The hyper immunoglobulin M syndromes(HIGM) are a heterogeneous group of genetic disorders resulting in defects of immunoglobulin class switch recombination,with or without defects of somatic hypermutation.They can be classified as defects of signalling through CD40 causing combined immunodeficiency,or intrinsic defects in B cells of the mechanism of class switch recombination resulting in a pure humoral immunodeficiency.This review summarizes the molecular pathogenesis of HIGM.

Objective To research the immunologic reaction and the potential of chemically extracted acellular nerve allograft(CEANA) to repair peripheral nerve defects in primates. Methods Adult SD rats were used as nerve donors and adult male Wistar rats used as nerve recipient hosts. 25 mm long nerve segments were excised from SD rats' sciatic nerves. The nerve segments were decellularized via an improved chemical decelluarization treatment as follows: 1) nerve segments were rinsed with cold sterile Ringer's solution; 2)stabilized by pinning the ends to a thin plastic support, and submerged in 4% Triton-100 solution 12 h; 3)soaked into 72 mM sodium deoxycholate for 12 h; 4)washed in distilled water for 6 h. The procedures were repeated once again. Median nerve segments were obtained from macaques and decellularized according to above procedures. The CEANA from SD rats were implanted into Wistar rats subcutanously. The control group was implantation of fresh nerve allografts from SD rats. The immunogenicity of acellular nerve allograft was tested by immunohistochemical examination of the intensity of CD3+, CD4+ and CD8+ cells that infiltrated the allografts. Median nerve defects for 5 cm were created in three macaques. CEANA were interposed across the gap. The CEANA were anastomosed microsurgically to the epineurium of proximal and distal stumps. Results The number of CD3, CD4 and CD8 positive lymphocytes infiltration in CEANA was far lower than that in the control group of fresh nerve allografts at 2 weeks and 4 weeks after implantation. There was no significant evidence of inflammatory in the CEANA grafted group. In the experiment of nerve regeneration of macaques, electromyographic activity was recorded across the allografts. The conduction velocity of regenerated nerve was (40.5?6.8) m/s. Regenerated axons sprouted from the proximal portion reached the distal portion of the grafts, and Schwann cells were also present in the central portion of the CEANA. Motor end-plates were observed in reinnervated muscles. Conclusion The immunogenicity that would have initiated cell-mediated immunological rejection of CEANA are removed. The implantation of CEANA could repair the defect of median nerve 5 cm long in the arm 5 months postoperatively. The CEANA as a type of substitute of nerve autografts has the potential to repair peripheral nerve defects in primates.

A registered dietitian credential is generally accepted and recognized as the most authoritative certificate of eligibility for American dietitians.In this article we describe in detail the American Registered Dieti-tian (RD) training system,administered by the Commission on Accreditation for Dietetics Education (CADE) and the Commission on Dietetic Registration (CDR) of the American Dietetic Association (ADA).Taking the Division of Nutritional Sciences of Cornell University as a good example of the RD training unit,we describe the Cornell Un-dergraduate Didactic Program in Dietetics and Dietetic Internship.Career opportunities and job outlook for Ameri-can registered dietitians are also presented.

AIM: To explore whether inhibition of NF-?B by antioxidant pvrrolidine dithiocarbamate (PDTC) sensitizes leukemia cells to cytotoxic drugs and its mechanism. METHODS: The indirect immunofluorescence method and electrophoretic mobility shift assay (EMSA) were used to measure the activation of NF-?B. The apoptotic cells were evaluated by flow cytometry (FCM) and the in vitro growth inhibitory effect was performed using a MTT assay. RESULTS: EMSA showed that NF-?B was activated by daunorubicin (DNR), VP-16 and then was inhibited by PDTC in a dose-dependent manner. NF-?B activation was further verified because of subunit RelA of NF-?B locating in the nuclei. FCM analysis showed that apoptotic index of HL-60 cells was up to (8.97?0.81)%, (16.01?1.06)%, (22.96?1.33)% from (5.34?0.62)%, (10.16?0.42)%, (17.32?1.15)% after exposure of HL-60 cells to 2.5-10 mg/L VP-16 combined with PDTC. VP-16 added with PDTC produced greater growth inhibitory effect to HL-60 cells than did VP-16 or DNR only (P

Objective To establish an assessment scale for hospital stroke patients with Delphi method,by using it to help the nurses evaluate patients' existing and potential problems,and to provide foundations for specific assessment on different patient groups.Methods The first-level indicators and second-level indicators were developed on the basis of the Omaha system.210 nursing records of hospital stroke patients were then combined with to form concrete items.Totally 22 nursing specialists were interviewed with two rounds in order to further collect the opinions and suggestions about the assessment scale.Results 4 first-level indicators,35 second-level indicators and a number of items were included in the assessment scale.Conclusions The assessment scale for hospital stroke patients established by Delphi method comprehensively shows the environmental,physical,mental and behavioral condition in hospital,and it could be used as a tool to assess the hospital stroke patients.

Objective To investigate the clinical value of the Classification of acute pancreatitis2012.Methods Medical records and clinical data of patients with acute pancreatitis (AP) who were admitted to First Affiliated Hospital of Guangxi Medical University between October 2009 and September 2012 were retrospectively reviewed and analyzed.Patients were divided into mild acute pancreatitis (MAP),moderately severe acute pancreatitis (MSAP),and severe acute pancreatitis (SAP) groups according to the Classification of acute pancreatitis-2012.The number of improved and cured patients,length of hospital stay,hospitalization costs,rate of ICU admission,length of ICU stay,incidence of SIRS,and length of SIRS continue,Ranson scores,APACHE Ⅱ scores,computed tomographic severity index (CTSI) scores among the 3 groups were compared.Results One hundred and sixty-six patients with AP (119 males and 47 females) were included,and 76 were MAP,65 MSAP and 25 SAP.The average interval between AP onset and hospital admission was (2.27 ± 1.46) d.The number of improved and cured patients,length of hospital stay,hospitalization costs,rate of ICU admission,length of ICU stay,incidence of SIRS,and length of SIRS continue,Ranson scores,APACHE Ⅱ scores,CTSI scores increased with the severity of AP.The corresponding values in SAP group were 21 cases (84.0％),(23.8 ± 13.6) d,(53900 ± 30260) Yuan,48.0％ (12/25) and (5.76 ± 13.8) d,96.0％ (24/25) and (5.00 ± 2.40) d,(3.76 ± 1.30) score,(8.52 ± 4.24) score,(5.44 ± 3.48) score.Seventy-nine patients developed local complications,among them 34 was acute peripancreatic fluid collection,45 was acute necrosis collection.The incidence of acute necrosis collection in SAP group was significantly higher than that in MSAP group (68.0％ vs 44.6％,P =0.047),but the incidence of acute peripancreatic fluid collection in SAP group was significantly lower than that in MSAP group (16.0％ vs 46.2％,P =0.016).Organ failure occurred in 42 patients,among them 35 cases were respiratory failure,2 cases were renal failure,and 5 cases were respiratary and renal failure.The incidence of organ failure in SAP and MSAP group was 100％ and 26.2％,the difference between the two groups was statistically significant (P ＜ 0.05).Conclusions Classification of acute pancreatitis-2012 is a simple and convenient system,which can predict the severity of AP and appropriate for clinical application.

Objective To investigate the effects of probiotics on the occurrence of ovalbumin (OVA) induced food allergy and the regulatory effects on immune function of rat models. Methods Thirty female Brown-Norway rats aged 3 weeks were randomly divided into blank control group,food allergy group and probiotics intervention group(n=10).The levels of serum OVA-IgE and intestinal sIgA were measured by ELISA method.Splenic lymphocytes were isolated and cultured in vitro,and the Treg lymphocyte subgroups in the spleen were analyzed by flow eytometry.The levels of IFN-γ,IL-4 and IL-10 in the supernatant of cultured splenic lymphocytes were measured by ELISA method. Results The serum OVA-IgE level in food allergy group was significantly higher than that in blank control group(P<0.05),while that in probiotics intervention group was significantly lower than that in food allergy group(P<0.05).Compared with food allergy group and blank control group,the level of intestinal sIgA in probiotics intervention group was significantly higher(P<0.05).The percentage of CD4~+CD25~+T lymphoeytes in food allergy group was significantly lower than that in blank contml group(P0.05).The levels of IL-4 and IL-10 in food allergy group were significantly higher than those in blank control group(P<0.05).Probiotics intervention group had significantly lower levels of IL-4,IL-10 and IFN-γ than food allergy group(P<0.05).The ratio of IFN-γ/IL-4 in food allergy group was significantly lower than that in blank control group(P<0.05),while that in probiotics intervention group was significantly higher than that in food allergy group(P<0.05). Conclusion Probioties intervention could prevent the occurrence of food allergy in animal models by modulating the Th1/Th2 eytokine balance.

Objective To investigate the expression patterns of fibroblast growth factor 23 (FGF23) in osteoblast and its responses to calcium, phosphate, exogenous PTH and 1,25(OH)_2D~3. Methods The primary rat calvarial osteoblasts were cultured in MEM medium which containing 10% FBS, then were harvested when cells were in half-confluence, confluence, osteoid deposition and osteoid mineralization stages respectively. The procedure was monitored under microscopy. Total RNA was extracted from cells according to the Trizol procedure. FGF23 mRNA levels were determined by Real-time PCR. Further, the confluent osteoblasts were treated with 3.2 mmol/L CaCl_2, 4.4 mmol/L β-glycerophosphate, 10~(-9) mol/L rhPTH(1-34) and 10~(-8) mol/L 1,25(OH)_2D_3 respectively for 3 days, and same volume of the medium was added as the control. The gene expressions were determined by Real-time PCR. Results FGF23 expression was transiently up-regulated at cell confluent stage and down-regulated after that. The FGF23 mRNA levels were 7.5-fold higher in confluent cells compared with that in half-confluent cells (P<0.001). The markedlly stimulating effect (about 16 times) on FGF23 expression was stimulated by exogenous 1,25(OH)_2D_3 treatment while no significant effect was found on FGF23 mRNA levels by CaCl_2,β-glycerophosphate, and rhPTH(1-34) treatments when compared with the control. Conclusions The FGF23 expression in osteoblast is developmental stage-related and its powerful stimulator is 1,25(OH)_2D.

Objective To investigate the clinical outcomes on implantation of hydroxyapatite orbit after scleral flap especially in the cosmetic results. Methods Implant hydroxyapatite orbital after scleral flap for the treatment of all kinds of patients who should be enucleated, including 14 cases of eyeball atrophy, 5 cases of sclerocorneal staphyloma, 3 cases of absolute glaucoma, 3 cases of neovaseular glaucoma and 7 cases of eyeball rupture. Results We observed that the orbit was full and the orbital movement was smooth in all cases. After 3 to 12 months follow-up we found that no hydroxyapatite exposed or moved. Conclusion Good cosmetic results can be achieved by the implantation of hydroxyapatite orbit after scleral flap.

Objectives:To understand the medical students'cognition of violence injury medical and the impact of medical injury events reports on medical students.Methods:A sample survey was conducted among 480 medical students in a medical university using self-developed questionnaire.Results:A total of 63.67％ of the medical students get violence injury events information through television news;more than 90％ of medical students were concerned about the media reports of violence injury medical events.The media reports of violence injury medical events had an important impact on medical students,and especially television reports had the greatest impact.41.2％ of the students would enhance their awareness of protection;37.9％ of medical students thought that work passion and enthusiasm would decline;the impact of reports on men was bigger than women (P ＜ 0.05).Conclusion:The report of violence injury medical events has an important impact on medical students.The media should improve self-discipline,create a harmonious public opinion environment and promote the healthy development of doctor-patient relationship.