ObjectiveTo investigate the predictive indicators of early efficacy of Bushen Shengxue prescription combined with western medicine in the treatment of aplastic anemia， and provide prognosis indicators for the treatment of aplastic anemia （AA） with kidney-tonifying therapy in traditional Chinese medicine （TCM） combined with western medicine. MethodA total of 126 patients treated by Bushen Shengxue prescription combined with western medicine in 19 hospitals including Xiyuan Hospital of the China Academy of Chinese Medical Sciences from September 2018 to March 2021 were selected for a retrospective study. The therapy was proven to be effective after six months of treatment. According to the efficacy after 4 months of treatment， the patients were assigned into a 4-month effective group and a 4-month ineffective group. The age， sex， disease severity （including severe aplastic anemia and non-severe aplastic anemia）， course of disease， degree of bone marrow nucleated cell proliferation， baseline hemogram levels ［including white blood cell count （WBC）， absolute neutrophil count （ANC）， hemoglobin （HGB）， platelets （PLT）， and reticulocytes （RET）］， T lymphocytes subsets， and the expression levels of T-box transcription factor （T-bet） and GATA-binding protein-3 （GATA-3） were compared between the two groups before treatment. ResultThe proportions of patients within the age ranges of ［20， 40） and ［60， 80） were higher in the 4-month effective group （P<0.05）. The sex， disease severity， course of disease， and comorbidities had no significant differences between the two groups. The 4-month effective group had higher baseline levels of HGB， WBC， ANC， and PLT than the 4-month ineffective group （P<0.05）， and there was no significant difference in the RET level between the two groups before treatment. Binary Logistic regression analysis showed that the PLT level before treatment was an independent factor affecting the onset time， while other indicators did not affect the onset time. The receiver operating characteristic （ROC） curve was established to analyze the value of PLT level before treatment for predicting the onset time， and the area under the curve was 0.691. With the critical value of 40.5×10⁹/L， the sensitivity and specificity of the prediction that the therapy will take effect within 4 months were 0.569 and 0.893， respectively. The two groups of patients were graded according to age ｛（14， 20）， ［20， 40）， ［40， 60）， and ［60， 80）｝ and PLT level before treatment （PLT<40×10⁹/L， PLT≥40×10⁹/L）. The proportion of the patients with PLT≥40×10⁹/L before treatment in the 4-month effective group was significantly higher than that in the 4-month ineffective group （P<0.05）. The degree of bone marrow nucleated cell proliferation before treatment had no significant difference between the two groups. The level of total T lymphocytes in the 4-month effective patients was lower than that in the 4-month ineffective patients before treatment （P<0.05）. The levels of Th1 cells， Th2 cells， CD4⁺ T cells， and CD8⁺ T cells showed no significant differences between the two groups before treatment. The T-bet expression level in the 4-month effective group was higher than that in the 4-month ineffective group before treatment （P<0.05）， while the expression level of GATA-3 showed no significant difference between the two groups before treatment. ConclusionBushen Shengxue prescription combined with western medicine will achieve faster effect for the patients within the age ranges of ［20， 40） or ［40， 60）， with higher levels of HGB， WBC， ANC， and PLT （especially those with PLT≥40×10⁹/L）， lower level of total T lymphocytes， or higher T-bet expression level before treatment.

Objective:To establish the biology reference interval (RI) of peripheral blood procalcitonin (PCT) for children between 3 days and 6 years old in China.Methods:Totally 3 353 reference individuals with apparent health or no specific diseases were recruited in 18 hospitals throughout the country during October 2020 to May 2021. Reference individuals were divided into four groups: 3-28 days, 29 days - 1 year, 1-3 years and 4-6 years. Vein blood or capillary blood were collected by percutaneous puncture from every reference individual. The PCT level in serum and the capillary whole blood were assayed by Roche Cobas e601 and Norman NRM411-S7 immunoanalyzer. Outliers were deleted and 95th percentiles of every group were provided as RIs. Man-Whitney U test or Kruskal-Wallis test were used performed to assess the difference among different gender, age or method groups. Results:The difference of PCT distribution between male and female is not statistically significant, but the difference between serum and capillary whole blood is statistically significant. The differences between age groups are significant too. For Roche e601, serum PCT RI of 3-28 days group is <0.23 μg/L, 29 days - 6 years are <0.11 μg/L. For NRM411, Serum PCT RI of 3-28 days group is <0.21 μg/L, 29 days - 1 year: <0.09 μg/L, 1 - 6 years: <0.10 μg/L. For whole blood PCT, RI of 3-28 days group is <0.26 μg/L, 29 days - 6 years is <0.15 μg/L.Conclusions:Serum and capillary whole blood PCT have different RIs, however, capillary whole blood PCT testing is valuable in pediatric application. Children in 3-28 days show higher PCT levels than other age group. To establish the RIs and understand the differences among different groups are essential for the interpretation and clinical application of peripheral blood PCT testing results.

Objective:To explore the performance of the commonly used whole blood C-reactive protein (CRP) detection systems and give related recommendation on the performance requirements of detection systems.Methods:A total of 7 540 venous blood samples from 26 maternal, child and children′s hospitals were collected to conduct this multi-center study on the analytical performance of 5 commonly used whole blood CRP detection systems from March to April in 2019. The blank check, carryover, repeatability, intermediate precision, linearity, sample stability, influence of hematocrit/triglyceride/bilirubin, comparison with SIEMENS specific protein analyzer and trueness were evaluated. The 5 systems included BC-5390CRP autohematology analyzer, AstepPLUS specific protein analyzer, Ottoman-1000 Automated Specific Protein POCT Workstation, i-CHROMA Immunofluorometer equipment Reader and Orion QuikRead go detecting instrument. The 5 systems were labeled as a, b, c, d and e randomly.Results:Within the 5 systems, all values of blank check were less than 1.00 mg/L, the carryovers were lower than 1.00%. The repeatability of different ranges of CRP concentrations including 3.00-10.00, 10.00-30.00 and>30.00 mg/L were less than 10.00%, 6.00% and 5.00%, respectively, and the intermediate precision was less than 10.00%. The linearity correlation coefficients of the 5 systems were all above 0.975, while the slope was within 0.950-1.050. Whole blood samples were stable within 72 hours both at room temperature (18-25 ℃) and refrigerated temperature (2-8 ℃). The CRP results were rarely influenced by high triglyceride or bilirubin, except for the immmunoturbidimetric test based on microparticles coated with anti-human CRP F(ab) 2 fragments. When triglyceride was less than 15.46 mmol/L, the deviation of CRP was less than 10.00%. When bilirubin was less than 345.47 μmol/L, the deviation of CRP was less than 10.00%. CRP was more susceptible to Hct on the systems without Hct correction. The deviation of CRP between different Hct dilution concentration and 40% dilution concentration can reach as high as 67.48%. The correlation coefficients ( r) of 5 systems were all more than 0.975 in the range of 0-300.00 mg/L compared with Siemens specific protein analyzer. All systems passed the trueness verification using the samples with specified values of 12.89 and 30.60 mg/L. Conclusion:The performance of 5 systems can basically meet the clinical needs, but it is suggested that the whole blood CRP detection system without automatic Hct correction should be modified manually.

Objective:To study the protective effects of different concentrations of curcumin on lung injury of rats in dry heat environment.Methods:Fifty Sprague-Dawley rats were randomly (random number) divided into five groups ( n = 10 each group): normal control group (NC), dry heat control group (DHC), and three different concentrations of curcumin pretreated dry-heat groups (50 mg/kg, 100 mg/kg, and 200 mg/kg). Rats in the NC and DHC groups were given a gavage of normal saline, and rats in the curcumin pretreatment groups were given a gavage of curcumin with different concentrations, once a day for 7 consecutive days. At 8th day, all groups except for the NC group were transferred to the climate cabin (The Simulated Climate Cabin for Special Environment of Northwest of China), with a temperature of (41 ± 0.5) and relative humidity of (10 ± 1)%. Rats in each group were anesthetized and sampled after reaching the state of heat stroke at 150 min, and same done to the NC group. Lung tissues were harvested and pathological changes were observed by HE staining. Lung wet/dry (W/D) weight ratio was detected and lung injury indicators such as total protein, white blood cell count and neutrophil count in bronchoalveolar lavage fluid (BALF) were also determined. Results:The lung injury pathology score, W/D weight ratio, total protein, white blood cell count and neutrophil count in BALF were the lowest in the NC group, and the highest in the DHC group, with significant difference ( P <0.01). With the increase of the concentration in the curcumin pretreatment groups, lung injury pathology score, W/D weight ratio, total protein, white blood cell count and neutrophil count in BALF were all declined. There were significant differences among the different concentration groups of curcumin and the NC and DHC groups ( P <0.01). Correlation analysis indicated that lung injury scores were correlated with W/D weight ratio of lung tissue, alveolar total protein content in BALF, white blood cell count, and neutrophil count (correlation coefficient r = 0.879, r = 0.935, r = 0.916, and r = 0.880, respectively, P <0.01). Conclusions:Pretreatment with different concentrations of curcumin can exert protective effects on lung injury of heat stroke rats in dry heat environment. Curcumin may have important clinical value in prevention and treatment of lung injury caused by heat stroke in dry heat environment.

TORCH, which is considered as a series of pathogens, including the Toxoplasma gondii, Rubella virus, Cytomegalovirus or Herpes simplex virus, often infects the pregnant women to induce the the fetus or newborn infection by transplacental infection or exposure to contaminated genital tract secretions at delivery. Increasing evidence have been confirmed that the infection of TORCH may cause the miscarriage, premature birth, malformed fetus, stillbirth, intrauterine growth retardation, neonatal multiple organ dysfunction and other adverse pregnancy outcomes. For most TORCH-infections cases may lacking the effective treatments during pregnancy, and it is important to achieve the effacing monitoring of TORCH infections before and during pregnancy. The laboratory testing of TORCH has the great significance. However, the consensus opinions still need to improve the the standardization of TORCH testing process and the correct interpretation. Based on the characteristics of the TORCH detection method, this article gives a consensus opinion on the standardized detection and clinical application of TORCH from the laboratory perspective according to the characteristics and types of infection of different pathogens.

Objective To construct phage display antibody library of artificial mutation to compare with the sequence of the natural phage display antibody library. To scientifically evaluate the quality of the artificial mutation of phage display library, and provide some references for the further transformation of the nanobody. Methods Using random mutation method, NNY fixed-point santuration mutation was performed on combine the follicle-stimulating hormone receptor (FSHR) of human nanobody. The mutant DNA sequence was connected to the vector pMECS to construct the phage display library of VHH06-CDR3 random mutation. By sequencing and analysis of DNA sequences, the diversity of the library and the amino acid distribution of CDR3 were compared between mutation library and the immune library of FSHR. The degree of enrichment of cloning was determined by six rounds of affinity screening. Results According to the NNY mutation rule ,the CDR3 regions with 16 amino acids by random mutations was synthesized and the VHH-CDR3 random mutant phage display library was constructed . The phage display library of VHH06-CDR3 random mutant size was 7.36×108 cfu/ml. Polyclonal and monoclonal phage ELISA showed that after six rounds of screening, the output phage and the combination of FSHR showed obvious enrichment, but there was no clone combined with FSHR. Conclusions Although the VHH06-CDR3 mutant phage display library has sequence diversity, it is not conducive to obtaining target antibodies in affinity screening due to the lack of functional diversity of CDR3.

Objective To modify CD47 nanobody with the self-folding peptide human cartilage oligomeric matrix protein (COMP48) so as to enhance its affinity to CD47 antigen. Methods The fusion sequences of COMP48 and CD47 nanobody (VHHB1) were designed and synthesized, and the recombinant plasmid pET22b-VHHB1-COMP48 was constructed and transformed into E. coli BL21 (DE3) to induce expression of the fusion protein. The binding specificity and affinity of the fusion protein and the antigen CD47 were detected by Western Blot, indirect enzyme-linked immunosorbent assay (ELISA) and non-competitive ELISA. Results The recombinant VHHB1-COMP48 was expressed in BL21(DE3) by inducing with 1 mmol/L IPTG and purified at 90％homogenous in IMAC. Western Blot results showed that the recombinant protein VHHB1-COMP48 specifically binds to antigen CD47 but not to unrelated protein. The indirect ELISA and non-competitive ELISA results showed that the affinity of the conjugated recombinant protein VHHB1-COMP48 was enhanced compared to that of the non-conjugated nanobody, and the difference was statistically significant ( P<0 . 01 ) . Through non-competitive ELISA , the constants of affinity and dissociation constants were 6.97 ×107 L/mol and 1.434 ×10-8 mol/L, respectively. Conclusions The affinity of the nanobody for the antigen can be improved by conjugating a human cartilage matrix protein (COMP48) after the nanobody.

Objective? To?investigate?the?effects?of?different?doses?of?curcumin?on?the?levels?of?immune?factors?CD11b?and?CD19?in?peripheral?blood?of?heat?stroke?rats?in?a?simulation?dry-heat?environment.? Methods? 160?SPF??healthy?male?Sprague-Dawley?(SD)?rats?were?selected?and?divided?into?different?groups?according?to?random?number?table?method:?normal?saline?(NS)?control?group?(given?NS),?solvent?control?group?[given?sodium?carboxymethylcellulose?(CMCNa)],?and?curcumin?low,?medium?and?high?dose?pretreatment?group?(given?0.05,?0.10,?0.20?mg/g?of?curcumin+0.5%?CMCNa?solution).?There?were?32?rats?in?each?group,?and?were?challenged?only?by?10?mL·kg-1·d-1?lavage,?and?continuous?dosing?for?7?days.?On?the?8th?day,?rats?were?challenged?at?ambient?temperature?(41.0±0.5)?℃,?relative?humidity?(10±1)%?of?the?northwest?in?the?special?environment?of?artificial?lab,?placed?in?0?(normal?temperature),?50,?100?and??150?minutes?respectively.?The?levels?of?CD19?and?CD11b?in?peripheral?blood?of?each?rat?were?detected?by?flow?cytometry?instrument.? Results? With?the?extension?of?time?in?the?simulated?dry?and?heat?environment,?the?level?of?CD11b?in?peripheral?blood?was?gradually?increased?in?each?group,?and?the?peak?value?was?reached?at?150?minutes,?the?NS?control?group,?solvent?control?group?and?curcumin?low,?medium?and?high?dose?pretreatment?groups?were?0.346±0.013,?0.342±0.013,?0.342±0.012,?0.325±0.012,?and?0.281±0.012,?respectively.?In?each?group,?the?level?of?CD19?was? first?increased?and?then?decreased,?reaching?its?peak?value?at?100?minutes,?and?the?level?of?the?NS?control?group,?solvent?control?group?and?curcumin?low,?medium?and?high?dose?pretreatment?groups?were?0.586±0.010,?0.601±0.014,?0.684±0.009,?0.613±0.012?and?0.604±0.006,?respectively.?The?level?of?CD11b?in?the?curcumin?medium?and?high?dose?pretreatment?groups?were?significantly?lower?than?those?in?the?NS?control?group?and?solvent?control?group??(50?minutes:?0.237±0.011,?0.188±0.006?vs.?0.283±0.009,?0.289±0.012;?100?minutes:?0.260±0.010,?0.248±0.008?vs.?0.293±0.008,?0.290±0.007,?all?P?

Objective To prepare camelid-derived nano antibodies with high affinity binding to programmed death receptor-1 (PD-1) antigen,and to provide experimental basis for subsequent functional studies.Methods The PD-1-Fc recombinant protein expressed in eukaryotic expression was used to immunize Xinjiang Bactrian camel 6 times.The peripheral blood was collected and the lymphocytes were isolated.Nested PCR amplification was performed to obtain the genes in variable region of camelid heavy chain antibody (VHH),and to construct a phage display library.The phage display library was screened by solid phase enzyme-linked immunosorbent assay (ELISA).The PD-1 antigen,which was sequentially reduced in mass concentration (5.00、2.50、1.00 μg/ml),was coated in an ELISA plate,and the phage display library was subjected to 3 rounds of affinity selection.Individual clones that bind to PD-1 were further screened by soluble monoclonal ELISA.According to the results of DNA sequencing,three VHH monoclonals with multiple repeats were selected and ligated into pET22b vector,and transformed into E.coli BL21 (DE3) competent cells,and then induced by isopropyl-β3-D-thiogalactoside.The recombinant VHH antibody protein was purified by nickel column affinity chromatography,and its binding activity and affinity to PD-1 antigen were detected by Western Blot and ELISA.Results After immunization of Bactrian camel 6 times with recombinant protein PD-1-Fc,high titer specific antibody was stimulated,and the immune serum titer reached 1∶32 000.A VHH phage display library with a reservoir size of 2.6×108 cfu/ml was constructed from the immunized camel lymphocytes.After 3 rounds of affinity selection,46 VHH monoclonals with absorbance (A600) values above 0.6 were obtained by soluble monoclonal ELISA.Among them,three clones of VHH-B7,VHH-H5 and VHH-H12 had higher repeats,indicating that significant enrichment was obtained.The results of Western Blot and ELISA showed that the purified B7,H5 and H12 nanobodies had good binding activity to PD-1 antigen and had high affinity.Their affinity constants were 1.19×1011 and 1.63×1011,1.59×1011 L/mol,respectively.Conclusion The anti-PD-1 camelid-derived nanobodies were obtained by affinity selection of VHH phage display library,which can bind to the PD-1 antigen with high affinity.This study can provide an experimental basis for subsequent functional studies.

BACKGROUND: Magnetic navigation META nailing for tibial fractures via the supra-patellar approach is a novel surgical method, exhibiting overt advantages.OBJECTIVE: To retrospectively analyze the clinical characters of magnetic navigation META nailing via the supra-patellar approach for tibial fractures.METHODS: Clinical data of 58 cases of tibial shaft fracture were collected and analyzed retrospectively, and all patients were treated with navigation META-NAIL via the supra-patellar approach. The patients received the postoperative prophylactic antibacterial therapy; non-weight bearing functional training was performed at 3 days postoperatively, and full weight-bearing functional exercise was conducted at an average of 12 weeks postoperatively.RESULTS AND CONCLUSION: (1) The Lysholm scores ranged from 83 to 95 (average, 90) at 24 weeks postoperatively. (2) The excellent and good rate evaluated by Johner-Wruh scoring reached up to 95％. (3) The average operation time was 65 minutes, and the blood loss was 30 mL. (4) There was no complaint of knee pain during the follow-up. (5) No postoperative complications, such as non-healing wounds, infection, bone nonunion, osteomyelitis or deformity recovery, occurred.(6) These results manifest that the magnetic navigation META-NAIL for tibial shaft fractures via the supra-patellar approach exerts a lot of advantages, including short operation time, accurate reduction and stable fixation. Most importantly, it can avoid cut patellar tendon tissue, and reduce the rate of knee pain, further promoting early functional exercise, which obtains satisfactory treatment outcomes.