Objective To study the location of mycobacterium tuberculosis(MTB) and whether the cellular immunity is induced after immunization of H37Ra in mice.Methods Totally 72 BALB/C mice were included.Thirty mice were intracutaneously injected of 0.1 ml H37Ra solution(about 10~(6) bacteria) at caudal region;thirty mice were injected of BCG of same quantity instead;twelve were free from immunization as control.Viable MTB were detected in spleen and lungs on day 15,30 and 60 after intracutaneous vaccination of H37Ra.The proliferation of T lymphocytes stimulated with purified protein derivative(PPD) was measured by MTT assay and the production of interleukin-2(IL-2) and soluble interleukin-2 receptor(sIL-2R) in the cultural supernatants of T lymphocytes was also determined by ELISA on day 30 and 60 after intracutaneous vaccination of H37Ra.Results Viable H37Ra or BCG could be located in the spleen and lungs in mice for at least 60 d.After H37Ra immunization,the stimulation index(SI) of T lymphocyte proliferation on day 30 and 60 was(2.81?0.63),(2.16?0.52) respectively,which was of no significant difference with that of BCG immunization,but of significant difference with that of non-immunized mice(P

Aim To explore the mechanism of E.coli heat-labile enterotoxin B subunit(LTB)as adjuvant by analysis of cellular proteins interacting with LTB. Methods Whole cell proteins were purified from RAW 264.7 cell after treated with LTB or NaCl 12 h, respectively.The cellular proteins were interacted with LTB and the interacting proteins were purified by pull-down assay and identified by mass spectrography.The LTB interaction proteins were conformed with Western blot and immunofluorescence assay.Results 25 LTB interaction proteins were found,and their interaction network was mapped;four proteins (Jup,Dsp,Ddx5 and Vimentin)were indicated to be related with LTB adjuvant activity;immunofluorescence assay indicated that GM130 interacted with LTB,however,Vimentin had no interaction with LTB in vivo.After treated by LTB,the expression of β-actin was upregulated obvi-ously in RAW 264.7 cell,whereras,Hspd1 did not show any change.Conclusions LTB exerts adjuvant activity through binding to GM1 of immune cells,cau-sing endocytosis and transporting to the Golgi apparatus by vesicles.Then LTB might bind to Jup and affect TCF/LEF activity,regulating the expression of Bcl 2, IL-6,and Runx3.The result is promoted T cell and B cell proliferation,differentiation and activation by se-cretion of cytokines and immunoglobulins.

Objective To develop a sandplay analysis evaluation matrix for children with tic disor?ders. Methods 113 children were chosen as the study subjects . Based on the grounded theory,the open coding,correlated coding and core coding were carried out on coding elements for sandplay process to gain the third?level,second?level and first?level evaluation codes. The reliability and validity of the codes were tested.Results The sandplay analysis evaluation matrix for children with tic disorders was established inclu?ding 48 third?level,17 second?level and 3 first?level evaluation codes. The codes were proved to be reliable and valid through the comparison and conditional coding with query. Conclusion The sandplay analysis e?valuation matrix for children with tic disorders,which is established based on the grounded theory,is reliable and operable. It can be used as a tool to assess the psychological or behavioral problems of children with tic disorders dynamically.

Objective To observe the effects of botulinum toxin A(BTX-A) injection combined with treadmill training on motor and gastrocnemius function in rats after spinal cord injury (SCI),so as to develop a possible treatment.Methods A total of 48 female Sprague-Dawley rats were randomly divided into four groups(n =12 in each):a control group which received normal saline injection(group Con-NS),an exercise group with normal saline injection(group Ex-NS),the other control group with BTX-A injection(group Con-BTX)and an exercise group which also received BTX-A injection(group Ex-BTX).All rats were subjected to incomplete SCI modelling using Allen's method.Each group then had l0 members left because of death or significant weight loss.After SCI modelling,BTX-A or normal saline were injected to rats' gastrocnemius,followed by weight support treadmill training(BWSTT) on days 7 through 35 days for the two exercise groups.Motor function was evaluated using inclined plane test before and 2 days,1,2,3,4 and 5 weeks after the injury.All rats were sacrificed 35 days after the surgery.Digit Abduction Scoring(DAS) and electrophysiological testing were performed prior to sacrifice,and the general form and the wet weight of gastrocnemius were observed after resection.Results No significant differences in the inclined plane angle among 4 groups were detected before injury and 2 days afterward (P ＞ 0.05).At the 2nd-Sth week,however,the inclined plane angles in group Ex-NS were significantly higher than those in group Con-NS (P ＜ 0.05).Those of group Ex-NS were also significantly higher than group Ex-BTX 2-5 weeks after injury (P ＜ 0.05).No significant differences were detected between group Con-BTX and group Ex-BTX,as well as group Con-NS and group Ex-BTX at each time point (P ＞ 0.05).And the average DAS score in group Con-BTX and group Ex-BTX was 0,while that of Con-NS group and group Ex-NS were both 4.There were no significant differences between the two normal saline injection groups (P ＜ 0.05),nor between the two BTX-A injection groups (P ＜ 0.05).However,the average DAS scores in the Con-BTX and Ex-BTX groups were significantly higher than the Con-NS and Ex-NS groups (P ＜ 0.05).No significant atrophy of gastrocnemius muscles were observed in the Con-NS group or Ex-NS group,and as would be expected,the muscles in group Ex-NS were thicker on average than those in group Con-NS.Significant atrophy was observed in group Con-BTX and group Ex-BTX.Moreover,the muscle wet weight was significantly higher in group ExNS than group Con-NS (P ＜ 0.05).Compared with group Con-NS and group Ex-NS,the muscle wet weight was significantly lower in group Con-BTX and group Ex-BTX (P ＜ 0.05).No significant differences in the latency of the compound muscle action potential (CAMP) were detected among 4 groups (P ＞0.05),but the CAMP amplitude was significantly less in the control groups than in the exercise groups.(P ＜0.05).Conclusions Exercise training can significantly improve motor and skeletal muscle function in SCI rats,but BTX-A injection can inhibit the improvement.

Objective To characterize 15 months later the quality of life (QOL) and depression of those with spinal cord injury (SCI) suffered during the Wenchuan earthquake,and to identify the influence factors.MethodsA sample of 27 individuals who sustained SCI during the Wenchuan earthquake were surveyed using face- to-face interviews.QOL was measured using the brief version of the World Health Organization's Quality of Life Assessment instrument.Depression was measured using the patient health questionnaire depression module 9.Stepwise multiple linear regression was employed to determine the factors most closely related with QOL and depression. ResultsStepwise linear regression showed a significant correlation of overall QOL with literacy and age.The younger or illiterate victims showed a lower overall QOL.General health was also associated with ability in the activities of daily living and with pain.Victims with better daily ability and less pain may have had better general health.Depression correlated with literacy and secondary condition.Illiterate patients or patients influenced more by a secondary condition displayed more serious depression than the others.Additionally,social participation was significantly associated with the physical health,psychological health and social relationships domains of QOL.ConclusionThe QOL of long-term SCI victims caused by the earthquake is closely related to age,literacy,pain,participation and physical independence.Depression is associated with illiteracy and secondary conditions.Attention should be paid to these correlations in designing long-term rehabilitation strategies.

Objective To analyze the outcomes of clinical management and rehabilitation interventions for earthquake victims with spinal cord injury. Methods Comprehensive rehabilitation intervention was conducted for 3 to 4 months with 51 earthquake victims with spinal cord injuries. The study involved their physical examination and on site interviews during hospitalization, and follow-up by telephone. Etiology, severity, complications and outcomes of rehabilitation and clinical management were analyzed. Results In 9.8% of the patients the spinal cord injury was at C7 or above, 5.9% at C8 to T6 , 68.6% at T7 to L2 , 13.7% at L3 to S2 and 2.0% at S2 or below. There were 22 complete injuries and 29 incomplete. After 4 months of training, 76.5% of the wounded reached wheelchair independence, 78.4% ambulated with an orthosis and 88.2% were partially independent in the activities of daily living.Conclusions The comprehensive rehabilitation intervention allowed most of the victims to resume an independent life. Their long-term care remains a challenge.

Objective To analyze factors contributing to the quality of life of earthquake victims with nonunion fracture in limbs after medical rehabilitation and to provide a clinical reference for future disasters.Methods Thirty-one wounded who sustained their injuries in the Sichuan earthquake completed the short form-36(SF-36)questionnaire 2 weeks before their amputation,and after 3,6 and 12 months of medical rehabilitation.The SF-36scores were compared with Sichuan population norms.Stepwise multiple linear regression was used to highlight variables which influenced their functional recovery and their physical and mental health.Results The physical and mental health composite scores of the 31 victims were significantly lower than Sichuan population norms before medical rehabilitation,but they had a significant increasing trend after 3,6 and 12 months of treatment.Their scores on all the domains remained significantly lower than Sichuan population norms at a later follow-up.Smoking,external fixations and chronic diseases were related to their recovery of physical function.Age,permanent housing,family income and casualties among family members were related to their mental health recovery.Conclusion The quality of life of patients with nonunion fracture caused by earthquake can be improved significantly through medical rehabilitation.But social factors should be considered in addition to medical rehabilitation after an earthquake.

With the development of imaging technology, high-resolution magnetic resonance vascular wall imaging technology has been gradually applied to the risk assessment of intracranial aneurysms rupture. It has provided more comprehensive information for clinicians to assess the stability of intracranial aneurysms. This article summarizes the indicators used for assessing the risk of intracranial aneurysms rupture in recent years with high-resolution magnetic resonance vascular wall imaging.

Objective:To construct and validate a theoretical model of residents′ willingness to participate in tiered medical care based on harmonious management theory, providing reference for promoting the tiered medical care system and aiding governmental decision-making.Methods:Based on the harmonious management theory and literature review, a model capturing residents′ propensity to engage in tiered medical care was formulated. Using convenience sampling method, a questionnaire survey was conducted on 2 067 residents from 24 communities in Zhejiang province from April to May 2022. Descriptive statistical analysis was conducted on the survey results, and multilevel linear regression and structural equation modeling were used to analyze the driving mechanism of residents′ willingness to participate in tiered medical care.Results:The willingness rate of residents to participate in tiered medical care was 69.7%, which was at an average level. Regression insights highlighted the positive influence of policy support perception ( β=0.170, P<0.01), awareness of management mechanisms ( β=0.093, P<0.01), cognitive attitudes ( β=0.102, P<0.01), and trust levels ( β=0.244, P<0.01) on residents′ participation willingness. In contrast, resource allocation perceptions lacked a significant effect ( β=0.065, P>0.05). The structural equation model revealed that cognitive attitudes played a mediating role in the " policy system perception → participation willingness" and " management mechanism perception → participation willingness" pathways, with effect sizes of 0.030 and 0.039, respectively. Trust levels also mediated these paths, with effect sizes of 0.039 and 0.045, and entirely mediated the " resource allocation perception → participation willingness" path, registering an effect size of 0.053. Conclusions:The harmonious management theory can be used to explain the formation mechanism of residents′ willingness to participate in tiered medical care. The government and medical institutions urgently need to further improve residents′ awareness of tiered medical care, focus on enhancing residents′ trust, and further improve policies and management measures such as financial investment, medical insurance reimbursement, and referral systems.

Objective: To compare the clinical effects of laparoscopic repair and open repair of gastroduodenal ulcer perforation. Methods: Retrospective analysis was performed on 117 patients with perforated gastroduodenal ulcer admitted to Sijing Hospital of Shanghai Songjiang District from October 2005 to February 2018, including 86 males and 31 females. The average age was 35.56 years with a range from 17 to 68 years. Patients were divided into two groups according to different surgical methods: laparoscopic group (n=56) and open group (n=61). Patients in the laparoscopic group were received laparoscopic repair for perforated gastroduodenal ulcer, while patients in the open group received open repair for perforated gastroduodenal ulcer. Comparison of two groups of patients with operation time, intraoperative blood loss, postoperative first anal exhaust time, analgesic utilization rate, length of hospital stay, the body′s inflammatory response [preoperative and 24 h, 72 h, 120 h of postoperative peripheral white blood cell (WBC)], C-reactive protein level (CRP), postoperative complications (postoperative incision infection, incision dehiscence, gastric duodenal fistula, abdominal abscess, adhesion intestinal obstruction and lung infection). Measurement data were expressed as mean±standard deviation (Mean±SD), and t-test was used for comparison between groups; count data were compared by Chi-square test. Results: All the patients in the two groups successfully completed the operation, and there were no cases transferred to laparotomy in the laparoscopic group. Intraoperative blood loss[(15.3±9.5) ml vs (30.5±11.3) ml, P<0.001], time of first anal exhaust[(56.5±9.8) h vs (83.8±15.6) h, P<0.001], analygesic utilization rate (10.71% vs 52.46%, P<0.005), and length of hospital stay [(7.5±1.5) d vs (10.0±3.4) d, P<0.001] of the laparoscopic group were significantly better in the open group, the differences were statistically significant. The WBC and CRP at 24 h, 72 h and 120 h after surgery of the laparoscopic group were also significantly better than in the open group [WBC: 24 h, (14.55±3.44) ×10⁹/L vs (16.02±4.12) ×10⁹/L, P=0.020; 72 h, (10.25±2.32) ×10⁹/L vs (14.22±3.29) ×10⁹/L, P<0.001; 120 h, (8.12±3.11)×10⁹/L vs (11.58±2.33) ×10⁹/L, P<0.001. CRP: 24 h, (50.35±13.73) mg/L vs (80.11±13.56) mg/L, P<0.001; 72 h, (29.37±7.81) mg/L vs (53.57±8.05) mg/L, P<0.001; 120 h, (17.71±7.01) mg/L vs (34.35±7.72) mg/L, P<0.001], the differences were statistically significant. There was no significant difference in operation time and postoperative complications between the two groups (P>0.05). Conclusion Compared with open gastroduodenal ulcer perforation repair, laparoscopic gastroduodenal ulcer perforation repair surgery trauma are smaller, and the body′s inflammatory response are lighter, postoperative complications is no statistical significance, but will look from actual data, the cases of complications is less, is now a better surgical treatment of gastroduodenal ulcer perforation.