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 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.

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.

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 evaluate the efficacy of liver grafts with warm ischemia and with different cold preservation time in liver transplantation.Methods The clinical data of 154 patients who received liver transplantation at the First Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2007 were retrospectively analyzed.The warm ischemia time of the liver grafts obtained from the non-heart-beating donors was within 10 minutes.According to cold perservation time of the liver grafts,patients were divided into 3 groups:the cold preservation time of the liver grafts was within 8 hours,8-12 hours and above 12 hours in group I(n=58),group Ⅱ(n=62)and group Ⅲ(n=34),respectively.The peak level of alanine aminotransferase(ALT),primary graft dysfunction(PGD)after liver transplantation,acute rejection response,biliary complications,vessel complications,perioperative infections and the survival of liver grafts and recipients among the 3 groups were analyzed via chi-square test,t test and variance analysis.Results No PGD was detected in the 3 groups after liver transplantation.All patients were followed up for 8-32 months.The peak level of ALT,incidence of infection and biliary complication,survival of liver grafts and recipients were(482±357)U/L,12%(7/58),12%(7/58),86%(50/58)and 88%(51/58)in group Ⅰ,and were(1274±608)U/L,29%(10/34),26%(9/34),68%(23/34)and 71%(24/34)in group Ⅲ,with significant difference between the 2 groups(t=5.23,X~2=4.28,6.77,4.51,4.28,P<0.05).The peak level of ALT in group Ⅱ was(953±424)U/L,which was significant higher than(482±357)U/L in group Ⅰ(t=4.76,P＜0.05).Conclusions Liver grafts with a warm ischemia time shorter than 10 minutes could tolerate the injury caused by cold preservation with the maximum time of 12 hours.The incidences of biliary complications and postoperative infections are significantly increased and the survivals of liver grafts and recipients are decreased when the cold preservation time exceeds 12 hours.

BACKGROUND:Nowadays,liver grafts for transplantation are clinically sourced from non-heart-beating donors.Moreover,there is still no uniform determination of safe time limit points for non-heart-beating donor liver in warm ischemia and cold preservation.OBJECTIVE:To evaluate the application safety and curative effects of warm ischemia liver graft affected by varied cold ischemia time (CIT) in liver transplantation.DESIGN,TIME AND SETTING:A randomized controlled observation was performed in the Organ Transplantation Center,First Affiliated Hospital of Sun Yat-sen University between January 2006 and December 2007.PARTICIPANTS:154 cases who underwent non-heart-beating liver transplantation were included in this study.All liver graftsinvolved had a warm ischemia time(WIT) less than 10 minutes.METHODS:All cases were assigned into 3 groups according to CIT:group Ⅰ (CIT＜8 hours,n=58),group Ⅱ (CIT 8-12hours,n=62),and group Ⅲ (CIT 13-16 hours,n=34).The liver grafts were randomly allocated for the patients.Following liver transplantation,the same immunosuppression protocol was employed for each group.MAIN OUTCOME MEASURES:Following surgery,peak level of alanine aminotransferase (ALT),primary graft dysfunction (PGD) after liver transplantation,acute rejection response,biliary complications,vessel complications,perioperative infections,graft and recipient survival rate were compared among 3 groups.RESULTS:Follow-up time was 8-32 months.No PGD was detected in all 154 cases.Group Ⅱ showed postoperative ALT peak levels significantly higher than group Ⅰ (P＜ 0.05).There was no significant difference between groups Ⅰ and Ⅱin terms of acute cellular rejection,perioperative infection,biliary complication,vessel complication,graft survival rate,and recipient survival rate (P＞0.05).Compared with group Ⅰ,the group Ⅲ exhibited significantly increased postoperative ALT peak level,biliary complications,and perioperative infections,and significantly decreased graft and recipient survival rate (P＜0.05).CONCLUSION:Non-heat-beating-liver grafts with less than 10 minutes of warm ischemia can tolerance 12 hours of cold ischemia.More than 12 hours,postoperative liver transplantation complications ascend and,contradictorily,graft and recipient survival rate descend.

Objective To evaluate the effect of endoscopic retrograde cholangiopancreatography (ERCP) in treatment of biliary complications after liver transplantation. Methods Data of 39 patients who underwent ERCP between January 2005 and December 2007 because of biliary complications after liver trans-plantation were retrospectively evaluated. Endoscopic sphincterotomy, dilatation, nasal-biliary drainage (ENBD) and stent placement were performed in 25 patients with biliary strictures (14 at anastomosis site and 11 at non-anastomosis site). ENBD and stent placement were applied in 6 patients with biliary leakage, while endoscopic sphincterotomy, ENBD and stone extraction with baskets were performed in 16 patients with biliary stones. Procedures were repeated when necessary. Results ERCP was successfully performed at a rate of 95.9% (94/98) without any severe complications. Strictures at anastomosis site were resolved in all patients (100%, 14/14), while for strictures at non-anastomosis site, only 27.3% (3/11) were cured. Biliary leakage was resolved in 83.3% (5/6) patients. Complete bile duet clearance was achieved in 81.3% (13/16) of the patients with biliary stones. Conclusion ERCP proves to be safe and effective in the treatment of post liver transplantation biliary complications with low incidence of severe complications.

Objective To investigate the effects of ischemic preconditioning on the cholesterol content and the activity of Na+-K+-ATPase of hepatocytes following cold preservation in rats.Methods Twenty-five rats were randomly divided into five groups,including control group (C),cold preservation group (Ⅰ),ischemic preconditioning group (ⅠP),atorvastatin (30 μmol/L) treatment group (A30),and atorvastatin (100 μmol/L) treatment group (A100).The cholesterol content and the activity of Na+ -K+ -ATPase were assessed.Results The cholesterol contents on the rat liver tissue cell membrane in the C group,Ⅰ group,ⅠP group,A30 group and A100 group were (310.4 ± 27.5),(187.7±13.1),(394.3±25.9),(201.8±14.6) and (122.6±7.7) nmol/mg protein,and activity of the Na+ -K+ -ATP enzyme was (46.55 ± 3.20),(27.4 ± 2.81),(52.71 ± 3.02),(30.67 ±2.78) and (19.64 ± 2.11) μmol Pi/hr mg protein,respectively (P＜0.05).There was no significant difference in the plasma membrane phospholipid content among the five groups (P＞0.05).Conclusion Reduction of cholesterol content and Na+ K+ -ATPase activity on the liver cytoplasmic membrane is one of the factors causing donor liver cold preservation injury,but ischemic preconditioning can significantly improve cell membrane Na+ -K+ -ATPase activity and increase cytoplasmic membrane cholesterol content. Use of atorvastatin statins can reduce cytoplasmic membrane cholesterol synthesis,and significantly decrease Na+ -K+ -ATPase activity,thereby alleviating the donor liver cold preservation injury.

Objective To investigate the diagnosis and treatment of pure red cell aplasia (PRCA) caused by human parvovirus B19 (HPVB19) after liver transplantation.Method The clinical data of one case of PRCA caused by HPVB19 after liver transplantation,including clinical manifestations,diagnosis and treatment,were retrospectively analyzed,and the related literatures were reviewed.Result The first case of PRCA caused by HPVB19 after liver transplantation in our center with typical clinical manifestations of anemia was diagnosed,including dizziness,fatigue,anhelation and so on.A progressive decrease in erythrocyte count,reticulocyte count and hemoglobin level were observed by blood routine test.Bone marrow aspiration biopsy showed an absence of erythroid cells and the HPVB19 DNA test of blood was positive.Erythrocyte count,reticulocyte count and hemoglobin level were back to normal after the anti-rejection strategy changing from tacrolimus and rapamycin to cyclosporin and rapamycin and a normal human myelogram was observed by bone marrow aspiration biopsy.The DNA concentration of HPVB19 in blood was below the lower test limit.The blood test of HPVB19 DNA showed a positive result again after the anti-rejection strategy changed back to tacrolimus and rapamycin duo to increased blood creatinine level while the reticulocyte count was still in normal scale.This is the first reported case of successfully cured PRCA caused by HPVB19 in liver transplantation patients through changing the anti-rejection strategy and also the first case of HPVB19 re-infection or relapse without PRCA recurrence in liver transplantation patients.Conclusion This case may indicate the importance of immunosuppressive drug changing in the treatment of liver recipients suffering from PRCA caused by HPVB19 infection,and the genotype test may promote the understanding and treatment for this disease.