Volume 99 ·  Issue 01 ·  2019

This paper describes the importance of immunology in the field of medical research in the past 50 years, and the important position occupied by the application research with disease prevention and treatment in the frontier fields of life sciences and basic medicine. This paper puts forward that China should pay attention to the development of this discipline, and the research trend and development ideas of immunology in China. Immunology and its role in disease prevention and treatment in realizing the strategy of healthy China are expounded.

Dementia and cognitive impairment disease is a syndrome with acquired and persistent cognitive impairment as its core, and leads to the decline of daily life and work ability and behavior change of patients. There are many kinds of dementia and cognitive impairment diseases, including Alzheimer's disease (AD), vascular dementia, Lewy body dementia, frontotemporal dementia, and secondary dementia caused by other diseases. Among them, AD is the most common, accounting for 50% to 70% of all types of dementia^[1]。 Based on the research progress of AD, the occurrence of dementia and cognitive impairment diseases is currently considered as a continuous pathophysiological process. There is also a pre-AD dementia stage before the AD dementia stage, including mild cognitive impairment (MCI) and preclinical stage. Mild cognitive impairment is when a patient has subjective or objective memory or cognitive impairment, but his ability to live daily life has not been significantly affected and has not yet reached the standard of dementia. The preclinical stage of AD is the earliest stage of AD. There are no clinical manifestations of cognitive impairment or only minor complaints of memory loss in this stage, which can be diagnosed by cerebrospinal fluid or imaging tests such as PET amyloid imaging^[2]。 The stage in which the complaint of memory loss occurs is also called subjective cognitive decline.

To investigate the value of morphometric analysis program (MAP) combined with magnetoencephalogram (MEG) in the localization of epileptogenic foci in MRI-negative pharmacoresistant focal epilepsy (MNPFE) patients.

A total of 42 consecutive MNPFE patients from Epilepsy center, Xuanwu Hospital, Capital Medical University from January 2015 to December 2016 were enrolled. The analysis process of MAP and magnetoencephalography (MEG) were performed independently. When the MAP+ region and the MEG+ region was in the same lobe, the MAP+ region was defined as the MAP+MEG+ region. The analysis results of MAP and MEG were used to do correlation analysis with surgical outcomes separately or simultaneously.

The positive rate of MAP was 69% (29/42), and the complete resection of MAP+ region was significantly associated with seizure-free outcome (P=0.027). The positive detection rate of MEG was 100% (42/42), and there was no significant association between the complete resection of MEG+ region and seizure-free outcome (P=0.517). The positive rate of MAP+MEG+ was 43% (18/42), and the complete resection of MAP+MEG+ region was significantly associated with seizure-free outcome (P=0.009).

The combination of MAP which indicates subtle structural abnormalities and MEG which pictures electrophysiological features could probably achieve better epileptogenic foci localization in MNPFE patients.

To investigate the prevalence of latent tuberculosis infection (LTBI) in patients with inflammatory arthritis, and to compare the efficacy of tuberculin skin test (TST) and QuantiFERON-TB Gold (QFT) in screening for LTBI in these patients.

Medical records of 149 patients with inflammatory arthritis admitted to inpatient of Peking University International Hospital from December 2015 to December 2017 (diagnosis with rheumatoid arthritis, ankylosing spondylitis, sero-negative spondyloarthropathy, psoriatic arthritis, or reactive arthritis) who accepted TST or QFT were collected. The information included gender, age, history of tuberculosis infection, calcifications presence in chest X-ray or chest CT, TST result, QFT result, medication history before test, and biological treatment and all the patients were made a follow-up.

The positive rate of TST was 18.2%(14/77) and that of QFT was 27.1%(26/96), and the overall consistency between the two tests was fair. The rate of LTBI diagnosed by QFT was 22.9%(22/96). The positive rate of TST in patients older than 50 years was significantly higher than those younger than 50 years, but there was no significant difference between the two groups screened by QFT. The M-N values in QFT were decreased in both the patients above the age of 50 and in the patients using immunosuppressive agents. A total of 64 patients accepted biological agent therapy, and in those with a positive result of TST or QFT, only 2 cases received anti-LTBI treatment, but the other 14 cases without anti-LTBI treatment. None of them developed active tuberculosis in the following 3-24 months.

The prevalence of LTBI in patients with inflammatory arthritis is consistent with that reported in rheumatoid patients, which is higher than in general people. In patients with inflammatory arthritis older than 50 years, especially those accepted immunosuppressive agents therapy, the immunity may be impaired and QFT is more sensitive than TST for screening LTBI.

To evaluate the efficacy and safety of dexmedetomidine as a basic analgesic sedative for patients with radiofrequency ablation of liver tumors.

A total of 443 liver cancer patients underwent percutaneous radiofrequency ablation in the 302 Hospital of PLA from January 2015 to December 2016 were retrospectively studied. The experimental group was dexmedetomidine group, with a total of 165 cases. The control group was pethidine group with a total of 278 cases. The indexes of systolic blood pressure, diastolic blood pressure, heart rate and respiratory rate of two groups were collected before and after operation, and the VAS score and incidence of nausea and adverse reactions were recorded.

The results of the experimental group added dose of pethidine (64.6 mg) lower than that of the control group pethidine dose (90.8 mg), the difference was statistically significant (Z=-10.205 3, P<0.01). The experimental group and the control group with VAS score average value was not statistically significant(Z=1.801 9, P=0.076), group two with 4 points for the critical point of the stratification, more than 4 points and<4 group comparison, the test group VAS score greater than 4 were significantly lower than the control group (χ²=7.05, P=0.007 9). The systolic blood pressure and diastolic blood pressure in the experimental group were significantly lower than those before operation (P<0.01), while the systolic blood pressure and diastolic blood pressure in the control group significantly increased compared with those before operation. Dexmedetomidine has the effect of stabilizing hemodynamics. The heart rate of the two groups decreased, and the rate of heart rate decreased in the experimental group. In addition, dexmedetomidine did not significantly increase the incidence of nausea and vomiting compared with the control group.

Dexmedetomidine is safe and effective as a basic drug for analgesic and sedative in patients with liver tumor radiofrequency ablation.

To investigate the efficacy of single-portal arthroscopic-assisted reduction technique in the developmental dislocation of the hip in infants.

From January 2014 to December 2016, 12 dislocated hips in 12 children with a median age of 14 months (10 to 20 months) were treated with single-portal arthroscopic-assisted reduction technique. The indication for intervention was failure of closed reduction after bilateral adductor and unilateral iliopsoas release under anesthesia. Adductor and iliopsoas tendon were released routinely through a medial approach. Through the same medial approach a single-portal arthroscopic-assisted reduction technique was selected, with a medial sub-adductor portal for both 4.0 mm cannulated system with a 30° arthroscope and the instruments. After assessing of the intraarticular structures, the hypertrophic ligamentum teres and acetabular pulvinar were resected, and transverse acetabular ligament (TAL) was incised and a limited release of the capsule was performed prior to reduction of the hip. Arthrography was performed after reduction in all children. Safe zone angle and the medialization ratio on the arthrogram were compared pre and post arthroscopic reduction. Acetabular index were compared at two time points: before operation and at the latest follow-up with paired t test.

All hips were reduced with single-portal arthroscopic procedures. The reduction was confirmed on arthrography. With a median follow-up of 26 months (18 to 36 months), all 12 hips remained stable. Safe zone angle increased from 18.5°±3.8° to 61.9°±6.5° immediately after arthroscopic reduction(t=-28.944, P<0.01); and the medialization ratio on the arthrogram increased from 62%±20% to 104%±16% immediately after arthroscopic reduction (t=-3.519, P<0.05). The mean acetabular index decreased from 40.6°±5.0° to 29.4°±5.0° at the latest follow-up (t=5.463, P<0.01). However, Kalamchi-MacEwen type Ⅰ avascular necrosis was developed only in 1 case, and residual dysplasia was observed in 2 hips.

Single-portal arthroscopic-assisted reduction technique is a safe and effective treatment for developmental dislocation of the hip in infants and toddlers.

To explore the efficacy and feasibility of the hemi-semilaminectomy microsurgical operation treatment of spinal dural arteriovenous fistula (SDAVF).

The clinical data of 32 patients with SDAVF were analyzed retrospectively. Before operation all patients were diagnosed by spinal MRI and spinal angiography, 14 patients were treated by hemi-semilaminectomy approach and other 18 patients were by traditional laminectomy approach. All the data were analyzed by T test and P<0.05 was considered to have significant difference.

The nidus of SDAVF located on thoracic segments in 18 cases, lumbar segments in 12 cases, and cervical segment in 2 cases, which was fed by single artery. The hemi-semilaminectomy microsurgical operation showed shorter operation time, less bleeding, less hospitalization time and cost. All the patients followed-up for 6 months-2 years. Symptoms of all the patients were improved compared with those before surgery.

On the premise of spinal angiography accurately positioning the location of fistula, the hemi-semi-laminectomy approach microsurgery clipping operation is safe and feasible, and the operation has fewer traumas, also helps to maintain the stability of spine.

To report a clinical protocol for the application of ventriculovesical shunts (VV shunts) in patient who may be unable to maintain or receive ventriculoperitoneal (VP) shunts.

25 patients underwent placement of VV shunts as an alternative to VP shunt therapy from March 2010 through March 2016. They all have malfunction of the VP shunt for the following reasons: peritoneal fluid inclusion(11 cases), failure of the peritoneum to absorb cerebrospinal fluid(7 cases), intra-abdominal infection(5 cases), peritoneal irritation pain(2 cases). The patients ranged in age from 5 years to 68 years old. All the patients underwent preoperative examine including urine routines, renal function electrolyte examination, imaging of the urinary bladder by ultrasonography.

Two patients died from other diseases, one patient′s shunts were removed due to proximal catheter occlusion 2 years after the operation, the penis pain was occurred in one patient. The rest patients had functional VV shunts.

Ventriculovesical shunts may be considered for the treatment of hydrocephalus when the peritoneal cavity cannot be used as a distal terminus.

To assess the effect of monochromatic images and metal artifact reduction (MAR) on the image quality of spectral CT portal venous angiography in patients with operation of after the performing transjugular intrahepatic portosystemic stent shunt(TIPS) and embolization.

From December 2017 to April 2018, the examination data of 28 patients with portal hypertension due to cirrhosis who underwent portal vein angiography 1 month after TIPS and embolization were prospectively collected. After spectral CT scanning in revolution CT, the monochromatic energy levels(60 keV, 120 keV), 60 keV + 120 keV, 120kV-like + 120 keV fused images combined with MAR algorithm were reconstructed. Quantitative parameters such as image artifact index (AI) and qualitative visual evaluation scores were recorded and compared.

The 120 keV monochromatic images showed the lowest AI value(30.8±8.5, 18.2±4.3) and highest metal artifacts reduction effect. The 60 keV monochromatic images showed the highest AI value (57.3±15.7, 32.1±7.9) and the lowest metal artifacts reduction effect. The AI value of 60 keV + 120 keV fused images was lower than that of 60 keV images(26.2%, 24.7%). The difference of AI value between each group was statistically significant(all P<0.05). The interobserver agreement in the subjective image scores was moderate with kappa value of 0.824. The overall image quality score of 60 keV + 120 keV fused image and the noise score of 120 kV-like+120 keV were higher than the remaining groups. The differences of the subjective scores among each group were statistically significant(all P<0.05).

The spectral CT with MAR algorithm can effectively improve the image quality of portal vein angiography after the TIPS and embolization therapy and the 60 keV + 120 keV fused images can eliminate artifacts and ensure a clear display of blood vessels.

To explore the correlation between breast density and breast cancer molecular subtype.

The data of 1 407 cases of breast cancer immunohistochemistry and preoperative mammography in Tianjin Medical University Cancer Institute and Hospital from August 2015 to August 2016 were retrospectively analyzed. All cases were divided into four groups: <45 years old, 45-54 years old, 55-64 years old and ≥ 65 years old, and all groups were divided into four molecular subtypes: Luminal A, Luminal B, HER2-enriched and triple-negative according to immunohistochemical results. Person correlation test was used to analyze the correlation between breast density and age; Kruskal-Wallis test was used to analyze the difference in breast density between different molecular subtypes.

There was a negative correlation between breast density and age (r=-0.55, P<0.01). Descriptive analysis results showed that the mean breast density of<45 years old, 45-54 years old, 55-64 years old and ≥65 years old was 20.0%±7.3%, 16.2%±8.4%, 10.5%±5.2%, and 7.9%±3.2%, respectively. The mean breast density of Luminal A, Luminal B, HER2-enriched and triple-negative was 14.0%±8.1%, 14.5%±7.6%, 14.8%±7.7% and 13.2%±7.3%, respectively.Kruskal-Wallis test showed significant statistical differences in breast density among molecular subtypes in the group of<45 years old (P<0.05), while no statistical significance in other groups (all P>0.05).

There is correlation between breast density and breast cancer molecular subtype in young patients, but whether breast density has a potential evaluation effect on breast cancer molecular subtype still needs to be further studied.

To investigate the diagnostic value of apparent diffusion coefficient in diffusion weighted imaging at 3.0 T MR for the differentiation in the larcrimal gland tumors.

A total of 73 cases, 36 males and 37 female; mean age 14-81(44±15)years, with lacrimal gland tumors confirmed by pathology in Beijing Tongren Hospital were retrospectively analyzed between January 2011 and April 2016.All cases underwent the preoperative routine MRI and DWI scan, the ADC values were measured in region of interest within the solid zone. The cases were divided into benign and malignant group by the histopathology, according the different pathological categories, the malignant cases were further divided into the epithelial and non-epithelial malignacy. The receiver operating characteristic curve (ROC) was constructed using various cut points of ADC for different parameters to confirm the diagnostic threshold value and evaluate the diagnostic efficacy.

There were totally 77 lesions in 73 cases, of which 69 involved unilateral lacrimal gland,4 bilateral lacrimal glands. The mean ADC value of malignant and benign masses in lacrimal gland was (1.36±0.16) and (0.90±0.30)×10^-3 mm²/s respectively. There was significantly statistical difference between the both(t=-8.319, P<0.01). The mean ADC value of epithelial and non-epithelial malignacy in lacrimal gland was (1.08±0.18) and (0.54±0.09)×10^-3 mm²/s respectively. There was significantly statistical difference between the both(t=11.988, P<0.01). The area under the ROC for distinguishing malignant from benign lesions was 0.940. Using an ADC value of 1.275×10^-3 mm²/s as the threshold value, the best result obtained had a sensitivity of 94.4%(34/36), specificity of 82.9%(34/41), accuracy of 88.3%(68/77). The area under the ROC for differentiating non-epithelial from epithelial malignacy was 1.0. Using an ADC value of 0.736×10^-3 mm²/s as the threshold value, the best result obtained had a sensitivity of 100%, specificity of 100%, accuracy of 100%.

The ADC value is helpful in differentiation among different kinds of tumors in lacrimal masses.

To observe the relationship between serum oxidative stress as well as brain-derived neurotrophic factor (BDNF) and cognitive function in first-episode drug-free schizophrenics, and to explore the possible effect of oxidative stress in cognitive impairment of first-episode schizophrenia.

A total of 125 first-episode drug-free schizophrenics (schizophrenia group) from the First Affiliated Hospital of Zhengzhou University and 80 healthy individuals (control group) were enrolled. The serum concentration of oxidized glutathione (GSSG) was measured by the Microenzyme method the serum concentration of nitric oxide (NO) was measured by one-step method, the BDNF level was measured by enzyme linked immunosorbent assay and Matrics Consensus Cognitive Battery(MCCB) was used to evaluate the cognitive function.

(1)The serum level of BDNF in schizophrenia group (2 763±1 728 pg/ml) was significantly lower than that in control group (4 165±1 299 pg/ml)(P<0.001). And the serum levels of GSSG and NO in schizophrenia group ((36±9), (81±65) μmol/L) were significantly higher than that in control group ((27±11), (24±16) μmol/L) ( P<0.001). In comparison with the control group scores were significantly lower in the seven domains of cognitive function in the schizophrenia group (all P<0.001). (2)After controlling the confounding factors like age, gender, cultural differences and course of disease by partial correlation analysis, the correlation analysis showed that: serum level of BDNF in schizophrenia group had positive correlation with Information processing rate T points, attentional facilitating T points, working memory T points and Reasoning and problem solving T points (r=0.417, 0.206, 0.247, 0.318, all P<0.05). In schizophrenia group the serum level of GSSG had a negative correlation with information processing rate T points and reasoning and problem solving T points (r=-0.321, -0.231, all P<0.05). The serum level of NO was negatively related to Information processing rate T points working memory T points Verbal learning T points(r=-0.201, -0.193, -0.237, all P<0.05).

Oxidative stress may be involved in the cognitive impairment of schizophrenia Oxidation products are risk factors for cognitive impairment of schizophrenia and BDNF is a protective factor of cognitive function.

To explore the expression and roles of nucleolin in cardiac injury in septic mice.

C57BL/6 mice (WT mice) and myocardium-specific expression of nucleolin transgenic mice (TG mice) were randomly divided into sham group (n=10, sham-operated) and sepsis group (n=15, animal model). Cecal ligation and puncture (CLP) was adopted to produce animal models of sepsis. The expression of nucleolin was detected by Western blotting analysis at 0, 12, 24, 48 hours after the operation. The 7-day survival rate, haemodynamic measurement, levels of isoenzyme of creatinekinase-MB (CK-MB) and cardiac troponin I (cTnI) in serum and levels of reactive oxygen species (ROS) and malondlaldehyde (MDA) in myocardium were evaluated 24 hours after the operation. The data were compared between groups with t test.

The expression of nucleolin in myocardium up-regulated significantly in WT+CLP group when compared with that in the WT+Sham group(2.57±0.34 vs 1.00±0.15, t=7.468, P<0.01). Compared with those in the WT+Sham group, the survival rate decreased (33.3% vs 100%, χ ²=13.375, P<0.01), maximal rate of pressure development (+dp/dtmax) declined (t=4.993, P<0.01), but the serum levels of CK-MB and cTnI and the levels of ROS and MDA in myocardium increased in the WT+CLP group(t=5.031, 4.335, 3.365, 2.375, all P<0.05). Compared with that in WT+CLP group, the 7-day survival rate of mice increased in TG+CLP group (60.0% vs 33.3%, χ ²=8.227, P=0.004), and the cardiac function improved (t=2.337, P=0.019), but the serum levels of CK-MB and cTnI and the levels of ROS and MDA in myocardium in TG+CLP group reduced significantly (t=2.127, 3.347, 2.115, 2.224,均P<0.05).

The expression of nucleolin is up-regulated in the myocardium of septic mice, and the overexpression of nucleolin can inhibit oxidative stress injury, attenuate the cardiac injury and dysfunction, and reduce mortality in septic mice.

To compare and analyze the epidemiological features of adult patients with Barton′s fractures between Western and Eastern in China.

The data of adult patients with Barton′s fractures treated from January 2010 to December 2011 in 63 hospitals in Western and Eastern of China were collected through the picture archiving and communication systems (PACs) and case reports checking system. The data of 28 hospitals in Western China were classified as group Western, while data of 35 hospitals in Eastern China were classified as group Eastern, and the analytic items included gender, age and age distribution. The counting data were tested by chi-square test, and the measurement data were compared with the corresponding statistical methods according to the normality.

A total of 1 191 cases were collected, accounted for 4.0% of all the distal radius fracture (1 191/29 825). The total male/female ratio was 1∶1.02. The adult Barton′s fractures predominated in an age range from 51 to 60 years (21.4%). There were 736 cases of volar Barton′s fractures (61.8%), and 455 cases of dorsal Barton′s fractures (38.2%). The patients were divided into group Western (403 cases) and group Eastern (788 cases) respectively. There were 222(55.1%) males and 181(44.9%) females in group Western, while 368(46.7%) males and 420(53.3%) females in group Eastern (χ²=7.502, P<0.05). The median age of the two groups were 44(16-94) years and 51(16-91) years (Z=-5.079, P<0.05). Cases of volar and dorsal Barton′s fractures in group Western were 238 and 165 cases, while there were 498 and 290 cases in Group Eastern (χ²=1.937, P>0.05).

The peak age of adult Barton′s fractures is from 51 to 60 years with more female patients than male. Volar Barton′s fractures outnumbers dorsal type. In Western China, the majority are male patients, which differs from Eastern. The patient age in Western China is significantly lower than it in Eastern.

Antiphospholipid syndrome (APS) is a group of autoimmune diseases caused by antiphospholipid antibodies and clinically manifested as recurrent arteriovenous thrombosis, habitual abortion, and/or thrombocytopenia. This paper reports a case of primary APS with choreographic involuntary movement as the main clinical manifestation, and analyzes its clinical manifestation, laboratory findings and therapeutic effect.

Amyloidosis refers to a group of diseases in which amyloid protein is abnormally deposited extracellularly in tissues and organs, and causes tissue and organ dysfunction. A female patient with cutaneous nodular amyloidosis accompanied by rheumatoid arthritis and Sjogren's syndrome was treated with methotrexate and prednisone.

Neuro-immune networks, centered on monocytes, connect the cardiovascular system and other organ systems in the progression of atherosclerosis. After acute myocardial infarction, sympathetic nerve activation, bone marrow and extramedullary hematopoietic function are enhanced, and a large number of monocytes are released into the circulation, which affects the function of plaque macrophages and accelerates the development of original plaque. This paper emphasizes the reverse regulation mechanism of neuro-immune regulatory network in the acceleration of arteriosclerosis in acute myocardial infarction, hoping to bring inspiration to the treatment of disease.

Total knee arthroplasty (TKA) is the only effective treatment for advanced knee osteoarthritis, rheumatoid arthritis and other diseases. Personalized osteotomy tool (PSI) technology can increase the accuracy of TKA surgery. Through personalized surgical plan design and customized osteotomy tool before surgery, it can theoretically improve the surgical accuracy, reduce the surgical steps and shorten the surgical time, and has won the favor of a large number of scholars. However, the results of relevant research are mixed and controversial. At present, PSI technique is not certain to bring more satisfactory surgical results for patients, and there is no clinical evidence to support the popularization and use of PSI technique in routine TKA surgery. It is possible that PSI technique is more suitable for cases such as extraarticular deformities, which are relatively complex and difficult to meet the needs of patients with traditional surgery, but there is still a lack of relevant literature to confirm it. In this paper, the research progress of PSI technology in recent years will be reviewed.