The level of Th17/Treg imbalance in sepsis is related to the occurrence and prognosis of MODS. High-volume hemofiltration can attenuate the Th17/Treg imbalance in sepsis patients, possibly by removing inflammatory mediators.

Rationale:The initial symptoms and signs of Takayasu arteritis vary due to the heterogeneity of affected vessels. Moreover, the vascular lesions are difficult to detect at initial presentation, making diagnosis even more challenging. Although cases of aortic dissection with arteritis history have been reported, Takayasu arteritis in men with aortic dissection as initial presentation is very rare.Patient concerns:A 37-year-old man presenting with persistent chest and back pain for 6 days was transferred to our hospital for further treatment. Left hand pulse was absent and right lower limb pulse was feeble. Blood pressure was 144/83 mmHg in the right arm but only 114/62 mmHg in the left arm.Diagnoses:Computed tomography angiography revealed aortic dissection (DeBakey type III b) from the descending aorta to the distal abdominal aorta.Interventions:High-dose glucocorticoid therapy and immunosuppressive therapy have been used to control inflammatory reaction during acute period of Takayasu arteritis. Endovascular graft exclusion (EVGE) surgery was performed to cover the primary entry tear and re-expand true lumen during inactive stage.Outcomes:His pain symptoms improved progressively and he was followed in our outpatient clinic after discharged from hospital, without recurrence.Lessons:Timely therapy (glucocorticoid and immunosuppressive) and corrective surgery (endovascular graft exclusion) for Takayasu arteritis with aortic dissection at the inactive stage is essential and beneficial.

Background: To investigate the effect of high-volume hemofiltration (HVHF) on Th17/Treg imbalance in patients with severe acute pancreatitis (SAP). Methods: Forty-two patients with SAP were randomly received 24 hours of continuous HVHF (n = 21) or without HVHF (n = 21). At day 28, all 42 patients were divided into survival group (n = 32) and non-survival group (n = 10). Venous blood samples collected at 0, 6, 12, and 24 hours during HVHF treatment (or equivalent time in non-HVHF group) were assessed by flow cytometry to detect Th17 and Treg cells. Concentrations of IL-6, IL-17, IL-10, and TGF-β1 were detected by enzyme-linked immunosorbent assay. Results: Th17%, Treg%, Th17/Treg, and levels of related cytokines were significantly higher in SAP patients than healthy controls ( P < .05), and these changes were more pronounced in SAP patients with multiple organ failure than those with single organ failure ( P < .05). After HVHF treatment, Th17%, Treg%, Th17/Treg, IL-6, IL-17, and IL-10 significantly reduced ( P < .05), while there were no significant changes in non-HVHF group ( P > .05). In addition, acute physiology and chronic health evaluation II and sequential organ failure assessment scores decreased markedly after HVHF treatment. Baselines of Th17%, Treg%, Th17/Treg, and related cytokines were significantly higher in non-survival group than survival group. Both acute physiology and chronic health evaluation I score and IL-6 level were positively correlated with Th17% before and after HVHF treatment ( P < .01). Conclusions: Th17/Treg imbalance is present in SAP and may be correlated with its severity and prognosis. HVHF effectively attenuates the Th17/Treg imbalance in SAP patients. The beneficial effect of HVHF on Th17/Treg imbalance is possibly associated with removing excess inflammatory mediators.

Citationand October 2016, were recruited for this study. All enrolled IMN patients received prednisolone acetate in combination with CsA on the basis of supportive treatment. After CsA therapy for 6 months, patients were assigned into the responsive and unresponsive groups according to the serum levels of albumin (ALB) and 24-hour urinary protein. The serum levels of ALB and 24-hour urinary protein were measured by full automatic biochemical analyzer. The peripheral Th17% and Treg% were detected and calculated by flow cytometry. The expression levels of Interleukin-17 (IL-17), tumor necrosis factor-alpha (TNF-α) and transforming growth factor beta (TGF-β) in the peripheral blood were quantitatively measured by ELISA. Results: Compared with the healthy controls, in the peripheral blood of IMN patients, Th17 percentage and the expression levels of IL-17 and TNF-α were upregulated, whereas Treg percentage and TGF-β level were downregulated. All patients were assigned into the high-, middle-and low-risk groups according to quantitative analysis of the 24-hour urinary protein.In the high-risk group, the expression levels of IL-17, TNF-α and TGF-β were significantly upregulated, whereas the Treg% and TGF-β level were dramatically downregulated compared with those in the middle and low-risk groups. The 24-hour urinary protein level was positively correlated with Th17% and Th17/Treg ratio, whereas negatively correlated with Treg%. After a 6 month combined therapy of CsA and prednisone, 18/24 IMN patients fell into the effective group. In these patients, the 24-hour urinary protein level, Th17%, IL-17 and TNF-α levels were significantly downregulated, whereas the peripheral Treg% and TGF-β level were dramatically upregulated in the effective group (all p<0.05). 6/24 IMN patients fell into the in effective group, no significant changes were noted in these parameters in the ineffective group. Conclusion: In IMN patients, present peripheral Th17/Treg imbalance is correlated with the severity of IMN. CsA treatment is an effective approach to improve peripheral blood Th17/Treg imbalance in a sub-population of IMN patients, which is associated with the clinical efficacy of CsA treatment. Monitoring the variations in peripheral concentration of Treg and Th17 is of significance for evaluation of the severity of IMN and clinical efficacy.