Objective To investigate the change of regulatory T-cells (Treg) before and after therapy in patients with autoimmune hemolytic anemia (AIHA),and to study the role of Treg in AIHA.Methods Treg cells numbers was measured by flow cytometry.Results Before treatment,Treg cells in AIHA patients was (1.32 ± 0.87) ％,which was significantly lower than (3.08 ± 0.96) ％ in the controls (t =-5.37,P ＜ 0.01).After treatment,Treg cells in AIHA patients was significantly increased [(4.96 ± 1.13)％] (t =-16.94,P ＜0.01).Conclusion Treg cells decreased in AIHA patients.Glucocorticoid might play a role in AIHA treatment by up-regulating Treg cells number.

BACKGROUND: Anterior decompression and internal fixation for treatment of cervical spondylotic myelopathy has been widely accepted. However, there are few clinical case reports regarding this.OBJECTIVE: To investigate the curative efficacy of anterior cervical decompression combined with bone grafting and titanium plate internal fixation in treatment of cervical spondylotic myelopathy.METHODS: A total of 118 patients with cervical spondylotic myelopathy who underwent anterior cervical subtotal vertebrectomy,iliac bone grafting (or bone grafting with titanium cage) and anterior locking titanium plate internal fixation at the Department of Orthopedics, Huang Gang Central Hospital of Hubei Province between January 2001 and August 2007 were retrospectively analyzed. According to the X-ray photographs taken before, immediately after surgery and during postoperative follow-up periods,Cobb's angle, anterior vertebral height and posterior vertebral height of fused segments. Bone graft fusion was evaluated.Neurological function was assessed according to Japanese Orthopaedic Association (JOA) scores.RESULTS: During the follow-up period (6-32 months, mean 19 months), three patients presented with slight titanium mesh sinking, and no fragmentation or loosening during internal fixation was observed in all patients, with a final bone fusion rate of 100％. JOA scores obtained immediately after surgery and during last follow-up were significantly greater compared with those obtained prior to surgery (P ＜ 0.05). The excellent and good rate of neurological function recovery during the last follow-up was 86.2％. After surgery, sagittal Cobb's angle, anterior and posterior vertebral heights of fused segments were significantly improved(P ＜ 0.05). These findings indicate that anterior cervical subtotal decompression combined with bone grafting and titanium plateinternal fixation for treatment of cervical spondylotic myelopathy can thoroughly decompress, effectively correct cervical vertebrae malformation, and achieve stable bone fusion and reconstruction, with satisfactory clinical efficacy.

Objective · To evaluate the value of ultrasonic measurement of distance from skin to epiglottis (DSE) for predicting the difficult airway. Methods · 71 patients (20-80 year-old, ASA Ⅰ-Ⅲ ) undergoing endotracheal intubation and general anesthesia for an elective surgical procedure were enrolled. Conventional airway evaluation was performed. The distance from skin at thyroid cartilage upper edge to epiglottis was measured using ultrasound before anesthesia and compared between patients with difficult airway and normal airway. The effects of different methods for evaluating difficult airway were analyzed Results · The ultrasonic measurements of DSE on parasagittal view in patients with difficult airway and normal airway were (23.31±0.43) mm and (19.21±0.27) mm, respectively. The difference was statistically significant (P=0.003). The area under the ROC curve of ultrasonic measurement was 0.799 (95% CI:0.639-0.958) with the best cutoff point of 23.6 mm. The specificity of ultrasonic measurement was significantly increased as compared with Mallampati classification (96.43% vs 71.40%, P=0.004). The difference in sensitivity was not statistically significant (60.00% vs 73.33%, P=0.170). Conclusion · Ultrasonic measurement of DSE on parasagittal view can be used to predict the difficult airway.

OBJECTIVE To study effective and convenient method for paraffin oil sterilization.METHODS By using carrier qualitative germicidal test,to compare pressure steam sterilization,dry heat sterilization and cobalt-60(gamma)-ray radiation sterilization to test the sterilizing effect and operating procedure.RESULTS Pressure steam sterilization was unable to achieve 100% sterilizing effect,whether we extended the time or use the intermittent(sterilization).After dry heat or radiation sterilization processes,no microorganism was found.CONCLUSIONS Effect of sterilization with dry heat or radiation sterilization is trustable,but its packing,operation and equipment are requested strictly,and pressure steam sterilization may be not good for paraffin oil.

In this cross-sectional study, consecutive Chinese Han ethnic inpatients in the Division of Cardiology, the First Affiliated Hospital of Soochow University from January 1, 2010 to December 31, 2013 were included. According to the exclusion criteria, 9 587 patients [1 604 with type 2 diabetes mellitus (T2DM) and 7 983 without T2DM]were obtained for final analysis. Logistic regression model was used to analyze the association of ApoB/A-1 ratio with T2DM and the possible interactions between ApoB/A-1 ratio and other risk factors. The results showed that the distribution of ApoB/A-1 ratio was positively skewed in Chinese Han ethic population. The median of ApoB/A-1 ratio of female was lower than that of male (0.68 vs 0.73,P<0.01). In all groups, the proportion of T2DM was increased with the raised ApoB/A-1 ratio. By the stratification analyses of sex, age, coronary artery disease, and the use of statins, ApoB/A-1 ratio was still correlated with T2DM. There existed significant interactions between ApoB/A-1 ratio and the smoking status or creatinine in T2DM.

Objective To investigate the long-term effect and radiation side reaction of different boost methods in patients with local remnants of locally advanced nasopharyngeal carcinoma after curative radiotherapy Methods Based on the retrospective analysis , 102 patients with local remnants of locally advanced nasopharyngeal carcinoma, after curative radiotherapy, were enrolled from February 2009 to May 2011. Forty-nine patients received gamma knife boost and 53 patients received 3-dimensional conformal radiotherapy (3D-CRT). The long-term effect and radiation side reaction were compared between the two groups. Results The 1-year, 3-year, and 5-year relapse-free survival rate (RFS) in the gamma knife boost group and the 3D-CRT group was 97.8%, 90.0%, 80.8%, and 94.3%,76.1%,72.9%, respectively (P < 0.05). No significant differences of the overall survival and metastasis-free survival rate wer found in two groups , as well as the long-term radioactive reaction. Conclusion The gamma knife boost is better than 3D-CRT with respect to local control rate , but the long-term radiation side reactions were similar between the methods.

Objective To explore the operative technique of liver retransplantation.Methods The clinical data of 24 patients who underwent liver retransplantation in the recent 4 years in our center were reviewed.In all of the patients a modified piggy-back liver transplantation was adopted.Extracorporeal venous bypass was used in 6 cases,and no bypass was used in 18 cases.We anastomosed the suprahepatic inferior vena cava to the annexed vena cava in a modified piggy-back figuration.The portal vein was reconstructed by end-to-end anastomosis.In 17 cases the hepaticy artery was anastomosed end-to-end,and in the other 7 cases was(anastomosed) to abdominal aorta by interposition graft.In 6 cases the biliary tract was reconstructed by(end-to-end) anastomosis,and in the others by choledochojejunostomy.All of the patients were routinely followed up after operation.Results Postoperative mortality of liver retransplantation was 41.6%(10/24).The cause of death was sepsis in 7 patients,intraoperative bleeding in 2,and cerebral hemorrhage in 1.The other patients(14/24,58.4%) successfully recovered after liver retransplantation.The complication rate in this group was 21.4%%(3/14),including biliary tract complications in 2 patients,and wound dehiscence in 1.Conclusions There was no significant difference in operative time and blood loss between liver(retransplantation) and primary transplantation.The key for success is to adopt individuation in selection of(methods) for liver retransplantation.The difficulty of liver retransplantation is exposure and mobilization of(inferior) vena cava. The probability of interposition graft from hepatic artery to abdominal aorta and(choledochojejunostomy) is higer than that of primary liver transplantation.

BACKGROUND: Tumor recurrence in liver transplant recipients greatly affects prognosis of liver transplantation with hepatocellular carcinoma (HCC). How to prevent tumor recurrence has aroused increasing attention. Arsenious acid chemotherapy is considered effective on treating moderate or advanced liver cancer, but its utilization following liver transplantation remains few. OBJECTIVE: To explore the role of arsenious acid on tumor recurrence in liver transplant patients with primary HCC extending Milan criteria. RESULTS AND CONCLUSION: All patients were routinely followed up for 3-32 months. Thirty recipients were presented with tumor recurrence, 16 in the chemotherapy group and 14 in the non-chemotherapy group. Tumor recurred in lung, liver graft and bones in most cases. The total recurrence rate was similar in these two groups, but chemotherapy could delay recurrence after transplantation (P=0.026). There was no significance in 6-month, 1-year survival rate between two groups, but the 2-year survival in the chemotherapy group was higher (P=0.037); 6-month tumor-free survival rates in the two groups had no significance, 1-year and 2-year tumor-free in the chemotherapy group were significantly higher than those in the non-chemotherapy group (P=0.030, 0.023). Intravenous arsenious acid chemotherapy can delay tumor recurrence and prolong survival in liver transplant patients with HCC extending Milan criteria.

Objective To study the impact of various donor hepatectomy techniques on clinical rehabilitation and postoperative liver regeneration on living donor liver transplant (LDLT) donors.Methods The data of 13 consecutive LDLT carried out from May 2006 to May 2011,including the surgical techniques,postoperative liver function,and liver regeneration in the donors were retrospectively studied.Results The donor operations included 8 right hepatectomies without the middle hepatic vein,2 right hepatectomies with the middle hepatic vein and 3 left hepatectomies.Hepatic function and blood coagulation function returned to normal within two weeks of hepatectomy in all the donors.There was no severe complication and no death.There was a significant positive correlation between the donor liver volume as measured preoperatively on CT and the resected liver weight as measured intraoperatively (r=0.838,P＜0.01).The volume of the remnant liver increased soon after transplantation.The liver regenerated significantly faster in right than in lefft liver donors.The remnant liver of the right liver donors with middle hepatic vein preservation grew faster than the right liver donors without middle hepatic vein preservation.However,there was no significant difference in the recovery of the liver function between the three groups.Conclusions Donor hepatectomy is safe.The postoperative liver regeneration is affected by multiple factors including the remnant liver volume and blood supply of the remnant liver.

Objective To study the significance of combined detection of procalcitonin ( PCT ) , C-reactive protein( CRP) and lipopolysaccharide( LPS) for early diagnosis of bacterial infection in newborns. Methods Clinical data of ninety-eight newborns from neonatal ward of our hospital were retrospectively studied. Fifty cases with bacterial infectious diseases were selected as infection group,in the same period,48 cases with non-bacterial infectious diseases were selected as control group. In the 24 hours after admission before use of antibiotics,all of cases were picked blood used for testing CRP,PCT,LPS and blood culture, and the results were contrasted and analyzed. Results The levels of serum PCT,CRP and LPS in infection group were respectively significantly higher than those in control group,and the differences were statistically significant(P<0. 05,respectively). In gram-positive bacterium group,the positive rate of combined detection of serum PCT and CRP was obviously higher than that of single detection of PCT or CRP ( 91. 3% vs. 60. 9%,P<0. 05;91. 3% vs. 56. 5%,P<0. 05 respectively) . In gram-negative bacteria group,positive rate of combined detection of serum PCT and LPS was obviously higher than that of single detection of PCT or LPS respectively(88. 9% vs. 59. 3%,P<0. 05;88. 9% vs. 66. 7%,P<0. 05 respectively). Conclusion Joint detection can improve the diagnostic efficiency, and reduce missed diagnosis. And we can identify disease which predominantly infected by positive bacteria or negative bacteria through joint detection,which can contribute to the choice of clinical antibiotic drugs.