10.3969/j.issn.2095-4344.2013.24.003

[Objective] To assess the changes in bone marrow microenvironment in patients with psoriasis by determining the level of transforming growth factor β1 (TGF-β1),stem cell factor (SCF),keratinocyte growth factor (KGF) and tumor necrosis factor-α (TNF-α) secreted by bone marrow stromal cells(BMSCs).[Methods] This study recruited 20 healthy controls with normal bone marrow picture and 20 patients with psoriasis vulgaris,including 10 at progressive stage and 10 at resting stage.The psoriasis area and severity index (PASI) score varied from 0.6 to 22.8 and averaged 10.97 in these patients.Bone marrow mononuclear cells were isolated by density-gradient centrifugation from bone marrow of these subjects,and BMSCs were cultured with adherent method.After three passages,the BMSCs were subjected to a 72-hour culture followed by the identification of cell phenotypes via flow cytometry and determination of TGF-β1,SCF,KGF and TNF-α levels in the culture supernatant via enzyme linked immunosorbent assay (ELISA).The parameters were compared by two independent samples t test between the two groups,and the correlation of eytokines with PASI was assessed by Pearson correlation analysis.[Results] Inverted microscopy revealed no obvious difference in the morphology of BMSCs between the patients and controls.CD29 was expressed by more than 90％ of the BMSCs,but no expression of CD45,CD34 or HLA-DR was observed in them.The BMSCs from patients showed a significantly lower level of supematant TNF-α ((22.93 ± 10.1 1 ) μg/L vs.(35.73 ± 15.15) μg/L,t =3.14,P ＜ 0.05),a higher level of supernatant SCF ((76.80 + 16.19) μg/L vs.(59.86 + 22.41) μg/L,t =2.74,P＜ 0.05),and asimilar level of supernatant KGF and TGF-β1 (both P＞ 0.05) compared with those from the controls.The PASI score was uncorrelated with the levels of SCF,TNF-α,KGF or TGF-β1 secreted by BMSCs in patients with psoriasis (all P＞ 0.05).[Conclusion]s The levels of SCF and TNF-α secreted by BMSCs are aberrant in patients with psoriasis,hinting an abnormal bone marrow microenvironment in these patients.

Objective To determine the prevalence and risk factors of Epstein-Barr virus (EBV) infection after pediatric liver transplantation for patients with biliary atresia. Methods Clinical data of 65 pediatric patients with biliary atresia, who underwent liver transplantation, were retrospectively analyzed. Patients were divided into EBV infection group
(n=30) and non-EBV infection group (n=35). The univariate analysis was used to analyse the preoperative, intraoperative and postoperative data of patients included. The variables with a P <0.1 were included in the multivariate Logistic regression analysis of EBV infections after pediatric liver transplantation for patients with biliary atresia. Results A total of 30 cases (46.15%) of pediatric recipients showed EBV infection in 65 cases, of which 23 cases (76.67%) occurred within 3 months after operation. The univariate analysis showed that there were significant differences in the ratio of patients younger than 1 year preoperation, EBV serology D+/R-, acute rejection, the usage of mycophenolate mofetil and supratheraputic tacrolimus level between two groups (P<0.05) . The type of graft (P=0.060), input quantity of red blood cell intraoperation (P=0.063) and factors mentioned above were included in the multivariate Logistic regression analysis. It revealed that donor EBV serology positive but recipient negative, acute rejection and supratheraputic tacrolimus level were risk factors of EBV infection for pediatric liver transplantation recipients with biliary atresia. Conclusion Donor EBV serology positive but recipient negative, acute rejection, supratheraputic tacrolimus level are closely related to EBV infection in pediatric recipients with biliary atresia after liver transplantation. Appropriate antiviral drugs should be adopted to prevent EBV infection in high risk patients.

Objective To summarize the clinical characteristics and treatment of rotavirus infection after liver transplantation in children.Methods Thirty nine children undergoing liver transplantation in Beijing Friendship Hospital affiliated to Capital Medical University from October to December 201 4 were retrospectively analyzed.And 6 cases were infected with rotavirus after liver transplantation.Characteristics of clinical symptoms,complications,treatments and prognosis in these six children were retrospectively analyzed.Results Six cases were diagnosed with rotavirus infection at 8-1 97 d after liver transplantation with a median time of 22 d,3 cases of whom mainly manifested as high fever,diarrhea and vomiting and the remaining 3 presenting with diarrhea.The longer interval time between rotavirus infection and liver transplantation was,the slighter degree of rotavirus infection-related symptoms was.Among 6 cases,5 cases were complicated with EB virus,cytomegalovirus or respiratory syncytial virus,and 2 cases were complicated with abnormal liver or heart function.The main treatment was decreasing the dose of FK506.Gamma globulin was administered in partial affected children to enhance immunity.Effective therapy was delivered to regulate intestinal tract bacterial colony and relieve diarrhea.All children recovered after oral use of antibiotics and supporting therapy using fluid infusion.Two cases complicated with severe cardiac and liver function abnormality were healed after expectant treatment.Conclusions Rotavirus infection-related symptoms are relatively severe after liver transplantation in children,occasionally complicated with cardiac and liver function injury,which can gradually return to normal after efficacious therapy.

Objective:To evaluate the application effect of microlecture combined with PBL on the teaching of orthodontics.Methods:One hundred and forty undergraduates from Batch 2014 to Batch 2016 of School of Stomatology, Henan University were randomly divided into two groups, with 70 undergraduates in each group. Traditional teaching method was adopted in the control group, while microlecture combined with PBL was used in the observation group. The theoretical knowledge, clinical thinking and analysis ability, and operational skills were compared between the two groups. SPSS 18.0 was used to conduct t test and χ2 test. Results:The scores of basic knowledge [(83.67±5.73) points], case analysis [(82.64±5.54) points] and discussion and questions and answers [(81.57 ± 5.06) points] in the observation group were higher than those in the control group [(72.36±5.41) points, (70.41 ± 5.36) points, and (69.37±4.48) points, respectively], with statistically significant differences ( P < 0.05). The total excellent rate of clinical thinking and analysis ability and operational skills in the observation group were 94.29%(66/70) and 92.86%(65/70) respectively, which were higher than those in the control group [75.71%(53/70) and 74.29%(52/70)], with statistically significant differences ( P < 0.05). Conclusion:The application of microlecture combined with PBL has good effect on the teaching of orthodontics, which can improve the mastery of theoretical knowledge, clinical thinking and analysis ability and operational skills of students, and make them better apply theoretical knowledge in practical operation, thus improving comprehensive quality.

Objective To analyze the donor specific antibody (DSA) in liver transplantation,and discuss the therapeutic schemes.Methods We retrospectively analyzed prospectively collected samples from 139 cases of liver transplantation from September 1,2013 to July 1,2015.Luminex assays were applied to determine human leukocyte antigen,panel reactive antibody (PRA).For PRA positive cases,DSA,C1q and C4d were detected,and liver biopsy was done.Results Of 139 cases enrolled,there were 12 cases positive for DSAs,including 2 cases of PreDSA:1 case of Ⅰ DSA (HLA-A mismatch),and 1 case of Ⅱ DSA (HLA-DQ mismatch).Ten cases of de novo DSA (including 1 case of PreDSA) all were HLA-DQ mismatch.The liver biopsy on 5 cases showed hepatic fibrosis,early rejection and intrahepatic cholestasis,and only 2 cases showed positive C4d.Of 6 cases of DSA,5 cases showed positive C1q.In the patients positive for DSA,tacrolimus dose was adjusted postoperatively,adding mycophenolatemofetil or increasing its dose,or methylprednisolone and immunoglobulin given.Conclusion DSAs are important indicators of sensitized recipients in liver transplantation,associated with trends toward worse outcomes in patients or allografts.The monitoring of DSA is requisite in order to adjust the immunosuppressant.

Objective:To investugate the unique electrocardiogram (ECG) characteristics of fulminant myocarditis (FM) patients and provide important clues for the diagnosis of FM.Methods:This was a retrospective study. Patients diagnosed with acute myocarditis at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from February 2017 to April 2022 were enrolled and divided into fulminant myocarditis group (FM) and non-fulminant myocarditis group (NFM) according to clinical diagnosis. A total of 246 healthy people who underwent physical examination in the Health examination Center of Tongji Hospital at the same period were selected as the control group. The clinical data and ECG characteristics of the above 3 groups were analyzed and compared. Logistic regression model was used to analyze the influence of ECG parameters on left ventricular ejection fraction in FM patients. Receiver operating curves were constructed to evaluate the predictive value of different ECG parameters for FM.Results:A total of 180 patients were included in this study (FM group: n=123; NFM group: n=57), with an age of (35.0±16.2) years and 106 males (58.89%). Compared with NFM group, ECG was significantly abnormal in FM group, with a higher incidence of sinus tachycardia, ventricular tachycardia or ventricular fibrillation, escape rhythm, right bundle branch block, third degree atrioventricular block, ST-segment elevation, low voltage, prolonged QTc interval, and widened QRS wave in the FM group (all P<0.05). The ECG parameters showed that the amplitude of the full lead QRS wave in FM group was lower than that in NFM group ( P<0.01). The average heart rate and QTc interval of FM group were significantly higher than those of NFM and control groups (all P<0.05). Although ST-segment elevation had a higher incidence in the FM group, ECG parameters showed that except for leads Ⅲ and aVF, the ST segment levels in all leads in the FM group were lower than those in the control group (all P<0.05). There was a statistically significant difference in some ST segment changes between FM and NFM groups, while there was no statistical difference between the NFM and control groups. Multivariate regression analysis showed that widened QRS wave and increased heart rate were the influencing factors for left ventricular systolic dysfunction in FM patients ( OR=16.914, 95% CI: 1.367-209.224, P=0.028; OR=1.026, 95% CI: 1.010-1.042, P=0.001). Receiver operating curve analysis showed that heart rate>86.90 beat/min, QTc>431.50 ms, and RV5+SV1<1.72 mV had certain predictive value for FM diagnosis. Conclusions:FM patients displayed marked and severe ECG abnormalities, and characteristic changes in ECG can provide important first clues for the diagnosis of FM.