Natural killer T(NKT) cells are a heterogeneous group T cells that share properties of both natural killer cells and T cells,play an important role in tumor immunity.Related researches have confirmed that actived NKT cells can inhabit tumor progress,but activated NKT cells commonly become anergic for some unknown reasons after a short time.This article reviews researches on the possible mechanisms and solutions to NKT cells anergy.

BACKGROUND:Massive blood loss was caused by an over-reactive fibrinolytic system, as a sequence of tourniquet usage and surgery trauma in total knee arthroplasty. As an antifibrinolytic drug, tranexamic acid has been proven to decrease not only the obvious and total blood loss, but also the ratio of alograft blood transfusion in total knee arthroplasty. Nevertheless, the effect of tranexamic acid on hidden blood loss in total knee arthroplasty had not been clarified yet. OBJECTIVE: To observe the effect of intravenous infusion of tranexamic acid on hidden blood loss in primary total knee arthroplasty. METHODS:Clinical data of 54 patients who received primary unilateral total knee arthroplasty in the Third Hospital, Peking University from June to December 2013 were retrospectively analyzed. They were divided into two groups according to the use of tranexamic acid. 22 patients in the tranexamic acid group were given 2 g tranexamic acid by intravenous infusion during surgery. 32 patients in the control group were given an equal volume of physiological saline. Patients in both groups were oraly given anticoagulant rivaroxaban after replacement. Hemoglobin level and blood hematocrit were recorded before and after surgery for 5 consecutive days. The total amount of blood loss and hidden blood loss were calculated by using Cross equation. The difference in the amount of blood loss was compared between the two groups. Lower extremity venous ultrasound examination was conducted at 1 week after replacement to determine deep venous thrombosis in the lower limb. RESULTS AND CONCLUSION:No significant difference in general data and perioperative conditions was detected between the two groups (P > 0.05). Postoperative drainage, dominant blood loss, total blood volume, the amount of autologous blood transfusion and the amount of alogeneic blood transfusion were significantly less in the tranexamic acid group than in the control group (P < 0.05). According to Gross formula, the difference of hidden blood loss was statisticaly significant between the tranexamic acid group (302.9±189.9) mL and the control group (596.8±271.4) mL (P < 0.05). Deep vein thrombosis appeared in one case between the two groups after replacement. Results indicate that intravenous infusion of tranexamic acid dramaticaly decreased the hidden blood loss in unilateral total knee arthroplasty, reduced alogeneic blood transfusion, and simultaneously did not increase the incidence of deep vein thrombosis in the lower limb.

Objective To evaluate the effect of the modified balloon dilatation intervention on the pharyngeal constriction function of the brainstem stroke survivors with dysphagia using videofluoroscopy-based digital analysis.Methods Thirty brainstem stroke survivors with pharyngeal dysphagia were recruited and randomly divided into a treatment group and a control group,with 15 in each.The treatment group was treated with the modified balloon dilatation in addition to the routine treatment of 30min,respectively,once a daily,3 days a week,whiled a control group was treated with routine treatment of 30min twice a day,3 days a week.Before and after the treatment,the rate and duration of pharyngeal constriction were measured in both groups.Results After the treatment,the rate of pharyngeal constriction in the treatment group was (0.20 ± 0.030),(0.14 ± 0.05) and (0.15 ± 0.04) when swallowing thin liquid,thick liquid and pasty food,significantly better than before the treatment.The duration of the pharyngeal constriction was (990.34 ±96.14),(1010.47 ± 133.64) and (1180.10 ± 121.27) ms,respectively,also significantly better than before the treatment.In the control group,significant differences were also observed in the rate and duration of pharyngeal constriction before and after the treatment.Conclusions Digital analysis based on videofluoroscopy can be used to quantify swallowing function effectively,and the rate and duration of pharyngeal constriction can be used to evaluate the pharyngeal function before and after treatment.

Objective To observe the effects of bolus volume on pharyngeal and upper esophageal sphincter pressures and durations in healthy volunteers by using high-resolution manometry (HRM).Methods Twentyfour health subjects were recruited and asked to swallow three volumes of bolus (3 ml,5 ml and 10 ml) in the neutral head position.Pressure and duration measurements were acquired by utilizing a high-resolution solid-state manometer,with an emphasis on the hypopharynx and upper esophageal sphincter (UES).Variables including UES residual pressure,UES relaxation duration,maximum hypopharygeal pressure and hypopharyngeal pressure duration were analyzed across bolus volumes and consistencies by using three-way repeated measures analysis of variance (ANOVA) to investigate influence of bolus volume.Results UES residual pressure [-1.71 mmHg(3 ml thick liquid)vs.-4.68 mmHg(10 ml thick liquid)],UES relaxation duration[590.45 ms(3 ml thick liquid) vs.702.49 ms (10 ml thick liquid)],maximum hypopharygeal pressure [169.91 mmHg (3 ml thick liquid) vs.204.42 mmHg (10 ml thick liquid)] and hypopharyngeal pressure duration(P ＜0.05) varied significantly across bolus volumes when swallowing water or thick liquid.The UES relaxation duration,UES residual pressure and maximum hypopharyngeal pressure had a direct positive relationship with bolus volume.There was significant differences with regard to UES relaxation duration [685.75 ms(3 ml paste)vs.772.27 ms (10 ml paste)] but not to UES residual pressure (P ＞ 0.05) and maximum hypopharyngeal pressure (P ＞ 0.05) across bolus volume when swallowing paste.Conclusions Difference in hypopharyngeal pressure and duration,UES residual pressure and duration were detected across varying bolus volumes.Consideration of these variables is paramount in understanding normal and pathological swallowing.

Objective To investigate and analyze the status quo of the patients of extended stay at 11 clinical hospitals of a general university in Beijing, and explore the countermeasures and solutions.Methods Contact with the medical affairs departments of these hospitals to collect information about such patients of extended stay.Results A total of 43 cases of patients were identified as extended stay at these hospitals, accounting for 0.00% to 0.93% of total beds.Their stay ranged from 1 month to 15 years, including 17 cases with medical disputes (39.5%), and 26 cases without (60.5%).Conclusions The phenomenon of extended stay at hospitals deserve enough attention and appropriate actions accordingly.

Objective To explore the effect of theta-burst stimulation (TBS) of the motor cortex on the suprahyoid muscles and the mechanism through which the bilateral motor cortex regulates the suprahyoid muscles.Methods Continuous TBS (cTBS) was applied to the left motor cortex followed by intermittent TBS (iTBS) applied to the right motor cortex of 24 healthy subjects.The motor-evoked potentials (MEPs) of the suprahyoid muscles on both sides were recorded before the stimulation and after 15 and 30 minutes.The MEP amplitudes of the left and right suprahyoid muscles were analyzed using repeated measures analysis of variance.Results Before stimulation, the average MEP amplitudes of the left and right suprahyoid muscles were (375.29 ± 176.09) μV and (368.17 ± 149.02) μV respectively, significantly lower than the values after the stimulation.Conclusion iTBS can distinctly enhance the excitability of the right motor cortex controlling the suprahyoid muscles and reverse the inhibition caused by cTBS applied to the left motor cortex.Clarifying the effect of TBS on the excitability of the bilateral motor cortex is important for the rehabilitation of dysphagic stroke survivors.

OBJECTIVETo study the application of VSD in the treatment of severe necrotizing fasciitis in extremities of patients.

METHODSEight patients, suffering from severe necrotizing fasciitis, who had been traditionally treated with iodophor-soaked gauze for 21 to 365 days in other hospitals, were transferred to our institute because of the nonhealing wounds and systemic toxic symptoms induced by infection, from January 2011 to August 2013. After admission, surgical debridement was performed timely, and the necrotic tissue was collected during the operation for pathological observation after HE staining. After the operation, VSD was started with negative pressure ranging from -100 to -80 kPa, and the furacilin solution (0.2 g/L) and oxygen (2 L/min) were continuously infused into the wound during the treatment. Surgical debridement was performed repeatedly according to the wound condition followed by change of VSD dressings to continue VSD treatment. The wounds were closed by suturing or with autologous skin grafts after being covered by fresh granulation tissue. The times of surgical debridement, times of change of VSD materials, wound healing status, and length of stay in our institute were recorded. All patients were followed up for a long time. Results HE staining showed that there were diffuse necrotic adipose and fibrous connective tissues in the necrotic tissue, and the normal tissue structure disappeared accompanied by significant infiltration of inflammatory cells. The number of surgical debridement was 2 to 10 (3.9 +/- 2.8) times. The number of VSD materials change was 2 to 10 (4.0 +/- 2.9) times. Wounds were closed by suturing and healed in two patients; wounds in the other six patients were partially sutured, their residual wounds were healed by autologous skin grafting. The length of stay in our institute was 20 to 49 (33 +/- 10) days. All patients were discharged after recovery. Patients were followed up for 2 to 24 months, and their wounds were found to be in good condition without ulceration or recurrence.

CONCLUSIONSVSD can effectively remove the necrotic tissues and exudates from the fascial spaces and promote proliferation of granulation tissue. Therefore it serves as an effective approach to the treatment of severe necrotizing fasciitis in extremities.

Debridement ; Drainage ; Extremities ; surgery ; Fasciitis, Necrotizing ; surgery ; Granulation Tissue ; Humans ; Negative-Pressure Wound Therapy ; Oxygen ; Pressure ; Skin ; Skin Transplantation ; Ulcer ; Vacuum

Objective To investigate the present situation on therapy and secondary prevention of coronary heart disease (CHD) in the elderly,and to improve treatment and secondary prevention.Methods Cross sectional,non-intervention and multicenter survey was used in this study.All 7962 effective interviewed cases were with aged ≥60 years from 116 hospitals of 21 provinces and cities during April and July of 2011.Among them,male was 63.4％,aged (73.0±7.9) years,24.1％cases were aged ≥80 years.The current treatment and risk factors of elderly CHD were investigated by questionnaire including basic information,health check,types and severe degree of CHD,its therapy and prevention,and control of the risk factors.Results (1) All cases were received drugs and percutaneous coronaryintervention (PCI) or surgery,27.5％ cases of PCI,2.6％ of coronary artery bypass grafting(CABG),70.4％ cases of expectant treatment.(2) The ratio of cases with angina pectoris and myocardial infarction was 76.5 ％,the attack of angina pectoris ≥3 times/weeks in recent month was 48.3％,Canadian Cardiovascular Society(CCS) Ⅱ scores and over was 79.3％.(3) The utility ratio of prevention drugs recommended by the guidelines were 70.3％ antiplatelet drug,54.9％ lipid regulating agents,47.5％ BB,29.0％/22.2％ ACEI/ARB.(4)The situation of risk factor control was as followed:among all the cases,38.9％ of them with active smoking≥1 counts/day,28.4％ of them with passive smoking,57.6％ of them with BMI ≥24,46.4％ of male with waistline ≥90 cm,41.1％ of female with waistline≥85 cm.In our cases,67.6％ of them with hypertension and 56.6％ achieved the level of blood pressure＜140/90 mm Hg; 23.4％ with diabetes mellitus and 49.5％ achieved the level of HbA1c ＜7.0％; 33.2％ with Lipids disorder and 26.6％ achieved the level of TC＜4.1 mmol/L,27.5％ of LDL-C＜2.6 mmol/L.(5) The analysis showed that there were more attacks of angina pectoris in the groups of male than female(P=0.0050),those HbA1c ≥7.0％ than those ＜7.0％ (P=0.019),and those LDL-C≥2.6 mmol/L than those ＜2.6 mmol/L (P =0.044),and that there were less attacks in those with CABG than without it (P＜0.001) and in those with PCI than without it (P＜0.001).Conclusions Inadequate control of symptom,insufficient utility ratio of prevention drugs and control of risk factors appear in elderly CHD.Coronary revascularization,drug use of guidelines recommend and control of high risks are the key points of high curative effect of elderly CHD.

Craniofacial Abnormalities ; genetics ; Humans ; Mutation ; Tooth Abnormalities ; genetics

Objective:To study the possible immune escape mechanisms of HCoV-OC43 from human dendritic cells(DC).Methods:HCoV-OC43 was isolated from clinical specimen using BSC-1 cells and identified by Real-time PCR,and the cytopathic effect was observed by phase contrast microscope.DCs were induced in vivo using hu-GM-CSF and IL-4 cytokines,and after 7 days of differentiation,DCs were infected by HCoV-OC43.The morphology of HCoV-OC43 infected DC was observed by transmission electron microscope,and the cytokines related to DC functions were detected by Real-time PCR after infection.DC proportion and function related co-stimulatory molecules were analyzed by flow cytometry.Results:In vitro HCoV-OC43 infected human DC model was successfully built.HCoV-OC43 can infect DC and generate immune response of DC in vitro,but no virus nucleonic acid could be detected in culture supernatant.The DC expression of IFN-α,IFN-β,CCL3 and CCL5 were significant decreased when infected with HCoV-OC43,but the expression of costimulatory molecules including HLA-DR,CD1c and CD86 were not affected by HCoV-OC43 infection.Conclusion:Human DC could be infected by HCoV-OC43 and generate immune response,but could not produce progeny virus.HCoV-OC43 may escape from immune response by suppressing the expression of IFN-α and other inflammatory cytokines and chemokines in DC.