CCR9+CD4+ T cells are associated with disease activity in patients with rheumatoid arthritis.

An increase in CD4+ T cells in the synovium is closely linked to the pathogenesis of rheumatoid arthritis (RA). We aimed to identify the possible causes of the elevated CD4+ T cell levels and to explore the factors influencing disease activity in RA. Fifty-five RA patients, including 28 with active RA (ARA), 27 with inactive RA, and 22 healthy controls, were recruited for this study. The proportion of CCR9+CD4+ T cells and the expression of chemokine receptor 9 (CCR9) on CD4+ T cells were analyzed by flow cytometry. Enzyme-linked immunosorbent assay and chemiluminescent immunoassay were used to evaluate interleukin (IL)-17A and IL-6 levels, respectively. The proportion of CCR9+CD4+ T cells and the expression of CCR9 on CD4+ T cells increased significantly in peripheral blood (PB) and synovial fluid (SF) in ARA compared to those in inactive RA. Furthermore, SF contained more CCR9+CD4+ T cells, IL-6, and IL-17A than PB in RA patients. Moreover, CD4+ T cells in the PB of patients with RA, especially ARA, expressed more CCR9 and secreted more IL-6 and IL-17A after activation. Here, we also demonstrated that both the percentage of CCR9+ cells in CD4+ T cells and the expression of CCR9 on circulating CD4+ T cells were positively correlated with erythrocyte sedimentation rate, hypersensitive C-reactive protein, rheumatoid factor, and anti-cyclic citrullinated peptide antibody. CCR9+CD4+ T cells are elevated in PB and SF, and are associated with disease activity in patients with RA.

Application of standardized patient and breast visual palpation simulation system in clinical probation of breast surgery / 中华医学教育探索杂志

Objective:To explore the application effects of standardized patient (SP) and breast visual palpation simulation system on clinical probation of breast surgery for medical students.Methods:A total of 110 students were randomly divided into experimental group and control group, and each group was further divided into 5 subgroups. In the experimental group, SP scripts of five common diseases in breast surgery department were designed according to the syllabus before probation, and the teachers were trained. During the probation, we first talked about the characteristics of disease diagnosis and treatment, and then the five subgroups collected the history of the disease according to the SP of different diseases mentioned above, and checked the corresponding lesions on the breast visual palpation simulation system. In the physical examination, SP responded to the students' questions. The control group also talked about the above-mentioned five diseases during the probation, and then the five subgroups carried out history collection and physical examination for specific patients in the hospital. Finally, the teaching effects were analyzed through medical record writing, theoretical examination, physical examination and student evaluation. SPSS 26.0 was used for chi-square test (or Fisher exact test) and Mann-Whitney U test. Results:There was no significant difference in the theoretical examination between the two groups. It was demonstrated that the correct rate of experimental group was significantly higher than that of the control group in medical history collection, especially in the main symptoms, incentives, aggravation and remission factors, accompanying and differential symptoms and so on. And the positive results of breast, nipple and axillary lymph node palpation in the experimental group were significantly higher than those in the control group through the physical examination operation of breast visual palpation simulation system. The analysis of students' evaluation showed that the teaching efficiency of the experimental group increased, and the students' satisfaction was improved (satisfaction rate: 92.73% vs. 76.36%).Conclusion:The application of SP and breast visual palpation simulation system in breast surgery probation teaching can not only protect the privacy of clinical patients, but also improve the teaching effects, which can be popularized in the clinical teaching of breast surgery.

The dichotomous and incomplete adaptive immunity in COVID-19

The adaptive immunity that protects patients from coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is not well characterized. In particular, the asymptomatic patients have been found to induce weak and transient SARS-CoV-2 antibody responses, but the underlying mechanisms remain unknown; meanwhile, the protective immunity that guide the recovery of these asymptomatic patients is also not well studied. Here, we characterized SARS-CoV-2-specific B-cell and T-cell responses in 10 asymptomatic patients and 49 patients with other disease severity (mild, n = 10, moderate, n = 32, severe, n = 7) and found that asymptomatic or mild symptomatic patients failed to mount virus-specific germinal center (GC) B cell responses that result in robust and long-term humoral immunity, assessed by GC response indicators including follicular helper T (TFH) cell and memory B cell responses as well as serum CXCL13 levels. Alternatively, these patients mounted potent virus-specific TH1 and CD8+ T cell responses. In sharp contrast, patients of moderate or severe disease induced vigorous virus-specific GC B cell responses and associated TFH responses; however, the virus-specific TH1 and CD8+ T cells were minimally induced in these patients. These results therefore uncovered the protective immunity in COVID-19 patients and revealed the strikingly dichotomous and incomplete adaptive immunity in COVID-19 patients with different disease severity, providing important insights into rational design of COVID-19 vaccines.

Disease severity dictates SARS-CoV-2-specific neutralizing antibody responses in COVID-19

COVID-19 patients exhibit differential disease severity after SARS-CoV-2 infection. It is currently unknown as to the correlation between the magnitude of neutralizing antibody (NAb) responses and the disease severity in COVID-19 patients. In a cohort of 59 recovered patients with disease severity including severe, moderate, mild and asymptomatic, we observed the positive correlation between serum neutralizing capacity and disease severity, in particular, the highest NAb capacity in sera from the patients with severe disease, while a lack of ability of asymptomatic patients to mount competent NAbs. Furthermore, the compositions of NAb subtypes were also different between recovered patients with severe symptoms and with mild-to-moderate symptoms. These results reveal the tremendous heterogeneity of SARS-CoV-2-specific NAb responses and their correlations to disease severity, highlighting the needs of future vaccination in COVID-19 patients recovered from asymptomatic or mild illness.

Human monoclonal antibodies block the binding of SARS-CoV-2 spike protein to angiotensin converting enzyme 2 receptor

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic of novel corona virus disease (COVID-19). To date, no prophylactic vaccines or approved therapeutic agents are available for preventing and treating this highly transmittable disease. Here we report two monoclonal antibodies (mAbs) cloned from memory B cells of patients recently recovered from COVID-19, and both mAbs specifically bind to the spike (S) protein of SARS-CoV-2, block the binding of receptor binding domain (RBD) of SARS-CoV-2 to human angiotensin converting enzyme 2 (hACE2), and effectively neutralize S protein-pseudotyped virus infection. These human mAbs hold the promise for the prevention and treatment of the ongoing pandemic of COVID-19.

Microdissection tungsten needle in protecting recurrent laryngeal nerve and parathyroid gland in open thyroid surgery / 中华内分泌外科杂志

Objective:To compare the therapeutic effects of microdissection tungsten needle and high-frequency electrosurgical generator on open thyroid surgery.Methods:95 patients who underwent open thyroid surgery from Jan. 2017 to Dec. 2017 in the Department of Breast and Thyroid Surgery, Daping Hospital of Army Military Medical University were divided into microdissection tungsten needle group ( n=50) and high-frequency electrosurgical generator group ( n=45) according to different methods. The operation time, intraoperative blood loss, postoperative drainage volume, postoperative complication rate and recurrence and metastasis rate of the two groups were compared. Results:There were no significant differences in operation time (79.3±14.7 vs 73.7±13.9, t=1.914, P=0.059) , intraoperative blood loss (31.8±9.7 vs 30.3±10.6, t=0.702, P=0.484) and postoperative drainage volume (67.3±13.0 vs 71.3±10.8, t=-1.650, P=0.102) between the two groups ( P>0.05) . There were significant differences between the two groups in temporary recurrent laryngeal nerve (RLN) injury (2% vs 17.8%,χ 2=5.518, P=0.023) and temporary hypoparathyroidism (18% vs 44%,χ 2=7.810, P=0.005) , and the results of the microdissection tungsten needle group were better than high-frequency electrosurgical generator group ( P<0.05) . There were no permanent RLN and permanent hypoparathyroidism in the two groups. There were no recurrence and metastasis during the follow-up period. Conclusions:The microdissection tungsten needle is superior to the high-frequency electrosurgical generator in the protection of RLN and parathyroid gland in open thyroid surgery, which is worthy of promotion in clinical application.

Investigation and Analysis of 435 Kinds of Chinese Patent Medicine Instructions in Outpatient Department of Our Hospital / 中国药房

OBJECTIVE： To investigate and analyze the current status and existing problems of Chinese patent medicine instructions in outpatient department of our hospital， and to provide suggestions for the improvement of Chinese patent medicine instructions. METHODS： A total of 435 copies of Chinese patent medicines instructions using in the outpatient pharmacy of our hospital were collected in 2018. The labeling of usage and dosage of the instructions and other items were not clear and missing items were analyzed statistically. RESULTS： In 435 copies of drug instructions， unclear usage and dosage included usage and dosage were marked only in grams or milliliters （54 kinds， 12.4％）； daily dosage was not clear （165 kinds， 37.9％）； the words “or follow the doctor’s advice” were involved in drug instructions （86 kinds， 19.8％）； the labeling of usage and dosage for special population were not clear （34 kinds， 7.8％）； medication time was not labeled （365 kinds， 83.9％）. Unclear labeling of other items included unclear drug interaction （121 kinds， 27.8％）， unclear matters needing attention （12 kinds， 2.8％）， unclear ADR （307 kinds， 70.6％）， unclear contraindications （257 kinds， 59.1％） and unclear indications （1 kind， 0.2％）. The missing items included that drug dosage for special population （41 kinds， 94.5％）， pharmacological and toxicological items （305 kinds， 70.1％）， clinical trial data （395 kinds， 90.8％）， storage temperature label （377 kinds， 86.7％）. CONCLUSIONS： Missing items and unclear information on safe medication are common in Chinese patent medicine instructions， which need to be standardized and perfected in order to provide reference for rational drug use and guarantee the safety of drug use in patients.

Impact analysis of medicine markups abolition on revenue structure of 12 public hospitals in Qingdao / 中华医院管理杂志

Objective@#To learn the impact of abolishing medicine markups on the revenue structure of public hospitals in Qingdao city.@*Methods@#The business performance of 12 public hospitals directly under the Qingdao Health and Family Planning Commission was analyzed to compare their revenue structure the year before (July 2015 to June 2016) and the year since the reform (July 2016 to June 2017).@*Results@#The reform has witnessed increased government subsidies, and decreased revenue from drugs and healthcare materials. For example, the proportion of drug expenditure decreased from 44.21% to 32.71%, while the proportion of medical service income and that of examination and laboratory examination increased to some extent.@*Conclusions@#Given the initial success of the reform, challenges remain in further curbing revenues from examinations and checkups, and growing revenue from TCM drugs as well.

Susceptibility of Acinetobacter baumannii isolates to eight antimicrobial agents tested by different methods / 中国感染与化疗杂志

Objective The purpose of this study was to analyze the susceptibility profile of Acinetobacter baumannii to antimicrobial agents,and validate the results of different antimicrobial susceptibility testing methods,for improving the quality of antibiotic resistance monitoring data.Methods The susceptibility data of Hebei Provincial Antimicrobial Resistant Investigation Net were analyzed retrospectively and 126 strains ofA.baumannii were collected.The susceptibility ofA.baumannii to piperacillintazobactam,amikacin,gentamicin,ciprofloxacin,levofloxacin,ceftazidime,imipenem,and meropenem was tested by E-test,KirbyBauer method and VITEK system.Results The susceptibility results of the 126 A.baumannii strains showed that the susceptibility to piperacillin-tazobactam,amikacin,gentamicin,levofloxacin and ceftazidime was significantly different between the three methods (P＜0.05).The categorical agreement,major error,minor error,and very major error of Kirby-Bauer method were within acceptable range.There were evident difference in classification consistency for piperacillin-tazobactam,amikacin,levofloxacin between Kirby-Bauer method and VITEK (P＜0.05).Conclusions Different antimicrobial susceptibility testing methods may lead to different results of resistance monitoring data.Bias may be generated in antibiotic resistance surveillance if different methods are used.The susceptibility results of piperacillin-tazobactam,amikacin,levofloxacin derived from VITEK system should be validated by Kirby-Bauer or E-test method.

Antimicrobial resistance of Streptococcus pneumoniae strains isolated from 53 hospitals across Hebei in 2015 / 中国感染与化疗杂志

Objective To investigate the antimicrobial resistance of Streptococcus pneumoniae strains isolated from multiple medical institutions across Hebei Province in 2015.Methods The bacterial data were collected from 53 member hospitals of Hebei Antimicrobial Resistance Investigation Net (HEBARIN) according to the unified surveillance program in Hebei province.WHONET 5.6 was used to review,analyze and summarize the surveillance data.The results were interpreted according to CLSI guideline 2014.Results A total of 2 408 strains of S.pneumoniae were included in this analysis.S.pneumoniae was the third most frequently isolated gram positive bacteria.More than 95％ of these S.pneumoniae strains were susceptible to vancomycin and moxifloxacin.However,96.4％,89.3％ and 67.4％ of these strains were resistant to erythromycin,clindamycin,and trimethoprim-sulfamethoxazole,respectively.The antimicrobial susceptibility profile was similar between the strains isolated from adults and those isolates from children.Conclusions The antimicrobial resistance profile ofS.pneumoniae isolates in Hebei Province is generally consistent with the nation-wide data,except higher resistance level to a few antimicrobial agents.We should be alert to and control the emergence of resistant S.pneumoniae.

Clinical significance of serum level of transforming growth factor-beta 1 in patients with chronic idiopathic thrombocytopenic purpura / 中国综合临床

Objective To investigate clinical significance of transforming growth factor-beta 1 ( TGF-β1 ) in patients with chronic idiopathic thrombocytopenic purpura(CITP). Methods The serum level of TGF-β1 in 38 pa-tients with initial CITP were detected using enzyme-linked immunosorbent assay(ELISA). Results The serum level of TGF-β1 in initial patients with CITP was significantly higher than that of the controls [( 132.57±5.17) μg/L vs ( 76.81±4.42) μ/L] ( P <0.01 ). The serum level of TGF-β1 in those having good response after therapy was sig-nificantly lower than before treatment[(81.26±3.78)μg/L] (P <0.01 ). There was no difference in TGF-β1 be-tween nonremission [(123.49 ± 4.31 ) μg/L] and initial patients (P > 0.05 ). There was negative correlation between TGF-β1 and platelet count(r = -0. 342 ,P < 0.05 ) ,there was positive correlation between TGF-β1 and megakaryo-cyte count (r = 0.409, P < 0.01 ). Conclusions TGF-β1 partakes in the pathogenesis of CITP, the determination of which in patients with CITP is useful to judge the state of illness, which can be regarded as an assistant index of cur-ative effect.

PREVENTION AND TREATMENT OF HAIZHENYUYE ON DAMAGE OF HEMATOPOIESICAL FUNCTION IN RATS / 中国海洋药物

Haizhenyuye(HY) is a nourishment made from fresh Stichopus japonicus Se-lecka and traditional Chinese medicine herbs. It can enhance hematopoiesical and immuologi-cal function, prevent and treat a decrease in the WBC Count caused by cyclophosphamide (CTX). Through prevention effect on rats by HY, we can prove that HY can increase the levels of WBC,Hb,PC,reticulocytes and improve hematopiesis. HY is a marine nourishment with great values.