“Hepatic hilum area priority,liver posterior first”:An optimized strategy in laparoscopic resection for type Ⅲ-Ⅳ hilar cholangiocarcinoma

BACKGROUND In recent years,pure laparoscopic radical surgery for Bismuth-Corlette type Ⅲ and Ⅳ hilar cholangiocarcinoma(HCCA)has been preliminarily explored and applied,but the surgical strategy and safety are still worthy of further improvement and attention.AIM To summarize and share the application experience of the emerging strategy of“hepatic hilum area dissection priority,liver posterior separation first”in pure laparoscopic radical resection for patients with HCCA of Bismuth-Corlette types Ⅲ and IV.METHODS The clinical data and surgical videos of 6 patients with HCCA of Bismuth-Corlette types Ⅲ and Ⅳ who underwent pure laparoscopic radical resection in our department from December 2021 to December 2023 were retrospectively analyzed.RESULTS Among the 6 patients,4 were males and 2 were females.The average age was 62.2±11.0 years,and the median body mass index was 20.7(19.2-24.1)kg/m^(2).The preoperative median total bilirubin was 57.7(16.0-155.7)μmol/L.One patient had Bismuth-Corlette type Ⅲa,4 patients had Bismuth-Corlette type Ⅲb,and 1 patient had Bismuth-Corlette type Ⅳ.All patients successfully underwent pure laparoscopic radical resection following the strategy of“hepatic hilum area dissection priority,liver posterior separation first”.The operation time was 358.3±85.0 minutes,and the intraoperative blood loss volume was 195.0±108.4 mL.None of the patients received blood transfusions during the perioperative period.The median length of stay was 8.3(7.0-10.0)days.Mild bile leakage occurred in 2 patients,and all patients were discharged without serious surgery-related complications.CONCLUSION The emerging strategy of“hepatic hilum area dissection priority,liver posterior separation first”is safe and feasible in pure laparoscopic radical surgery for patients with HCCA of Bismuth-Corlette types Ⅲ and Ⅳ.This strategy is helpful for promoting the modularization and process of pure laparoscopic radical surgery for complicated HCCA,shortens the learning curve,and is worthy of further clinical application.

经内踝截骨入路微型钢板固定治疗Hawkins Ⅲ型距骨颈骨折

目的探讨经内踝截骨入路微型钢板固定治疗Hawkins Ⅲ型距骨颈骨折的手术方法及疗效。方法 2008年1月至2014年3月,我们对14例Hawkins Ⅲ型距骨颈骨折的患者行经内踝截骨的前内侧入路切开复位微型钢板内固定术治疗,根据患者主诉、后跟及踝关节外形、功能及X线片征象来评价临床疗效。结果本组14例病例均获得随访18~41个月,平均随访29.6个月。末次随访时患者的平均AOFAS踝与后足评分为（79.8±17.3）分,按其疗效标准进行评价,优6例（42.9%）,良3例（21.4%）,可4例（28.6%）,差1例（7.1%）,优良率64.3%。3例患者出现不同程度的距骨缺血坏死,6例患者发生创伤性关节炎,累及胫距关节3例,累及距下关节2例,同时累及胫距及距下关节1例。结论经内踝截骨手术入路微型钢板固定治疗Hawkins Ⅲ型距骨颈骨折具有软组织创伤小、对距骨颈显露充分、并发症发生率低、疗效优良等特点。

微针导入重组Ⅲ型人源化胶原蛋白在皮肤屏障功能修复中的应用效果

目的探究微针导入重组Ⅲ型人源化胶原蛋白治疗因皮肤炎性衰老导致的皮肤屏障功能下降的有效性及安全性。方法选取2020年6月至2021年5月在本院接受面部皮肤治疗的30例患者作为研究对象,采用随机数字表法将其分为对照组(重组Ⅲ型人源化胶原蛋白)与治疗组(微针导入重组Ⅲ型人源化胶原蛋白),各15例。治疗后定期对患者进行随访,分别进行主观疗效评价及客观疗效评价。结果治疗后4、8、12周,治疗组的满意度显著高于对照组(P<0.05)。治疗后,治疗组的皮肤皱纹、纹理、红区、毛孔、弹性、皮肤经皮失水及皮肤含水量改善明显(P<0.05);对照组治疗后油脂改善明显(P<0.05)。治疗后12周,治疗组的总症状评分显著低于对照组(P<0.05)。结论微针导入重组Ⅲ型人源化胶原蛋白对皮肤修复有较好的疗效,可增强皮肤屏障功能,为改善皮肤屏障功能、治疗因皮肤屏障受损引起的炎性衰老提供了新选择。

柴归颗粒对水瘀互结型Ⅲ型前列腺炎患者的影响

目的观察柴归颗粒治疗Ⅲ型前列腺炎水瘀互结证患者的临床疗效及对前列腺液细胞因子等指标的影响。方法将水瘀互结型Ⅲ型前列腺炎患者随机分为治疗组(35例)与对照组(27例)。对照组予盐酸坦索罗辛缓释胶囊口服,治疗组予柴归颗粒口服。比较2组患者治疗前后慢性前列腺炎症状指数(NIH-CPSI)评分、前列腺液细胞因子变化情况及临床疗效。结果治疗组在接受治疗后,其NIH-CPSI评分明显降低,与治疗前相比存在显著差异(P<0.05)。此外,与对照组相比治疗组治疗后的NIH-CPSI评分明显降低(P<0.05)。在对照组中,治疗后的IL-2水平与该组治疗前相比存在统计学意义的差异(P<0.05)。治疗后,治疗组的IL-2、IL-6、IL-8水平显著降低(P<0.05),且与对照组相比,IL-2、IL-6水平更低(P<0.05)。治疗组的中医证候总有效率明显高于对照组(P<0.05)。结论柴归颗粒能明显改善Ⅲ型前列腺炎水瘀互结证患者临床症状,提高临床疗效,其机制可能与调节前列腺液细胞因子水平有关,值得进一步研究。

少腹逐瘀汤联合针刺对Ⅲ型前列腺炎疼痛症患者的治疗效果及对患者生活质量的影响

目的:探讨少腹逐瘀汤联合针刺对Ⅲ型前列腺炎疼痛症患者的治疗效果及对患者生活质量的影响。方法:选取2021年4月~2023年3月于武汉大学中南医院接受诊治的122例符合标准的Ⅲ型前列腺炎患者为研究对象,随机分为两组,对照组(n=61)与观察组(n=61)。对照组接受盐酸坦索罗辛缓释胶囊加针刺治疗,观察组在对照组基础上加少腹逐瘀汤治疗,疗程为4周。比较两组疼痛、生活质量、相关炎症指标及临床有效率、不良反应发生率。结果:观察组临床总有效率显著高于对照组(P<0.05);治疗前两组患者慢性前列腺炎症状积分指数(NIH-CPSI)评分、中医症候积分及前列腺液白细胞(WBC)、卵磷脂小体(SPL)计数、白细胞介素(IL-6)水平均无显著差异(P>0.05),治疗后观察组NIH-CPSI评分、中医症候积分及WBC计数、IL-6水平均显著低于对照组,观察组SPL计数低于对照组(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论:少腹逐瘀汤联合针刺治疗Ⅲ型前列腺炎可有效提高疗效,降低疼痛与不适程度、改善排尿症状,以改善患者生活质量,调节炎症指标,同时无不良反应增加,具有良好的推广价值。

成人骨型Ⅲ类矫治前后前牙区变化的临床研究

目的探讨成人骨型Ⅲ类患者矫治前后上下前牙区牙槽高度和宽度变化以及前牙区牙根位置变化。方法选取2020年5月—2022年11月在中山市小榄人民医院口腔科正畸掩饰治疗的成人骨型Ⅲ类患者50例,比较正畸治疗前后患者上下颌前牙牙槽骨厚度和高度,其中包括上前牙槽骨厚度(upper anterior alveolar bonethickness,UA)、上后牙槽骨厚度(upper posterior alveolar bone thickness,UP)、上牙槽骨总厚度(upper alveolar bone width,UW)、下前牙槽骨厚度(lower anterior alveolar bone thickness,LA)、下后牙槽骨厚度(lower posterior alveolar bone thickness,LP)、下牙槽骨总厚度(lower alveolar bone width,LW)、根中水平上前牙槽骨厚度(upper anterior alveolar bone thickness at the mid-root level,UA-m)、根中水平上后牙槽骨厚度(upper posterior alveolar bone thickness at the mid-root level,UP-m)、根中水平上牙槽骨总厚度(upper alveolar bone thickness at the mid-root level,UW-m)、根中水平下前牙槽骨厚度(lower anterior alveolar bone thickness at the mid-root level,LA-m)、根中水平下后牙槽骨厚度(lower posterior alveolar bone thickness at the mid-root level,LP-m)、根中水平下牙槽骨总厚度(lower alveolar bone thickness at the mid-root level,LW-m)以及上前牙槽骨高度(upper anterior alveolar bone height,UAH)和下前牙槽骨高度(lower anterior alveolarbone height,LAH)。结果正畸治疗前后患者UA、UP-m测量值比较,差异无统计学意义(P>0.05)。与正畸治疗前比较,正畸治疗后患者UP、UW、UA-m、UW-m测量值均显著降低(P<0.05)。正畸治疗后患者LP、LA-m测量值与正畸治疗前比较,差异无统计学意义(P>0.05)。与正畸治疗前比较,正畸治疗后患者LA、LW、LP-m、LW-m测量值均降低(P<0.05)。与正畸治疗前比较,正畸治疗后患者UAH、LAH测量值均显著降低(P<0.05)。正畸治疗后,患者上下颌前牙解剖牙根长度分别为(10.62±0.57)mm、(9.65±0.48)mm,正畸治疗前患者上下颌前牙解剖牙根长度分别为(11.01±0.58)mm、(10.37±0.48)mm,与正畸治疗前比较,患者上下颌前牙解剖牙根长度明显减小(P<0.05)。结论成人骨型Ⅲ类患者进行正畸掩饰治疗后,牙槽形态会发生相应改变,患者上下前牙牙槽骨厚度和高度会一定程度地减少。因此,在矫治过程中应当对患者牙槽形态的变化给予密切关注,尽量避免上下前牙发生代偿性移动,从而降低不良反应情况发生的风险。

羟基酸与Ⅲ型胶原蛋白的护肤功效研究

旨在研究验证羟基酸和重组Ⅲ型胶原蛋白对皮肤水分及屏障的影响。招募志愿者共12人,使用多功能皮肤测试仪测量了受试者连续使用含羟基酸和Ⅲ型胶原蛋白护肤品时皮肤水分含量、经皮失水量的变化。结果表明复合酸类产品具有保湿补水、修复屏障的功效,且其补水效果与酸种类有关。证明了重组Ⅲ型胶原蛋白对于促进皮肤水含量提升及经皮失水量降低有显著效果,且当水杨酸与Ⅲ型胶原搭配时会发挥协同作用,可以进一步强韧屏障,实现皮肤水含量的大幅度提升。

上颌前方牵引联合螺旋扩弓器对替牙期骨性Ⅲ类错[牙合]颌面软硬组织的影响

目的在上颌前方牵引的基础上给予骨性Ⅲ类错[牙合](替牙期)患儿螺旋扩弓器进行扩缩处理治疗,观察疗效以及对患儿牙颌面软硬组织的影响。方法按随机数表法将2021年1月至2022年12月信阳市中心医院诊治的60例替牙期骨性Ⅲ类错[牙合]患儿分两组。对照组30例采用上颌前方牵引治疗,联合组30例在上颌前方牵引的基础上给予螺旋扩弓器治疗,评估两组临床疗效,对比两组治疗前后颌面结构、上气道间隙及三维指标。结果联合组临床有效率(86.67%)较对照组(63.33%)更高,差异有统计学意义(P<0.05)。联合组治疗后颌面结构相关指标上下颌突差(ANB)、下颌平面角(FH-MP)、下面高(ANS-Me)、腭平面角(SN-PP)较对照组更高,上中切牙的突度(L1-MP)较对照组更低,差异有统计学意义(P<0.05)。联合组治疗后上气道间隙指标鼻咽直径(PNS-R)较对照组更高,差异有统计学意义(P<0.05)。联合组治疗后上气道三维指标鼻咽段最小截面积(NP area)、鼻咽段最小截面积处冠状径(NP cor.)、鼻咽段最小截面积位置矢状径(NP sag.)、鼻咽段容积(NP volume)较对照组更高,差异有统计学意义(P<0.05)。结论上颌前方牵引联合螺旋扩弓器疗效确切,可有效促进替牙期骨性Ⅲ类错[牙合]患儿颌面结构及上气道状态恢复,改善颌面软硬组织状态。

基于上皮细胞-间充质细胞转分化(EMT)理论的艾灸配合化纤Ⅳ号方对实验大鼠Collagen Type Ⅲ和PDGF干预作用实验研究

目的:基于上皮细胞-间充质细胞转分化(EMT)学说观察化纤Ⅳ号方、艾灸以及二者相配合治疗肺纤维化大鼠Collagen TypeⅢ(Ⅲ-C)和PDGF的变化,探讨其治疗效应及生物学机制。方法:将鼠龄约为6周的SD大鼠随机分为空白组、模型组、化纤Ⅳ号方组、艾灸组、化纤Ⅳ号方与艾灸配合治疗组(简称为"灸药组"),治疗30 d后处死观察其肺组织病理改变,并检测其Collagen TypeⅢ、PDGF的基因和蛋白表达情况。结果:实时荧光定量结果显示:与空白组相比,各组Ⅲ-C和PDGF m RNA表达增高(P<0.05)。与模型组相比,各组的Ⅲ-C和PDGF m RNA表达有明显降低(P<0.01)。而各组中,灸药组疗效最明显,Ⅲ-C和PDGF的表达最低。蛋白免疫印迹法检测结果显示:与模型组相比各组的Ⅲ-C蛋白表达有差异。结论:1艾灸、化纤Ⅳ号方均可减轻博莱霉素诱导肺纤维化大鼠的肺纤维化程度。2艾灸配合化纤Ⅳ号方可减轻博莱霉素诱导肺纤维化大鼠的肺纤维化程度,且其效果优于单用艾灸或单用化纤Ⅳ号方。3艾灸、化纤Ⅳ号方及其二者配合使用不同程度阻抑博莱霉素诱导肺纤维化大鼠肺纤维化进程的效应机制,可能与通过调控其EMT过程中的Ⅲ-C和PDGF表达环节紧密相关。

经跗骨窦切口与外侧L形切口钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折的疗效分析

目的分析SandersⅡ、Ⅲ型跟骨骨折患者采用经跗骨窦切口与跟骨外侧L形切口钢板内固定治疗的临床疗效。方法回顾性选取2017年9月至2021年3月池州市人民医院收治的62例SandersⅡ、Ⅲ型跟骨骨折患者,按照手术方式不同分为对照组和观察组,每组31例。其中,观察组采用经跗骨窦切口复位微型钢板内固定手术治疗,对照组采用跟骨外侧L形切口钢板内固定手术治疗。对比分析两组患者的手术相关指标、术后12个月跟骨Bohler角、Gissane角以及Marland足部功能评分,并比较术后并发症发生情况。结果62例患者均接受术后随访,随访时间13~16个月。术后6个月所有患者骨折均愈合,平均骨折愈合时间3~6个月。观察组患者的手术时间、手术切口分别为(53.1±10.3)min、(4.3±0.9)cm,明显短于对照组[(84.0±15.3)min、(11.1±1.2)cm],术后疼痛评分为(1.8±0.5)分,明显低于对照组[(3.2±1.1)分],差异均有统计学意义(P<0.05)。两组患者术后12个月Bohler角、Gissane角、Maryland足部功能评分比较,差异均无统计学意义(P>0.05)。观察组患者并发症发生率为6.45%,明显低于对照组(22.58%),差异有统计学意义(P<0.05)。结论经跗骨窦切口复位微型钢板内固定手术对SandersⅡ、Ⅲ型跟骨骨折患者造成的创伤较小,骨折复位及内固定强度效果明显,术后并发症发生率降低,足部功能恢复较快。

电压模式Buck电路中Type Ⅲ型环路补偿优化方法

设计了以UP1542为电源转换芯片的电压模式Buck电路,提出了一种基于Type Ⅲ型环路补偿中零极点理论的优化方法,引入无补偿时电压模式Buck电路与传统电压模式Buck电路Type Ⅲ型环路补偿方法进行比较。试验测试结果表明:所提优化方法与Buck电路无补偿方法和传统电压模式Buck电路Type Ⅲ环路补偿理论设计方法相比,输出电压超调分别下降33.6%和14.9%,动态响应速度分别提升72.6%和24%,同时保证了品质因素Q附近频率的电路稳定性。该优化方法降低了动态响应误差,同时有效地减小了输出电压动态响应时间,达到了提高电路稳定性的目的,验证了该优化方法的有效性。

硬膜外磨除前床突在Al-Mefty分型Ⅲ型前床突脑膜瘤翼点入路手术中的应用

目的探讨硬膜外前床突旁磨除在Al-Mefty分型Ⅲ型前床突脑膜瘤(ACM)翼点入路手术中应用价值。方法回顾性分析2011年12月至2021年3月经翼点入路显微手术治疗21例Al-Mefty分型Ⅲ型ACM的临床资料。15例术中在硬膜外磨除前床突,6例未磨除前床突。结果磨除前床突的15例中,10例(66.7%)肿瘤全切除,3例大部分切除,2例部分切除;12例(80.0%)术后视力改善,3例无明显变化。未磨除前床突的6例中,2例(33.3%)肿瘤全切除,1例大部分切除,3例部分切除;2例(33.3%)术后视力改善,4例无明显变化。磨除前床突病人肿瘤全切除率和术后视力改善率较未磨除前床突病人明显提高(P<0.05)。术后新发暂时性动眼神经麻痹1例、癫痫发作1例、脑脊液漏1例。21例术后随访6~97个月,平均(37.4±13.8)个月;2例肿瘤部分切除病人出现肿瘤进展;随访期间无死亡病例。结论Al-Mefty分型Ⅲ型ACM与颈内动脉及其分支、视神经、海绵窦等重要神经血管结构的解剖关系紧密,手术难度大。术中硬膜外磨除前床突可增加手术空间,早期控制视神经和ICA,有助于提高肿瘤全切除率和视神经改善率。

Serum hyaluronic acid, procollagen type Ⅲ and Ⅳ in histological diagnosis of liver fibrosis

OBJECTIVE: To assess the significance of serum hyaluronic acid (HA), proeollagen type Ⅲ (PCⅢ), collagen type Ⅳ (CⅣ) in the histological diagnosis of liver fibrosis. METHODS: The concentrations of serum HA, PCⅢ, CⅣ in 253 patients with chronic liver diseases were measured by radioimmunoassay. Liver biopsies were performed in all patients at the same time. The liver was pathologically evaluated by a pathologist according to a scoring system. Combined with the results of liver pathological diagnosis, the accuracy of serum HA, PCⅢ, CⅣ in diagnosing patients with hepatic fibrosis (staging≥S_2) or cirrhosis (S_4) was assessed using the receiver operating curve (ROC). RESULTS: The cutoff values of serum HA, PCⅢ and CⅣ for identifying patients with hepatic fibrosis (≥S_2) or cirrhosis (S_4) were determined. The cutoff values of serum HA, PCⅢ and CⅣ for detecting patients with fibrosis (stage≥S_2) were 90μg/L, 90μg/L, 75μg/L, respectively; their sensitivity (Se) was 80.4%, 82%, 63.1%; their specificity (Spe) was 70.2%, 60.8%, 83.8%; their positive predictive values (PPV) were 86.7%, 83.5%, 90.4%; their negative predictive values (NPV) were 59.8%, 58.4%, 48.4%, respectively. The cutoff values for detecting patients with liver cirrhosis were 210μg/L for HA, 96.2% for Se, 85.3% for Spe, 65.4% for PPV, 98.8% for NPV; 150μg/L for PCⅢ, 76.4% for Se, 68.7% for Spe, 40.4% for PPV, 91.3% for NPV; 90μg/L for CⅣ, 80% for Se, 75.8% for Spe, 47.8% for PPV, 93.2% for NPV, respectively. CONCLUSIONS: Serum HA, PCⅢ and CⅣ can be determined for an accurate diagnosis of hepatic fibrosis in various stages. HA is the best for screening liver cirrhosis.

An enriched environment increases the expression of fibronectin type Ⅲ domain-containing protein 5 and brain-derived neurotrophic factor in the cerebral cortex of the ischemic mouse brain

Many studies have shown that fibronectin type III domain-containing protein 5(FDNC5) and brain-derived neurotrophic factor(BDNF) play vital roles in plasticity after brain injury. An enriched environment refers to an environment that provides animals with multi-sensory stimulation and movement opportunities. An enriched environment has been shown to promote the regeneration of nerve cells, synapses, and blood vessels in the animal brain after cerebral ischemia;however, the exact mechanisms have not been clarified. This study aimed to determine whether an enriched environment could improve neurobehavioral functions after the experimental inducement of cerebral ischemia and whether neurobehavioral outcomes were associated with the expression of FDNC5 and BDNF. This study established ischemic mouse models using permanent middle cerebral artery occlusion(pMCAO) on the left side. On postoperative day 1, the mice were randomly assigned to either enriched environment or standard housing condition groups. Mice in the standard housing condition group were housed and fed under standard conditions. Mice in the enriched environment group were housed in a large cage, containing various toys, and fed with a standard diet. Sham-operated mice received the same procedure, but without artery occlusion, and were housed and fed under standard conditions. On postoperative days 7 and 14, a beam-walking test was used to assess coordination, balance, and spatial learning. On postoperative days 16–20, a Morris water maze test was used to assess spatial learning and memory. On postoperative day 15, the expression levels of FDNC5 and BDNF proteins in the ipsilateral cerebral cortex were analyzed by western blot assay. The results showed that compared with the standard housing condition group, the motor balance and coordination functions(based on beam-walking test scores 7 and 14 days after operation), spatial learning abilities(based on the spatial learning scores from the Morris water maze test 16–19 days after operation), and memory abilities(based on the memory scores of the Morris water maze test 20 days after operation) of the enriched environment group improved significantly. In addition, the expression levels of FDNC5 and BDNF proteins in the ipsilateral cerebral cortex increased in the enriched environment group compared with those in the standard housing condition group. Furthermore, the Pearson correlation coefficient showed that neurobehavioral functions were positively associated with the expression levels of FDNC5 and BDNF(r = 0.587 and r = 0.840, respectively). These findings suggest that an enriched environment upregulates FDNC5 protein expression in the ipsilateral cerebral cortex after cerebral ischemia, which then activates BDNF protein expression, improving neurological function. BDNF protein expression was positively correlated with improved neurological function. The experimental protocols were approved by the Institutional Animal Care and Use Committee of Fudan University, China(approval Nos. 20160858 A232, 20160860 A234) on February 24, 2016.

Macroscopic appearance of TypeⅣand giant Type Ⅲ is a high risk for a poor prognosis in pathological stage Ⅱ/Ⅲ advanced gastric cancer with postoperative adjuvant chemotherapy

AIM To evaluate whether a high risk macroscopic appearance(Type Ⅳ and giant Type Ⅲ) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage Ⅱ/Ⅲ(p Stage Ⅱ/Ⅲ) gastric cancer.METHODS One hundred and seventy-two advanced gastric cancer(defined as pT2 or beyond) patients with p Stage Ⅱ/Ⅲ who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined. RESULTS Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival(RFS)(35.7%) and overall survival(OS)(34%) than an average risk appearance(P = 0.0003 and P < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13^(th) Japanese Gastric Cancer Association(JGCA) pT(P = 0.01), but not with the 13^(th) JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13^(th) JGCA p Stage(P < 0.0001)and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified highrisk macroscopic appearance(P = 0.036, HR = 2.29 for RFS and P = 0.021, HR = 2.74 for OS) as an independent prognostic indicator. CONCLUSION A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13^(th) JGCA stage in p Stage Ⅱ/Ⅲ advanced gastric cancer.

Yersinia type Ⅲ effectors perturb host innate immune responses

The innate immune system is the first line of defense against invading pathogens. Innate immune cells recognize molecular patterns from the pathogen and mount a response to resolve the infection. The production of proinflammatory cytokines and reactive oxygen species, phagocytosis, and induced programmed cell death are processes initiated by innate immune cells in order to combat invading pathogens. However, pathogens have evolved various virulence mechanisms to subvert these responses. One strategy utilized by Gram-negative bacterial pathogens is the deployment of a complex machine termed the type Ⅲ secretion system(T3SS). The T3SS is composed of a syringe-like needle structure and the effector proteins that are injected directly into a target host cell to disrupt a cellular response. The three human pathogenic Yersinia spp.(Y. pestis, Y. enterocolitica, and Y. pseudotuberculosis) are Gramnegative bacteria that share in common a 70 kb virulence plasmid which encodes the T3 SS. Translocation of the Yersinia effector proteins(YopE, YopH, YopT, YopM, YpkA/YopO, and YopP/J) into the target host cell results in disruption of the actin cytoskeleton to inhibit phagocytosis, downregulation of proinflammatory cytokine/chemokine production, and induction of cellular apoptosis of the target cell. Over the past 25 years, studies on the Yersinia effector proteins have unveiled tremendous knowledge of how the effectors enhance Yersinia virulence. Recently, the long awaited crystal structure of YpkA has been solved providing further insights into the activation of the YpkA kinase domain. Multisite autophosphorylation by YpkA to activate its kinase domain was also shown and postulated to serve as a mechanism to bypass regulation by host phosphatases. In addition, novel Yersinia effector protein targets, such as caspase-1, and signaling pathways including activation of the inflammasome were identified. In this review, we summarize the recent discoveries made on Yersinia effector proteins and their contribution to Yersinia pathogenesis.

Vitamin D deficiency: Correlation to interleukin-17, interleukin-23 and PⅢNP in hepatitis C virus genotype 4

AIM: To assess vitamin D (Vit D) abnormalities in hepatitis C infected patients and their relationship with interleukin (IL)-17, IL-23 and N-terminal propeptide of type Ⅲ pro-collagen (PⅢNP) as immune response mediators. METHODS: The study was conducted on 50 Egyptian patients (36 male, 14 female) with hepatitis C virus (HCV) infection, who visited the Hepatology Outpatient Clinic in the Endemic Disease Hospital at Cairo University. Patients were compared with 25 ageand sexmatched healthy individuals. Inclusion criteria were based on a history of liver disease with HCV genotype 4 (HCV-4) infection (as new patients or under followup). Based on ultrasonography, patients were classified into four subgroups; 14 with bright hepatomegaly; 11 with perihepatic fibrosis; 11 with hepatic cirrhosis; and 14 with cirrhosis and hepatocellular carcinoma (HCC).Total Vit D (i.e., 25-OH-Vit D) and active Vit D [i.e., 1,25-(OH) 2 -Vit D] assays were carried out using commercial kits. IL-17, IL-23 and PⅢNP levels were assayed using enzyme linked immunosorbent assay kits, while HCV virus was measured by quantitative and qualitative polymerase chain reaction. RESULTS: Levels of Vit D and its active form were significantly lower in advanced liver disease (hepatic cirrhosis and/or carcinoma) patients, compared to those with bright hepatomegaly and perihepatic fibrosis. IL-17, IL-23 and PⅢNP levels were markedly increased in HCV patients and correlated with the progression of hepatic damage. The decrease in Vit D and active Vit D was concomitant with an increase in viral load, as well as levels of IL-17, IL-23 and PⅢNP among all subgroups of HCV-infected patients, compared to normal healthy controls. A significant negative correlation was evident between active Vit D and each of IL-17, IL-23 and PⅢNP (r = -0.679, -0.801 and -0.920 at P < 0.001, respectively). HCV-infected men and women showed no differences with respect to Vit D levels. The viral load was negatively correlated with Vit D and active Vit D (r = -0.084 and -0.846 at P < 0.001, respectively), and positively correlated with IL-17, IL-23 and PⅢNP (r = 0.951, 0.922 and 0.94 at P < 0.001, respectively). Whether the deficiency in Vit D was related to HCVinduced chronic liver disease or was a predisposing factor for a higher viral load remains to be elucidated. CONCLUSION: The negative correlations between Vit D and IL-17, IL-23 and PⅢNP highlight their involvement in the immune response in patients with HCV-4related liver diseases in Egypt.

Microscopic removal of type Ⅲ dens invaginatus and preparation of apical barrier with mineral trioxide aggregate in a maxillary lateral incisor:A case report and review of literature

BACKGROUND Invaginated teeth pose greater challenges in clinical management because of their complex configuration.With advancements in equipment and materials,such as the dental operation microscope,cone-beam computed tomography and mineral trioxide aggregate,the preservation rate of type Ⅲ dens invaginatus could be greatly increased.CASE SUMMARY This case report presented a 31-year-old woman with complaints of spontaneous swelling and pain in the right maxillary lateral tooth.With the aid of cone-beam computed tomography,type Ⅲ dens invaginatus with apical periodontitis was diagnosed and confirmed.Three-visit endodontic treatment was performed.In the first visit,the invagination was carefully removed under the dental operation microscope,and chemomechanical preparation was done.In the second visit,mineral trioxide aggregate apical barrier surgery was performed in this tooth.In the third visit,the canal was finally obturated with thermoplastic gutta-percha to recover the crown morphology.A 26-mo follow-up revealed a satisfied outcome both in the radiographic and oral examinations.CONCLUSION In this case,removal of the entire abnormal structure provided great convenience for the follow-up treatment.When confronted with the same clinical case in the future,we can take a similar approach to address it.

Molecular Cloning and Bioinformatics Analysis of TypeⅢSecretion System Effector Protein Va1686 Gene of Vibrio alginolyticus

In this study, Va 1686 gene was cloned from Vibrio alginolyticus . The total length of the gene is 1 164 bp, and it could encode 387 amino acids. The physicochemical properties, protein structure, genetic evolutionary relationship and antigenic characteristics of the effect protein Va1686 of V. alginolyticus HY9901 type Ⅲ secretion system were studied and analyzed by bioinformatics methods and tools. The results showed that Va1686 is a stable hydrophilic and acidic protein without a transmembrane region and a signal peptide, and secondary structure to α-helix. The evolutionary analysis showed that V. alginolyticus HY9901 and V. harveyi were clustered together, which indicated that the genetic relationship between the two species was the closest. Va1686 contains a Fic superfamily conserved domain associated with cell division. Bioinformatics analysis showed that the B-cell preponderant epitopes of Va1686 might be localized in the regions of 48-49, 82-85, 125-126, 150-153, 185-186, 236-237 and so on. The 3D structure model of Va1686 subunit was simulated by SWISS-MODEL software and it was found that the vopS of V. parahaemolyticus was similar and the similarity was 89.46%. In this study, the feasibility of Va1686 as a common antigen of Vibrio was verified from the perspective of bioinformatics, which laid the foundation for the next step in vaccine development.

Uniform persistence of multispecies ecological competition predator-pray system with Holling Ⅲ type functional response

The main purpose of this paper is to study the persistence of the general multispecies competition predator-pray system with Holling Ⅲ type functional response. In this system, the competition among predator species and among prey species are simultaneously considered. By using the comparison theory and qualitative analysis, the sufficient conditions for uniform strong persistence are obtained.