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Objective:To explore the differences of gene expression profiles of precursors of exhausted T cells (Tpex) and terminal exhausted T cells (Tex) in the peripheral blood of patients with active pulmonary tuberculosis (ATB).Methods:Twenty-five cases of ATB, 13 cases of latent tuberculosis infection (LTBI) and 10 health controls were enrolled from January 2021 to October 2022 in the Fifth People′s Hospital of Wuxi. The proportions of Tpex and Tex in the peripheral blood mononuclear cells (PBMCs) of the three groups were detected by flowcytometry. PBMCs of ATB were separated into Tpex and Tex by fluorescence-activated cell sorting. RNA-sequencing was performed and up-regulated and down-regulated genes were screended. Differently expressed genes were analyzed by gene set enrichment analysis of gene ontology (GO) to find regulatory pathways affecting cell metabolism and function. Wilcoxon matched-pairs signed rank test, Kruskal-Wallis test and Dunn multiple comparsion test were used for statistical analysis.Results:The proportion of Tpex in ATB group was 2.86%(1.74%), which was lower than 7.93%(6.16%) of Tex, and the difference was statistically significant ( Z=-3.91, P<0.001). The proportions of Tpex and Tex in LTBI group were 9.47%(6.26%) and 7.43%(5.48%), respectively, and the difference was not statistically significant ( Z=-0.93, P=0.345). The proportions of Tpex and Tex in healthy control group were 8.42%(2.69%) and 6.49%(5.14%), respectively, with no statistical significance ( Z=-1.36, P=0.170). There was statistical difference of the proportion of Tpex among the three groups ( H=21.93, P<0.001), and the proportion of Tpex in ATB group was lower than those in LTBI and heathy control groups, and the differences were both statistically significant ( Z=4.16, P<0.001 and Z=3.34, P=0.003, respectively), while the proportions of Tex in these three groups were not statistically different ( H=2.17, P=0.338). Compared with Tex, the gene expressions of memory markers, such as B-cell lymphoma 2 of Tpex were up-regulated, and the gene expressions of exhausted markers, such as lymphocyte activation gene 3 were down-regulated. In terms of cellular metabolism, the gene expressions of mitochondrial protein complex, mitochondrial matrix and oxidative phosphorylation of Tpex were up-regulated, and the gene expressions of glycolysis were down-regulated. The gene expressions of pyruvate metabolism in Tex were up-regulated, and the gene expressions of CD4 + T lymphocyte activation and differentiation and glycolytic process in Tpex were down-regulated. Conclusions:Tpex in ATB express more characteristics of memory cells and less features of exhausted markers compared with Tex, and the function of mitochondria of Tpex preserves well.
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Objective:To explore the evaluation value of serum levels of positive pentameric protein 3 (PTX3) and creatine kinase isoenzyme MB (CK-MB) on volume load in patients with chronic decompensated heart failure (CDHF).Methods:A total of 300 CDHF patients who visited the Xingtai Central Hospital from July 2019 to July 2022 were selected and divided into a capacity overload group ( n=182) and a non capacity overload group ( n=118) based on their capacity balance level. Two clinical data sets were compared and analyzed. The receiver operating characteristic (ROC) curve was used to analyze the evaluation value of serum PTX3 and CK-MB levels on the volume load of CDHF patients. The clinical disease characteristics of the two groups of patients were analyzed using univariate analysis, and the influencing factors of volume load of CDHF patients were analyzed using logistic regression. A column chart model was constructed and validated. Results:The body mass index (BMI), waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose (FBG), glycosylated hemoglobin (HbA 1c), C-reactive protein (CRP), uric acid (UA), homeostasis model assessment of insulin resistance (HOMA-IR) of patients in the capacity overload group were higher than those in the non-capacity overload group, and the differences were statistically significant (all P<0.05). The PTX3, CK-MB, pulmonary capillary wedge pressure (PCWP), and CVP levels of patients in the capacity overload group were higher than those in the non-capacity overload group, while albumin, hemoglobin, and hematocrit were lower than those in the non-capacity overload group, and the differences were statistically significant (all P<0.05). The ROC curve showed that the area under the curve (AUC) of PTX3 and CK-MB for predicting capacity overload in CDHF patients are 0.795 and 0.718, with sensitivity of 86.2% and 83.7%, specificity of 65.4% and 68.6%, respectively, indicating high predictive accuracy; The AUC of the two joint predictions is 0.817, the sensitivity was 92.5%, and the specificity was 70.6%. The prediction accuracy was higher than PTX3 ( Z=3.812, P<0.05) and CK-MB ( Z=3.365, P<0.05). PTX3, CK-MB, albumin, hemoglobin, hematocrit, PCWP, and central venous pressure (CVP) were all influencing factors of volume load status in CDHF patients (all P<0.05). The column chart risk prediction model established based on these factors had high accuracy and strong applicability in clinical treatment. Conclusions:Serum PTX3 and CK-MB levels are influencing factors for volume overload in CDHF patients. A column chart model constructed in combination with indicators such as albumin, hemoglobin, hematocrit, PCWP, and CVP has high predictive value for the volume overload status of CDHF.
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Systemic lupus erythematosus(SLE)is an autoimmune disease with unknown etiology and pathogenesis, and is characterized by multiple organ involvement and the production of autoantibodies.Late-onset SLE means that clinical symptoms first occur after 50 years of age, often without typical skin lesions and implicating fewer target organs.It exhibits low disease activity, a high degree of cumulative damage, high rates of comorbidity and mortality, and abnormal immunological profiles, which make its diagnosis difficult.Due to the physiological state and disease characteristics in the elderly, the treatment is slightly different from that for SLE.This article reviews the clinical features, diagnosis and treatment of late-onset SLE to provide a basis for accurate diagnosis and treatment.
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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.
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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.
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Objective To study the expression difference and the meaning of interleukin (IL)-1β and Claudin-5 in the kidney and kidney's membrane between lupus mice and the control mice. Methods Gene expression difference of IL-1βand claudin-5 between lupus mice and control mice in their kidney and kidney's membrane was detected with quantitative polymerase chain reaction (Q-PCR). The location of the expression was identified by immunohistochemistry. One-way analysis of variance (ANOVA) was used to compare the means of each group, pair-wise comparison was used to compare the difference between multiple sample means. LSD method was used when the variance was equal, and Tamhane's T2 method was used when the variance was different. Results Q-PCR test results showed that IL-1β expression in lupus mice's kidney membrane (0.0095±0.0052) was statistically higher than lupus mice's kidney parenchyma (0.0057±0.0013) (t=2.137, P=0.0458) and control mice's kidney membrane (0.0045±0.0033) (t=2.709, P=0.0131), however, there's no statistical significant difference between control mice's kidney membrane and parenchyma (0.0065± 0.0011) (P>0.05), and there's no statistical difference between control and lupus mice's kidney parenchyma (P>0.05). Claudin-5 expression was statistically higher in control mice kidney membrane (0.0192 ±0.0048) than its kidney parenchyma (0.01156 ±0.002190) (t=4.009, P=0.0015) but statistically lower in lupus mice kidney membrane (0.0069±0.0004) than its kidney parenchyma (0.0098±0.0027) (t=2.727, P=0.0173);there's no statistical significant difference between control mice's kidney parenchyma and lupus mice's kidney parenchyma (P>0.05), and lupus mice's kidney membrane expression was statistically lower than control mice's kidney membrane (t=6.018, P=0.0001). Immun-ohistochemistry showed that IL-1β expression was mainly around glomerulus and membrane, but not renal tu-bule. Claudin-5 expression was mainly around glomerulus and membrane. Conclusion Immune inflammation induced by IL-1β has mainly shown in blood vessels, while claudin-5 has protective effect on lupus immune inflammation.
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In China's new healthcare reform, the pilot local governments explore the practice of establishing a new model of hierarchical diagnosis and treatment system.Zhejiang Province has adopted a special policy of effectively allocating hospital resources and human resources, and efficiently improving primary healthcare institution capability and patient satisfaction(hereinafter referred to as double allocation, double improvement), focusing on the implementation of the 'Healthcare Talents Project', in order to fill a vacancy of human resources in primary healthcare institutions.This paper uses system dynamics modeling and the WISN method of WHO to estimate the gap in physician supply in primary healthcare institutions.After building the system dynamics model of 'Healthcare Talents Project', this paper simulates the influence of the policy on the vacancy of doctors in primary healthcare institutions and analyzes the sensitivity of regulatory factors.The simulation results show that, there are a big gap in physician supply of about 14,000 to build the hierarchical diagnosis and treatment system.The project can gradually increase the number of primary doctors, and the policy may fill the vacancy by 2021.However, if the efficiency of the hospital doctors who give assistance to primary institutions is increased by 10%, the targeted training and recruitment 100% achieve the policy plans and objectives, the project goal may be achieved by 2020.Therefore, this project can effectively adjust the human resources structure quickly and reasonably, and it can be used as reference for the reform of hierarchical diagnosis and treatment system.
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Adrenal medullary hyperplasia (AMH) is a rare cause of secondary hypertension. Herein we analysed clinical manifestation of 4 cases. The clinical and biochemical features of AMH were similar to those of pheochromocytoma. 131 I MIBG scintigram and CT scanning were helpful to make differential diagnosis. Etiology, diagnosis and treatment of AMH were discussed.
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Objective To investigate the mechanism of orotic acid-induced fatty liver in rats. Method Rats were randomly divided into 2 groups,and fed AIN93 diet with or without 1% orotic acid (OA) for 10d. Serum total cholesterol (TC),triglyceride (TG),high density lipoprotein-cholesterol (HDL-C),hepatic lipids concentrations (TG,TC and phospholipids),hepatic enzymes activities and mRNA levels of key enzymes related to lipids metabolism,as well as hepatic genes expression of transcription factors were determined. Results OA administration significantly increased serum and hepatic TG concentration. The activity and mRNA level of fatty acid synthase (FAS) were obviously up-regulated by OA treatment,whereas the activities and mRNA concentrations of carnitin palmitoyl transferase (CPT) and microsomal triglyceride transfer protein (MTP) were depressed significantly. Furthermore,OA also stimulated the mRNA expression of sterol regulatory element binding protein-1c (SREBP-1c),but did not alter the mRNA concentrations of peroxisome proliferator-activated receptor alpha (PPAR?) in liver. Conclusion:The stimulation of TG synthesis caused by enhancement of SREBP-1c and its target genes-FAS,which could be responsible for development of fatty liver. On the other hand,the inhibition of fatty acid beta-oxidation and VLDL secretion were related to the observed lipids accumulation.