th17 cells in peripheral blood of AA patients increase, and the inflammatory reaction in the patients are enhanced. It may be related with the rise of RORγt and STAT3 gene expression, which provides a research direction for clinical treatment of AA.

OBJECTIVE: To investigate the risk factors for cow's milk protein allergy (CMPA) among infants through a multicenter clinical study. METHODS: A total of 1 829 infants, aged 1-12 months, who attended the outpatient service of the pediatric department in six hospitals in Shenzhen, China from June 2016 to May 2017 were enrolled as subjects. A questionnaire survey was performed to screen out suspected cases of CMPA. Food avoidance and oral food challenge tests were used to make a confirmed diagnosis of CMPA CMPA. A multivariate logistic regression analysis was used to investigate the risk factors for CMPA. RESULTS: Among the 1 829 infants, 82 (4.48%) were diagnosed with CMPA. The multivariate logistic regression analysis showed that maternal food allergy (OR=4.91, 95%CI: 2.24-10.76, P<0.05), antibiotic exposure during pregnancy (OR=3.18, 95%CI: 1.32-7.65, P<0.05), and the introduction of complementary food at an age of <4 months (OR=3.55, 95%CI: 1.52-8.27, P<0.05) were risk factors for CMPA, while exclusive breastfeeding (OR=0.21, 95%CI: 0.08-0.58, P<0.05) and the introduction of complementary food at an age of >6 months (OR=0.38, 95%CI: 0.17-0.86, P<0.05) were protective factors. CONCLUSIONS The introduction of complementary food at an age of <4 months, maternal food allergy, and antibiotic exposure during pregnancy are risk factors for CMPA in infants.
Animals ; Cattle ; China ; Female ; Humans ; Infant ; Milk Hypersensitivity ; Milk Proteins ; Pregnancy ; Risk Factors ; Surveys and Questionnaires

OBJECTIVE: To investigate the guiding significance of lumbar quantitative computed tomography (QCT) in percutaneous vertebroplasty (PKP) for osteoporotic vertebral compression fractures (OVCF). METHODS: The clinical data of 90 patients with OVCF underwent PKP from December 2017 to December 2018 were retrospectively analyzed. There were 24 femalesand66males, withanaverage agedof (74.47±6.60) yearsold. Allpatientswere received QCT examination before surgery, andaccording to the QCT value oflumbarspine, the patientswere dividedinto osteopenia decrease group (80 to 120 g/L, 17 cases, 30 vertebrae), osteoporosis group (40 to 80 g/L, 44 cases, 66 vertebrae) and severe osteoporosis group (<40 g/L, 29 cases, 39 vertebrae). Bone cement was injected into vertebral body, AP and lateral X-rays were done during operation. The diffusion and leakage of bone cement in injured vertebrae of patients with different QCT values were observed. Unilateral approach was used for patients whose bone cement diffused beyond the midline of the vertebral body, otherwise, and bilateral approach was adopted, and guiding significance of QCT in PKP for OVCF was analyzed. RESULTS: In 90 cases of 135 vertebrae, 72 cases of 98 vertebral bone cement diffused beyond the midline, accounting for 72.59%. Unilateral approach was used for the 72 patients whose bone cement diffused beyond the midline of the vertebral body, among them, there were 5 cases with 8 vertebrae in osteopenia group, 40 cases with 55 vertebrae in osteoporosis group and 27 cases with 35 vertebrae in severe osteoporosis group. There was significant difference in the bone cement dispersion between three groups (=41.397, =0.000). Moreover, no bone cement leakage occurred in osteopenia group, 3 cases of 4 vertebrae occurred in osteoporosis group and 2 cases of 3 vertebrae in severe osteoporosis group. However, none of the patients with bone cement leakage caused nerve injury and other symptoms, and there was no significant difference in bone cement leakage between the three groups (=2.242, =0.326). CONCLUSION According to the QCT examination of lumbar spine, defining the degree of osteoporosis and guiding the puncture method can shorten the operation time, reduce the number of fluoroscopy, and effectively improve the safety of vertebroplasty.

Objective To investigate the effects of smoking on chronic obstructive pulmonary disease(COPD) and respiratory symptoms. Methods A multi-stage, stratified cluster sampling strategy was used to select participants aged 40 or older in 5 surveillance points of Anhui Province. Questionnaires, body measurements and spirometry were used to collect data. Based on complex sampling design, Logistic regression model was conducted to analyze the effects of smoking on COPD and respiratory symptoms. Results The smokers who had smoked for ≥30 pack-years accounted for 13.9% (95% CI:10.3%-17.5%, P＜0.001) of the total population. And the smokers who had smoked for ≥40 years accounted for 8.5% (95% CI:6.7%-10.3%, P＜0.001) of the total population. On average, one smoker had smoked for 32.4 years (95% CI:31.2-33.5). Average daily cigarette consumption of daily smokers was 21.1 cigarettes (95% CI:19.6-22.7). As shown by multiple-variables Logistic regression analyses, the risk of COPD and respiratory symptoms increased with the increment of smoking pack-years and duration (all Ptrend <0.001). Conclusions Smoking was associated with COPD and respiratory symptoms. The risk of developing COPD and respiratory symptoms was greater with the increment of smoking pack-years and duration.

Objective: To evaluate the new compensation mechanism for primary healthcare institutions in Zhejiang province, in terms of fairness, performance, incentive mechanism and sustainability in pilot areas. Methods: Evaluation indicators were constructed based on stakeholder theory, fairness theory, expectation theory and sustainable development theory.Focus group interviews were conducted with stakeholders and quantitative data were collected through questionnaires. Meanwhile, the financial compensation, income and expenditure and work equivalent data were collected from such institutions of the four pilot areas, with quantitative data subject to descriptive analysis. Results: This study found the reform used reasonable proportion of funds allocated(the proportion of basic salary for employees was lower than 50%)and adjustment factors(1.0-1.8)of different primary healthcare institutions to guarantee the fairness of the reform; the increase of work equivalents(the per capita work equivalents of medical staff in pilot counties had increased from 38.435 million in the previous year to 42.590 million work equivalents)reflected the performance outcomes of the reform. The incentive and sustainability of the reforms were the weak parts. These were mainly due to the fact that the internal distribution system of primary healthcare institutions failed to make corresponding reforms. Conclusions The reform of the compensation mechanism based on the equivalent method has changed medical staff′s perception of the distribution of funds. The principle of" more pay for more work" and the use of information technology to capture work equivalents have improved the enthusiasm of primary medical staff and the operational efficiency of these institutions, thus, making reform generally scientific and reasonable.

Purpose To investigate the expression of CYP4 A11 and CYP4 A22 in triple-negative breast carcinoma (TNBC) and its relationship with clinicopathological features and M2 tumor-associated macrophages (TAMs). Methods 72 cases of TNBC with clinical and pathological data were collected. The expression of CYP4 A11 and CYP4 A22 in the carcinoma cells and the expression of CD68 and CD163 of the TAMs were detected by immunohistochemically and analyzed with image processing software. The relationship between the expressions of CYP4 A11 and CYP4 A22 with clinicopathologic features and its correlation of the M2 state of TAMs was studied. Results Both the immunohistochemically staining scores of CYP4 A11 and CYP4 A22 were higher in cancer tissues than that in breast tissues (P<0.001, P<0.001). The higher expression of CYP4 A11 was associated with tumor diameter increase (P<0.001), lymph node metastasis (P<0.001), higher clinical stage (P<0.001) and higher Ki-67 index (P=0.011). Both the positive rates of CD68 and CD163 in the high expression group of CYP4 A11 were higher than those in the low expression group of CYP4 A11 (P=0.021, P<0.001). The higher expression of CYP4 A22 was associated with lymph node metastasis (P<0.001), higher clinical stage (P=0.006), higher recurrence rate (P<0.001), and higher Ki-67 index (P=0.040).The positive rates of CD163 in the high expression group of CYP4 A22 was higher than that in the low expression group of CYP4 A22 (P<0.001). Conclusion Both the expression of CYP4 A11 and CYP4 A22 may be associated with M2 polarization state of TAMs, high proliferative activity and lymph node metastasis in the TNBC.

Objective: To evaluate the effects on the apical sealing ability of iRoot SP used for straight root canals. Methods: 73 extracted human teeth with straight roots were randomly assigned to 8 groups. The root canals in groups A3 was obturated with single gutta-percha cone. The others were obturated with thermoplasticized gutta-percha cones. The canals were filled with AH Plus (group A1 and B1), iRoot SP (group A2, A3 and B2) and ZOE (group A4) . The post space was prepared either immediately after obturation (A1-A4) or 7 days later group (B1 and B2) . The extent of dye penetration was measured by transparent dental technology. Results:There were no significant differences among A1-A3 groups, between group A1 and B1, A2 and B2, P＞ 0. 05. The dye penetration extent of group A4 and C was greater than that of group A2 (P ＜ 0. 05) . Conclusion: iRoot SP and AH Plus have same performance on root canal seal. There was no significant difference between iRoot SP + thermoplasticized gutta-percha and iRoot SP + single gutta-percha cone for apical sealing.

Objective To investigate and control the outbreak of infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) in a gastroenterology intensive care unit (ICU), so as to provide reference for the prevention and control of clinical multidrug-resistant organisms (MDROs).Methods Epidemiological investigation was conducted on 3 patients with CRKP infection in a gastroenterology ICU on January 21-31, 2018, specimens were collected with environmental biology monitoring method, CRKP in environment was searched, homology between patients and environmental isolates were analyzed by pulsed-field gel electrophoresis (PFGE).Results Three patients were all isolated CRKP from sputum and blood specimens, all were male, with adjacent beds in the same ward, and treated by the same doctor.The number of isolated CRKP and infection rate in January 2018 were higher than those in other months, infection rate was significantly different (χ2=13.67, P＜0.01).A total of 102 environmental specimens were collected, including air and surface of objects, only 1 of which (nurse's uniform) was isolated 1 strain of KP.PFGE typing of KP isolated from patients and environment showed that there were two genotypes A and B, KP isolated from uniform of a nurse, hydrops abdominis and blood specimen of patient at bed 07, blood specimen of patient at bed 08, as well as sputum and blood specimen of patient at bed 09 were all type A, KP isolated from sputum specimen of patient at bed 07 was type B, KP isolated from hydrops abdominis in patient at bed 09 was not be typed.After comprehensive intervention, CRKP was not no longer isolated from 3 patients, and there was no new case in the ward.Conclusion Imperfect implementation of prevention and control measures for MDROs by health care workers may be an important cause for the spread of CRKP.

Objective To investigate the efficacy of Ilizarov technique in treatment of Gustilo type Ⅲ B and C of large tibia bone defect combined with soft tissue defect. Methods Thirty cases with large tibia bone defect combined with soft tissue defect in our hospital from January 2016 to December 2018 were selected including 25 cases with type Ⅲ B and 5 cases with type Ⅲ C,who were all open tibia fractures and treated with Ilizarov technique. Results All patients were followed up for 10 to 18 months with an average of 15 months. The bone defects were reconstructed, the difference between the length of the affected limb and the healthy side was less than 2 cm. The fracture was healed and the wound was closed. One case was with paralysis of common peroneal nerve and recoveried after 3 months. Twenty-two cases recovered without extra surgery, five cases restored with skin graft and three cases covered the wound by rotating skin flap. Conclusion Ilizarov technique is one of effective ways to treat Gustilo Ⅲ type B and type C of large defect combined with soft tissue defect.

Currently, individualized exercise prescription plays a vital role in the cardiac rehabilitation of patients with chronic cardiovascular diseases. Many cardiopulmonary exercise tests proved that individualized exercise prescription can lower blood pressure and glucose of patients with cardiovascular diseases, improve cardiopulmonary function, and improve exercise endurance and quality of life. At the same time, this paper also summarized that the individualized exercise prescription should be formulated in compliance with the principle (individuality, effectiveness, safety, professionalization, comprehensiveness and permanence), exercise intensity evaluation method (from previous heart rate, fatigue grading methods into cardiopulmonary exercise test) and the contents of the individualized exercise prescription (with a focus on the exercise intensity formulation).