Objective:To explore potential predictors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in early stage. Methods:The prospective multicenter study was conducted in Zhejiang, China from May 1 st, 2019 to January 31 st, 2020. A total of 1 428 patients with fever >48 hours to <120 hours were studied. Their clinical data and oral pharyngeal swab samples were collected; Mycoplasma pneumoniae DNA in pharyngeal swab specimens was detected. Patients with positive Mycoplasma pneumoniae DNA results underwent a series of tests, including chest X-ray, complete blood count, C-reactive protein, lactate dehydrogenase (LDH), and procalcitonin. According to the occurrence of RMPP, the patients were divided into two groups, RMPP group and general Mycoplasma pneumoniae pneumonia (GMPP) group. Measurement data between the 2 groups were compared using Mann-Whitney U test. Logistic regression analyses were used to examine the associations between clinical data and RMPP. Receiver operating characteristic (ROC) curves were used to analyse the power of the markers for predicting RMPP. Results:A total of 1 428 patients finished the study, with 801 boys and 627 girls, aged 4.3 (2.7, 6.3) years. Mycoplasma pneumoniae DNA was positive in 534 cases (37.4%), of whom 446 cases (83.5%) were diagnosed with Mycoplasma pneumoniae pneumonia, including 251 boys and 195 girls, aged 5.2 (3.3, 6.9) years. Macrolides-resistant variation was positive in 410 cases (91.9%). Fifty-five cases were with RMPP, 391 cases with GMPP. The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients (39.6 (39.1, 40.0) vs. 39.2 (38.9, 39.7) ℃, 333 (279, 392) vs. 311 (259, 359) U/L, both P<0.05). Logistic regression showed the prediction probability π=exp (-29.7+0.667×Peak body temperature (℃)+0.004×LDH (U/L))/(1+exp (-29.7+0.667×Peak body temperature (℃)+0.004 × LDH (U/L))), the cut-off value to predict RMPP was 0.12, with a consensus of probability forecast of 0.89, sensitivity of 0.89, and specificity of 0.67; and the area under ROC curve was 0.682 (95% CI 0.593-0.771, P<0.01). Conclusion:In MPP patients with fever over 48 to <120 hours, a prediction probability π of RMPP can be calculated based on the peak body temperature and LDH level before the first visit, which can facilitate early identification of RMPP.

Hepatocellular carcinoma (HCC) is the most common liver malignancy, where HCC segmentation and prediction of the degree of pathological differentiation are two important tasks in surgical treatment and prognosis evaluation. Existing methods usually solve these two problems independently without considering the correlation of the two tasks. In this paper, we propose a multi-task learning model that aims to accomplish the segmentation task and classification task simultaneously. The model consists of a segmentation subnet and a classification subnet. A multi-scale feature fusion method is proposed in the classification subnet to improve the classification accuracy, and a boundary-aware attention is designed in the segmentation subnet to solve the problem of tumor over-segmentation. A dynamic weighted average multi-task loss is used to make the model achieve optimal performance in both tasks simultaneously. The experimental results of this method on 295 HCC patients are superior to other multi-task learning methods, with a Dice similarity coefficient (Dice) of (83.9 ± 0.88)% on the segmentation task, while the average recall is (86.08 ± 0.83)% and an F1 score is (80.05 ± 1.7)% on the classification task. The results show that the multi-task learning method proposed in this paper can perform the classification task and segmentation task well at the same time, which can provide theoretical reference for clinical diagnosis and treatment of HCC patients.
Humans ; Carcinoma, Hepatocellular ; Liver Neoplasms ; Learning

Objective:To explore the effect of Tai chi ball combined with Baduanjin in patients with acute myocardial infarction after PCI.Methods:From October 2018 to October 2019, a total of 118 patients with acute myocardial infarction after PCI in Department of Cardiology of Shangqiu First People's Hospital were selected as the research objects using the convenient sampling method, and divided into the observation group (57 cases) and the control group (61 cases) by the random number table method. The control group adopted conventional treatment and nursing, and the observation group conducted Tai Chi ball combined with Baduanjin exercise program on the basis of conventional treatment and nursing. One month after discharge, the ability of activity of daily living and quality of life were compared between the two groups.Results:One month after discharge, the total score of the ability of activity of daily living and the score of each dimension of the observation group were lower than those of the control group, and the differences were statistiocally significant ( P<0.05) ; the total score of the quality of life and the score of each dimension of the observation group were higher than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Tai Chi ball combined with Baduanjin can effectively improve the ability of activity of daily living and quality of life of patients with acute myocardial infarction after PCI.

Objective:To investigate the role of CD155 in hepatocyte apoptosis and liver fibrosis in mice infected with Echinococcus multilocularis. Methods:Thirty-six female C57BL/6 mice were randomly divided into a sham surgery group and a model group, with 18 mice in each group. Mice in the model group were injected with protoscolex via the portal vein to create an animal model of E. multilocularis infection. Mice in the sham surgery group were injected with the same amount of saline. The mice were sacrificed at 1 month, 3 months, and 6 months after modeling, and liver samples were collected. Hepatic pathological changes were observed by hematoxylin-eosin staining. Liver fibrosis was detected by Sirius red staining, and expression of Caspase-3 and CD155 in hepatocytes was detected by immunohistochemical staining. The correlation between CD155 expression in hepatocytes and Caspase-3 and liver fibrosis levels were analyzed by Person. Results:There were obvious lesions in the liver of the model group accompanied by severe liver fibrosis. Compared with the sham surgery group, the expression of CD155 and Caspase-3 in mouse hepatocytes at different stages in the model group was significantly increased, and the differences were statistically significant ( P<0.05). The model group's liver fibrosis level was significantly higher at different stages than the sham surgery group, with statistical significance ( P<0.05). In addition, correlation analysis showed that expression of CD155 in hepatocytes was positively correlated with the expression of Caspase-3 ( r=0.956 8; P<0.001; 95% CI: 0.885 5-0.984 1) and that expression of CD155 in hepatocytes was positively correlated with the degree of liver fibrosis( r=0.853 9; P<0.001; 95% CI: 0.643 7-0.944 3). Conclusions:CD155 expression was significantly up-regulated in mouse hepatocytes infected with E. multilocularis at different stages, which was positively correlated with the degree of hepatocyte apoptosis and liver fibrosis, suggesting that CD155 may be involved in the process of hepatocyte apoptosis and liver fibrosis caused by E. multilocularis infection.

Objective:To explore the immunomodulatory activity of ethanol extract of cultivated Cistanche deserticola (EECCD) in Xinjiang. Methods:Ovalbumin (OVA) was used antigen, ICR mice were divided into 9 g/L NaCl group (blank control group), EECCD group (1 200 μg EECCD), OVA group (10 μg OVA), low-dose EECCD/OVA group (400 μg EECCD+10 μg OVA), medium-dose EECCD/OVA group (800 μg EECCD+10 μg OVA), high-dose EECCD/OVA group (1 200 μg EECCD+10 μg OVA) and aluminum adjuvant (Alum)/OVA group (200 μg Alum+10 μg OVA). Mice were immunized subcutaneously, and the immunization was strengthened once 14 days after the initial immunization. The level of splenocyte proliferation was determined by thiazolyl blue tetrazolium bromide (MTT) method, and interferon γ (IFN-γ) and interleukin-4 (IL-4) in CD4 + T cell, dendritic cells (DCs) surface markers and CD4 +CD25 +Foxp3 + Treg were evaluated by fluorescence-activated cell sorting (FACS). Results:Three dose of EECCD can enhance OVA-specific IgG titers in serum. The antibody titer in medium-dose EECCD/OVA group was 250 000, which was the same as that in the Alum/OVA group. The medium-dose EECCD/OVA significantly improve IgG1 and IgG2a (both P<0.01). Therefore, the medium dose EECCD was selected as the best dose. MTT results displayed that splenocyte proliferation were significantly stimulated by medium-dose EECCD/OVA ( P<0.05), and the levels of IL-4 and IFN-γ in CD4 + T cells were promoted in groups administered with medium-dose EECCD/OVA (both P<0.01). Furthermore, medium-dose EECCD/OVA significantly up-regulated the levels of CD40, CD80, CD86 and major histocompatibility complex class Ⅱ (MHCⅡ) on DCs and down-regulated the frequency of CD4 +CD25 +Foxp3 + Treg (all P<0.05). Conclusions:EECCD has good immunomodulatory activity, can promote Th1-biased response, and has the therapeutic potential for the prevention of diseases.

Objective:To assess the value of amide proton transfer weighted (APTw) imaging in the evaluation of pH changes in infarct core (IC) and ischemic penumbra (IP) in subacute cerebral infarction.Methods:The data of twenty-three subacute cerebral infarction patients with unilateral steno-occlusive disease of the middle cerebral artery (subacute infarction group) from April to November 2019 in the First Affiliated Hospital of Dalian Medical University were prospectively analyzed. Fifteen healthy volunteers were enrolled in this study as the control group. All subjects underwent conventional MRI, DWI, 3D-pseudo continuous arterial spin labeling (3D-pCASL) and APTw sequences. Based on DWI images, relative cerebral blood flow (rCBF) and APTw images to determine the region of IC, blood flow penumbra [cerebral blood flow(CBF)-DWI mismatch area, IP CBF] and metabolic penumbra (APTw-DWI mismatched area, IP APT). 3D ROIs were used to semi-automatically measure the APTw signals and the volume of IC and IP CBF of the patients in subacute infarction group. The comparison of APTw signals between the infarct side and the contralateral side in the subacute infarction group, the comparison of bilateral APTw signals in the control group, and the comparison of APTw signals in the IC and IP CBF regions were performed by paired-sample t test or Wilcoxon signed-rank test. The paired-sample t test or Mann-Whitney U test was used to compare the APTw signals between the two groups. The Friedman test was applied to compare the difference of volumes among IP CBF1.5, IP CBF2.5 and IP APT . Results:There was no significant difference of the APTw signals among the IC, the contralateral side in the subacute infarction group and the control group ( P>0.05). The APTw signals of IP CBF and IC of the infarction group were statistically different ( P<0.05). Compared with the contralateral side of IP CBF1.5 (3.7±1.7, -1.84±1.48, 5.57±2.75), the APTwmax (3.07±1.41, t=-3.012, P=0.006), APTw min [-1.30 (-1.74, -0.57), Z=-2.099, P=0.036], and APTwmax-min(4.51±2.58, t=-3.273, P=0.003) signals in the IP CBF1.5 were decreased ( P<0.05). Compared with the contralateral side of IP CBF2.5 [-1.53 (-2.80, -0.91), 5.31±2.61], the APTw min [-1.08 (-1.60, -0.49), Z=-2.616, P=0.009] and APTwmax-min (4.41±2.72, t=-3.228, P=0.004) signals in the IP CBF2.5 were decreased. The volumes of IP CBF1.5 [107.51(50.08, 138.61)mm 3], IP APT [99.00 (53.27, 121.335) mm 3] and IP CBF2.5 [89.91 (51.53, 139.87) mm 3] were successively reduced (χ2=7.913, P=0.019), and the volume of IP CBF2.5 was significantly smaller than that of IP CBF1.5 ( P=0.037). Conclusion:The acid-base metabolism in the IC of subacute cerebral infarction is not obvious, but the blood flow penumbra has local acid-base metabolism imbalance, and the range of metabolic penumbra coincides with the blood flow penumbra.

Objective:To evaluate the in vitro and in vivo immunostimulatory activity and the safety of ethanol extract of wild Artemisia rupestris L. (EEWAR). Methods:Bone marrow dendritic cells (BMDCs) from C57BL/6 mice were treated with different concentrations of EEWAR in vitro and the expression of CD40 and CD80 on BMDCs was detected by flow cytometry. ICR mice were subcutaneously immunized with different concentrations of EEWAR in combination with ovalbumin (OVA) or OVA alone. Aluminum adjuvant was used as the positive control. OVA-specific IgG antibodies in mouse serum samples were measured by ELISA following immunization. T cell proliferation in spleen tissues was detected by MTT method. Acute toxicity test was conducted in ICR mice to analyze the safety of EEWAR. Results:In vitro experiment showed that EEWAR at the concentrations of 10-20 μg/ml increased the expression of CD40 and CD80 on BMDCs ( P<0.05), and had no significant effect on the morphology of BMDCs; EEWAR at the concentrations of 100-200 μg/ml significantly promoted the expression of CD40 and CD80 on BMDCs ( P<0.01), but had a certain influence on the morphology of BMDCs. In vivo experiment showed that EEWAR enhanced the production of IgG, IgG 1 and IgG 2a antibodies against OVA and the proliferation of splenocytes ( P<0.05). In the acute toxicity test, EEWAR at the concentrations of 50-5 000 μg/ml had no side effects on mouse body weight and was relatively safe. Conclusions:EEWAR could promote the maturation of DCs and enhance the humoral and cellular immune responses when used as an adjuvant to OVA. It was safe in a certain dose range. This study provided reference for further research on EEWAR as a new-generation adjuvant.

Background: New-generation adjuvants for foot-and-mouth disease virus (FMDV) vaccines can improve the efficacy of existing vaccines. Chinese medicinal herb polysaccharide possesses better promoting effects. Objectives: In this study, the aqueous extract from Artemisia rupestris L. (AEAR), an immunoregulatory crude polysaccharide, was utilized as the adjuvant of inactivated FMDV vaccine to explore their immune regulation roles. Methods: The mice in each group were subcutaneously injected with different vaccine formulations containing inactivated FMDV antigen adjuvanted with three doses (low, medium, and high) of AEAR or AEAR with ISA-206 adjuvant for 2 times respectively in 1 and 14 days. The variations of antibody level, lymphocyte count, and cytokine secretion in 14 to 42 days after first vaccination were monitored. Then cytotoxic T lymphocyte (CTL) response and antibody duration were measured after the second vaccination. Results: AEAR significantly induced FMDV-specific antibody titers and lymphocyte activation. AEAR at a medium dose stimulated Th1/Th2-type response through interleukin-4 and interferon-γ secreted by CD4+ T cells. Effective T lymphocyte counts were significantly elevated by AEAR. Importantly, the efficient CTL response was remarkably provoked by AEAR. Furthermore, AEAR at a low dose and ISA-206 adjuvant also synergistically promoted immune responses more significantly in immunized mice than those injected with only ISA-206 adjuvant and the stable antibody duration without body weight loss was 6 months. Conclusions These findings suggested that AEAR had potential utility as a polysaccharide adjuvant for FMDV vaccines.

Background: New-generation adjuvants for foot-and-mouth disease virus (FMDV) vaccines can improve the efficacy of existing vaccines. Chinese medicinal herb polysaccharide possesses better promoting effects. Objectives: In this study, the aqueous extract from Artemisia rupestris L. (AEAR), an immunoregulatory crude polysaccharide, was utilized as the adjuvant of inactivated FMDV vaccine to explore their immune regulation roles. Methods: The mice in each group were subcutaneously injected with different vaccine formulations containing inactivated FMDV antigen adjuvanted with three doses (low, medium, and high) of AEAR or AEAR with ISA-206 adjuvant for 2 times respectively in 1 and 14 days. The variations of antibody level, lymphocyte count, and cytokine secretion in 14 to 42 days after first vaccination were monitored. Then cytotoxic T lymphocyte (CTL) response and antibody duration were measured after the second vaccination. Results: AEAR significantly induced FMDV-specific antibody titers and lymphocyte activation. AEAR at a medium dose stimulated Th1/Th2-type response through interleukin-4 and interferon-γ secreted by CD4+ T cells. Effective T lymphocyte counts were significantly elevated by AEAR. Importantly, the efficient CTL response was remarkably provoked by AEAR. Furthermore, AEAR at a low dose and ISA-206 adjuvant also synergistically promoted immune responses more significantly in immunized mice than those injected with only ISA-206 adjuvant and the stable antibody duration without body weight loss was 6 months. Conclusions These findings suggested that AEAR had potential utility as a polysaccharide adjuvant for FMDV vaccines.

Objective ToinvestigatethefeasibilityofassessingliverfunctiongradingbyIDEAL-IQsequenceon1.5T MR.Methods The patientswhowereclinicallydiagnosedaslivecirrhosisandunderwent1.5T MRIDEAL-IQsequenceinourhospitalfrom February 2016toDecember2017wereanalyzedretrospectively.TheyweredividedintoA,BandCgradesaccordingtotheChild-Pughgrading standardofliverfunction.Finally,therewere30patientsinChild-PughA,25patientsinChild-PughBand16patientsinChild-Pugh C.ThefatratiomapsandR2?relaxationratemapswereusedtomeasuretheliverfatcontentandironcontentbythetwoobservers onAW4.6workstation,respectively.ThemeanvaluesofthefatfractionsandtheR2?valuesweremeasuredandcomparedbyusing K ruskal-W allis H testamongthethreegroups.Then,thegroupAandBwerecombinedtoestablishthepredictivemodelindiagnosingthegroup Cbyusingthe L o g istic regressionanalysis,whichcombinedthefatfractionandR2?value.TheROCcurvewasdrawntoobtainedtheAUC,and calculatedthesensitivityandthespecificitywiththeoptimalthreshold.Results Thereweregoodconsistencyofmeasurementdata betweenthetwoobserves(ICC>0.8).ThefatfractionandR2?valueincreasedwiththedecreaseoftheliverfunction.Thefatfractionsofthe Child-PughA,BandCgroupwere(3.58±0.91)%,(3.64±1.20)%,(6.87±3.91)%,respectively.TheR2?valuesoftheChild-Pugh A,BandCgroupswere(33.31±11.80)Hz,(38.00±13.31)Hz,(58.98±44.54)Hz,respectively.TheAUCofwhichcombinedfat fractionandR2?valuediagnosingChild-PughCwas0.843.Thesensitivityandthespecificitywere81.8% and81.3%,respectively. Conclusion The1.5T MRIDEAL-IQsequencecanbeusedtoevaluatetheliverreserveunctionoflivercirrhosispatientsaccording ffatfractionandR2?value,especiallyfortheChild-PughCcirrhosis patientswithhighsensitivityandspecificity.