ObjectiveTo investigate the prevalence and characteristics of depressive symptoms among urban elderly six years after Lushan earthquake in Ya'an， so as to provide references for the mental health interventions for elderly following catastrophic stressful life events. MethodsFrom March to April 2019， a multi-stage stratified cluster random sampling method was adopted to enroll 885 urban elderly people aged 60 and above in Ya'an. A self-compiled questionnaire was used to collect the general demographic information， health-related and disaster-related information， meantime， the elderly was assessed using Geriatric Depression Scale （GDS-30）. Thereafter， univariate and multivariate Logistic regression were applied to explore the influencing factors of depressive symptoms in urban elderly. ResultsA total of 783 valid questionnaires were collected， with a questionnaires response rate of 88.47%. Depressive symptoms were detected in 161 cases （20.56%）. The prevalence of depression showed statistical differences among the elderly of different gender， age， marital status， family relationship， monthly per capita household income， physical exercise status， health status， self-care ability， sleep status and disaster-affected degree （P<0.05 or 0.01）. Logistic regression analysis showed that the urban elderly of the female gender （OR=1.552， P=0.040）， monthly per capita household income of 2000~3000 yuan （OR=6.982， P<0.01）， monthly per capita household income≤2000 yuan （OR=6.857， P<0.01）， lack of physical exercise （OR=1.693， P<0.01）， being less capable of self-care （OR=3.838， P<0.01）， being incapable of self-care （OR=8.547， P<0.01）， complicating multiple curable diseases （OR=4.892， P<0.01） and complicating refractory chronic diseases （OR=5.657， P=0.031） were at high risk of depressive symptoms. The risk of depressive symptoms among the divorced or widowed elderly was greater than that among married elderly （OR=0.063， P<0.01）. ConclusionThe prevalence of depressive symptoms is relatively high among the urban elderly six years after Lushan earthquake in Ya'an， moreover， female gender， low monthly per capita household income， lack of physical exercise， being incapable of self-care and poor health status are risk factors affecting the depressive symptom， while being married is a protective factor.

Objective To investigate the changes of T lymphocyte immune balance in the patients with COPD.Methods Forty-eightpatients with AECOPD from January 2015 to December 2016 in this hospital were selected as study group and 30 healthy subjects as control.T cells and cytokines in peripheral blood were detected by flow cytometry and ELISA,respectively.The levels of them were compared between the two groups.The correlations of them and principal components were analyzed among the two groups.Results (1) CD8+T cells in the study group decreased [23.8％(17.5％,30.1％) vs.28.2％(23.8％,31.5％),P＜0.05],TregandTh17increased[8.5％(8.3％,9.0％) vs.5.6％(4.9％,6.1％),P＜0.01;2.9％(2.8％,3.0％) vs.1.2％(1.2％,1.4％),P＜0.01],respectively.(2)In the study group,IL-12 [54.97 pg/mL(31.20,161.59) pg/mL],IL-22 [17.70 pg/mL(15.60,35.99) pg/mL],IL-23[120.28 pg/mL(82.97,169.27) pg/mL],IL-23R [0.15 pg/mL(0.15,0.71)pg/mL]and TNF-α[1 000 pg/mL(1 000,1 000)pg/mL] were higher than that of the control group[31.20 pg/mL(31.20,56.23)pg/mL,15.60 pg/mL(15.60,15.60)pg/mL,78.10 pg/mL(78.10,99.08)pg/mL,0.15 pg/mL(0.15,0.15)pg/mL,722.16 pg/mL(494.25,941.44)pg/mL,P＜0.05].(3)Correlation analysis showed that there was a negative correlation between Th17 and Treg (r=-0.883,P＜0.01) in the study group (r=-0.883,P＜0.01),and IL-22 was positively correlated with IL-23 (r=0.340,P＜0.05).In the control group,there was a negative correlation between CD4+T cells and CD8+ T cells,Th17 and CD3+ T cells,Th17 and CD8+T cells (r was-0.578,-0.393 and-0.569,respectively,P＜0.05),and a positive correlation between Th17 and Treg,IL-23 and CD4+T cells,TNF-α and DNT(r=0.403,0.440 and 0.392,respectively.(4) There were 5 main components among each group,but the variable factors differed in the study group from the controls,as that:Th17/Treg,Th17,Treg vs.CD4+ T/CD8+ T cells,CD4+ T cells,CD8+ T cells and CD4+T/CD8+T cells,CD8+ T cells vs.Th17/Treg,Treg and CD4+ T cells,CD3+ T cells vs.IL-12,IL-23R andIL-12,IL-23R vs.CD3+ T cells and IL-23,IL-22 vs.TNF-α,DNT.Conclusion The increasing immune function of Th17 cells with IL-22 and IL-23 may be involved in the pathological mechanism of COPD,which accompanied with the weakened toxicity of CD8+T cells and regulation of DNT.

Objective To analyze the distribution and antimicrobial resistance of bloodstream pathogens in surgical intensive care unit (SICU) and medical intensive care unit (MICU) of Fujian Provincial Hospital in the past four and half years for better use of antimicrobial drugs.Methods A retrospective analysis was carried out for the bloodstream pathogens isolated from SICU and MICU patients from January 2012 to June 2016.The clinical data and outcomes of patients were also reviewed.Results A total of 329 strains of isolates were recovered from blood samples in SICU,including gram-negative bacteria (53.5％),gram-positive bacteria (39.2％),and fungi (7.3％);258 strains were collected from MICU,including gram-negative bacteria (57.8％),gram-positive bacteria (36.0％),and fungi (6.2％).A.baumannii,K.pneumonia and E.coli were the top three gram-negative species in both SICU and MICU.The main gram-positive species were coagulase-negative Staphylococcus and Enterococcusfaecium.Overall,386 cases of bloodstream infections were diagnosed,including 226 cases in SICU (202 cases of single bacterial infection and 24 cases of multiple bacterial infection),and 160 cases in MICU (138 cases of single bacterial infection and 22 cases of multiple bacterial infection).A.baumannii isolates showed significantly higher rate of resistance to antibiotics in SICU than in MICU,while the K.pneumoniae and E.coli isolates in MICU showed higher resistance rates to cephalosporins,quinolones,penicillins and carbapenems than the corresponding isolates in SICU.The coagulase negative Staphylococcus and E.faecium isolates in MICU were associated with significantly higher resistance rates to quinolones and tigecycline than those strain in SICU.The bloodstream infections due to K.pneumoniae,E.coli and E.faecium were associated with higher mortality in MICU than in SICU,while the bloodstream infections due to A.baumannii were associated with higher mortality in SICU than in MICU.The total mortality rate of bloodstream infections was higher in MICU than in SICU.Conclusions SICU and MICU share similar profile of main bloodstream pathogens even though the disease spectrum was different between SICU and MICU.All the bloodstream pathogens isolated from MICU patients except A.baumannii showed significantly higher antimicrobial resistance rates than the isolates from SICU.The mortality rate associated with bloodstream infection was also higher in MICU patients than in SICU.

Objective: To study the cytomorphologic features and determine whether pancreatic neuroendocrine tumors (PanNET) sampled by fine-needle aspiration (FNA) can be accurately graded based on the Ki-67 index when compared to surgical samples. Methods: Corresponding intraoperative (19 cases) or endoscopic ultrasound-guided (3 cases) FNA cytology and surgical tissue specimens were obtained from 22 tumors, which were reviewed and stained for Ki-67 proliferation marker. The cytological samples included more than 200 tumor cells. Samples were graded by scoring the Ki-67 positive index in accordance with the 2010 WHO criteria. The grading scores assigned to the FNA cytology samples were compared with the scores assigned to the corresponding histological samples. Concordance was achieved by using 5% (instead of 2%) as a cut-off value for defining G2 tumors. One cytological sample included less than 500 tumor cells was excluded in the concordance calculation. Results: The cytological smears consisted of uniform, monotonous and isolated cells, loose cellular aggregates and rosette-like formations. Some tumor cells clustered around segments of capillaries. The cells demonstrated distinct cytoplasmic and nuclear features. Mitoses and necrosis were rarely seen. When traditional 2% Ki-67 index cut-off value were used to classify G2 tumors, the majority (86.4%, κ=0.812, P<0.01) of FNA cytology samples and corresponding surgical tissue specimens demonstrated concordance. When a 5% cut-off value was adopted, the concordance rate was 95.5% (21/22, κ=1.000, P<0.01). Similar concordance rates between the cytological and histological grades were achieved with threshold value of cytological assessment material set at more than 500 or 200 cells. Conclusions The cytological Ki-67 index in adequate material (>200 tumor cells) is useful in grading pancreatic neuroendocrine tumors, and a cut-off value of 5% showed better predictive value compared with that of 2%. Accurate grading of PanNET is critical for predicting tumor biology, patient prognosis, and making informed decisions regarding patient management and treatment.

Objective:To investigate the effect of compound 48/80(C48/80) activated mast cell on dendritic cell homing to draining lymph nodes(DLN) in order to explore the potential mechanism of C48/80 promoting adaptive immune response.Methods: C57BL/6 mice bone marrow derived dendritic cells(BM-DC) and MC/9 mast cell line were propagated in vitro.Chemotaxis of BM-DC supplemented with supernatant of C48/80 treated MC/9 to CCL21 was measured by transwell chemotaxis assay.C48/80 was injected into murine scapular site,local skin mast cell degranulation was detected by toluidine blue staining method.The number of CD11c+ DC in draining lymph nodes(DLN) was detected by Flow cytometry.Exogenous green microbeads labeled BM-DC homing to DLN was detected by fluromicroscope.The mice pretreated with or without C48/80 were vaccinated by ovalbumin pulsed DC(OVA-DC),DLN lymphocyte proliferation was detected by WST-8 reagent.Results: A large amount of typical BM-DC were harvested from media supplemented with murine recombinant IL-4 and GM-CSF.Product of activated MC/9 enhanced chemotaxis of BM-DC to CCL21(P<0.01).Intradermal injection of C48/80 induced local mast cell obvious degranulation and local inflammation.Mice pretreated with C48/80 demonstrated high number of total cells and DC cells in DLN.The number of fluorescent positive BM-DC in DLN also increased in C48/80 pretreated mice.Antigen specific lymphocyte proliferation enhanced in OVA-DC inoculated C48/80 pretreated mice.Conclusion: Mast cell activation induced by C48/80 can enhance DC homing to DLN and increase specific lymphocyte proliferation,which may be one of a mechanism of C48/80 in promoting adaptive immune response.

Objective To study the genetic polymorphism of 20 autosomal short tandem repeats(STR)loci in Yunnan Han population. Methods The 20 STR loci(D3S1358,D1S1656,D6S1043,D13S317,Penta E,D16S539,D18S51,D2S1338,CSF1PO,Penta D,TH01,vWA,D21S11,D7S820,D5S818,TPOX, D8S1179,D12S391,D19S433 and FGA)which were included in the PowerPlexR21 System kit were genotyped in 1085 unrelated Han individuals living in Yunnan province using multiplex amplication. PCR products were separated and analyzed by the AB 3130 automatic genetic analyzer and GeneMapper ID v3.2 software. Forensic parameters of each locus were calculated by Modified-Powerstates software. Results All the studied loci except for TH01 and TPOX were highly polymorphic. The observed heterozygosity(Ho)ranged from 0.6130 to 0.8743. Match probability(PM)ranged from 0.0179 to 0.2030. Power of discrimination(DP)ranged from 0.7970 to 0.9821. Probability of exclusion(PE)ranged from 0.3067 to 0.7432. Paternity index(PI)ranged from 1.2919 to 3.9766. Polymorphism information content(PIC)ranged from 0.5598 to 0.8958. No deviation of the Hardy-Weinberg equilibrium was observed. Conclusion The studied 20 STR loci were highly polymorphic in Yunnan Han population and could be used in forensic individual identification and paternity testing practice.

Objective To analyze the efficacy and tolerance of methotrexate(MTX)in remission maintenance of Crohn′s disease (CD).Methods From June 2012 to August 2015 ,49 CD patients who received MTX as mainly treatment medication to maintain remission were enrolled.The pre-medication history,efficacy,dosage and side effects of MTX were analyzed.The effects of inducing strategy on disease recurrence were analyzed.Chi-square test and t test were used for statistical analysis.Results Among the 49 patients,34 (69.4%)received steroids for remission inducing,nine (18.4%)received infliximab for remission inducing and six (12.2%)achieved remission after operation.In the 44 patients treated with azathioprine (AZA)before,the median treatment time was one month and the dosage for withdrawal of AZA was (42.0 ± 14.8)mg/d.The most common reason was leucopenia (81 .8%, 36/44).Till the time point of follow-up,46 of the 49 CD patients still took MTX orally with a median treatment time of 16 months,and the weekly dosage was (12.7 ±2.0)mg.Thirty-one cases (67.4%) achieved clinical stability,while 15 cases (32.6%)underwent clinical recurrence.The median Crohn′s disease activity index (CDAI)was 123.5 ± 66.6.The weekly dosage of clinical stability group was (12.5 ±2.1)mg,and that of clinical recurrence group was (13.0 ±1 .7 )mg,there was no statistically significant difference between the two groups (t =0.802,P =0.426 ).The recurrence rate of steroids-induced remission group was 41 .2% (14/34 ),which was higher than that of infliximab and surgery-induced remission group (1/15),and the differnce was statistically significant (χ2 =5 .177,P =0.023 ). The common side effects were gastrointestinal reaction (26.5 %, 13/49 ), impaired liver function (20.4%,10/49)and leukopenia (12.2%,6/49).Only three cases could not tolerate the side effects and underwent medication withdrawal.Conclusions As a second-line immunosuppressant for maintanence remission in CD,MTX is effective and well-tolerated in patients.So it can be an important option during the long course of CD.

Objective To evaluate the roles of cytomorphology and immunohistochemistry in distinguishing between basaloid squamous cell carcinoma ( BSC) and small cell carcinoma ( SCC) of lung. Methods The direct smears and/or liquid-based cytology preparation ( ThinPrep) of bronchial brushing/washing and fine-needle aspiration ( FNA ) specimens from 17 cases of biopsy-proven BSC of lung were retrospectively reviewed and compared with those from 17 cases of SCC.The cytomorphologic parameters analyzed included proportion of cohesive cell clusters, cell palisades/rosettes, adenoid cystic features, crushing artifact, nuclear maximum diameter, nuclear molding, scantiness of cytoplasm,“salt-and-pepper”nuclei, distinct nucleoli, spindly configuration, individual cell keratinization, necrosis, hyaline material, apoptosis and mitotic activity.Immunocytochemical/immunohistochemical study of 25 cases was performed. Ten FNA samples of basaloid squamous cell carcinoma were also analyzed for epidermal growth factor receptor mutations in exons 18, 19, 20 and 21 using amplification refractory mutation system.Results Most of the 17 BSC cases ( 15/17 ) showed a predominance of tightly cohesive tumor cell clusters.The proportion of isolated tumor cells was high in SCC ( more than 60% in 14 cases ) .The nuclear maximum diameter of BSC was slightly larger than that of SCC (9 to 11μm in BSC versus 7 to 9μm in SCC).“Salt-in-pepper” nuclei, nuclear molding and crushing artifact were detected in all SCC cases (15/17, 17/17 and 14/17, respectively).These features were only occasionally found in BSC group.Nucleoli were present in BSC and rarely ( 2/17 ) in SCC. Only 9 of 17 BSC cases showed individual cell keratinization. The differences in the above-mentioned cytomorphologic features were statistically significance (P<0.05).The results of immunohistochemistry performed on the cell block sections and immunocytochemistry performed on the ThinPrep slides were identical to that performed on the corresponding biopsy specimens.The tumor cells in BSC were consistently positive for CK5, p40 and p63.TTF1, chromogranin A, synaptophysin and CD56 were positive in most of SCC.One of SCC cases showed focal PAX5 expression.No EGFR mutations were detected in the 10 BSC cases studied.Conclusions Selected cytomorphologic features, including presence of cohesive cell clusters, larger nuclear size, distinct nucleoli, lack of crushing artifact, absence of nuclear molding and presence of individual cell keratinization, are helpful in diagnosing BSC on cytology specimens. Immunohistochemistry using a panel of TTF1, CK5, p40/p63 and chromogranin A/synaptophysin/CD56 provides further clues in differential diagnosis between BSC and SCC.EGFR mutation study is often negative in lung BSC.

OBJECTIVETo perform a meta-analysis of randomized controlled trials (RCTs) assessing the benefit of providing branched chain amino acid (BCAA)-enriched nutrition to improve hepatic function in patients undergoing hepatic operation.

METHODSThe electronic databases of PubMed, Springerlink, the Chinese Biomedical Database (CBM), the Cochrane Library, and the China National Knowledge Infrastructure (CNKI) were searched for relevant RCTs using the following search terms: nutritional support, enteral nutrition, parenteral nutrition, hepatic/liver surgery, liver cirrhosis, cancer, hepatectomy, and liver transplantation. The quality of the retrieved RCTs was assessed according to the scale developed by the Cochrane Collaboration. The meta-analysis was conducted using RevMan software, version 5.2.

RESULTSA total of 11 relevant RCTs, representing 510 patients, were included in the meta-analysis. Compared to patients in the control (normal nutrition) group, the patients in the BCAA group experienced an effective improvement in hepatic function, as evidenced by significant decreases in total bilirubin (by 0.07 mumol/L; 95% confidence interval (CI): -0.18 to 0.05, P more than 0.05]. In addition, the BCAA group showed improvements in plasma levels of albumin (weighted mean difference (WMD) = 0.07; 95% CI: 0.06, 0.24, P less than 0.05) and alanine aminotransferase (WMD = +5.61; 95% CI: -8.63 to 19.86, P more than 0.05] but neither of the changes reached the threshold of a statistically significant improvement. The BCAA group did however show significantly lower complication rate after operation (65%, 95% CI: 0.48, 0.87, P less than 0.01] and mean duration of hospital stay (4.61 days; 95% CI: -6.61, -2.61, P less than 0.01].

CONCLUSIONBCAA-enriched nutrition improves hepatic function in patients undergoing hepatic operation, thereby helping to reduce the complication risk, duration of hospital stay, and financial burden. BCAA-enriched nutrition is a safe and effective therapy and further clinical application may be beneficial.

Amino Acids, Branched-Chain ; therapeutic use ; Hepatectomy ; methods ; Humans ; Intraoperative Period ; Liver ; physiology ; surgery ; Liver Transplantation ; methods ; Nutritional Support ; methods ; Randomized Controlled Trials as Topic

Objective:To examine the pathological change and intima thickness of thoracic aorta, detect the serum concentration of hypoxia-inducible factor-1α(HIF-1α), oxidized LDL (ox-LDL), and pentraxin 3 (PTX3) in the rat model of chronic intermittent hypoxia (CIH), and to determine the effect of CIH on endarterium injury and its possible pathway.Methods:Twenty-four male Sprague-Dawley (SD) rats were divided into 4 groups:a CIH+N-acetylcysteine (NAC) group, a CIH+normal saline (NS) group, a CIH control group and a control group. CIH rats were subjected to alternating cycles of hypoxia (6%-8%O2 in N2 for 20-25 s) and normoxia (21%O2 in N2 for 2 min) every 180 s for 7 h/d. Rats in the control group were not treated. Rats in the CIH+NAC group were treated with NAC [800 mL/(kg.d)] intraperitoneal injection, and rats in the CIH+NS group were treated with NS [5 mL/(kg.d)] intraperitoneal injection. Atfer 42 day treatment, the rats were sacriifced, blood taken, and thoracic aorta cut off. hTe serum concentration of HIF-1α, ox-LDL, and PTX3 were detected by ELISA. hTe thickness of intima was taken by computer digital image analysis. Results:Vascular endothelial cell injury and detachment were found in the thoracic aorta in the CIH and the CIH+NS group. The intima in the CIH and the CIH+NS group was thicker than that in the control and the CIH+NAC group (P<0.001). The serum concentration of HIF-1α, ox-LDL, and PTX3 in the CIH and the CIH+NS group was higher than that in the control and the CIH+NAC group (P<0.001). The serum concentration of HIF-1α, ox-LDL, and PTX3 was pairwise positive correlation, and the serum concentration of ox-LDL and PTX3 was positively correlated with the thickness of intina (P<0.001). Conclusion:hTe vascular endothelial cell injury and endarterium thickening can be induced by CIH. It is an important pathway that CIH activates oxidative stress and elevates the levels of HIF-1α, ox-LDL, and PTX3.