Objective To explore the mechanisms underlying the mediating effect of regulatory B (Breg)cells in the pathogenesis of pemphigus.Methods Peripheral blood specimens were collected from 48 patients with pemphigus at different degrees of severity and 20 healthy controls.Flow cytometry was conducted to analyze the frequency of Breg(CD19 +CD24hiCD38hi)cells in peripheral CD19+ B cells,enzyme linked immunosorbent assay(ELISA)to determine the titer and subtypes of anti-desmoglein(Dsg)1 and 3 antibodies in sera from these subjects.The relationship of anti-Dsg 1 and 3 antibodies with the frequency of Breg cells was assessed by Spearman's rank correlation test.Results Significant differences were observed in the proportion of Breg cells in CD19+ B cells between patients with pemphigus and healthy controls(11.54％ ± 0.97％ vs.8.19％ ± 0.85％,P =0.04),as well as between patients with acute mild pemphigus and those with moderate and severe pemphigus(5.17％ ± 2.14％ vs.11.38％ ± 5.30％ and 11.17％ ± 5.31％,P =0.042,0.046,respectively).The frequency of Breg cells was positively correlated with the absorbance value for anti-Dsg1 antibodies of IgG4 subclass and IgG4/IgG1 ratio(r =0.527,0.565,respectively,both P ＜ 0.01).Conclusions Breg cells are mainly associated with the production of antibodies in and disease severity of pemphigus,while the actual mechanism of action remains unknown.

Objective To assess the correlation between the subclasses of antibodies against desmoglein (Dsg) 1 and Dsg3 and disease activity in patients with pemphigus. Methods Sera were collected from 47 patients with pemphigus, and ELISA was performed to determine the titers and subclasses of antibodies against Dsg1 and Dsg3. The correlation of antibody titers and subclasses with disease activity was assessed.Results Clinical phenotype was associated with antibody profiles in these patients with pemphigus. Of 17 patients with mucocutaneous involvement, 14 (82.4%) had both anti-Dsg3 and anti-Dsg1 antibodies; of 16 patients with cutaneous involvement, 15 (93.7%) had anti-Dsg1 antibody, only 1 (6.3%) developed anti-Dsg3 antibody; of 6 patients with mucosal involvement, all ( 100% ) had only anti-Dsg3 antibody. The serum levels of antibodies against Dsg1 and Dsg3 were increased, but not in parallel with the disease severity in these patients.Moreover, the subclasses of antibodies were correlated with disease severity. IgG4 subclass antibodies against Dsg1 and Dsg3 predominated in patients with pemphigus at active stage, whereas IgG1 subclass in those at remission stage. The serum levels (expressed as absorbance value) of IgG4 and IgG1 subclass antibodies were 1.92 ± 1.21 and 0.60 ± 0.61 respectively, with the ratio of IgG4 to IgG1 more than 1, in patients with antiDsg1 antibodies at active stage, 0.03 ± 0.02 and 0.22 ± 0.11 respectively with the ratio of IgG4 to IgG1 less than 1, in those at remission stage, 2.35 ± 2.17 and 1.84 ± 1.16 respectively with the ratio of IgG4 to IgG1 more than 1 in patients with anti-Dsg3 antibodies at active stage, 0.15 ± 0.16 and 1.05 ± 0.77 respectively with the ratio of IgG4 to IgG1 less than 1 in those at remission stage. Conclusions The subclasses of pemphigus-specific antibodies are closely correlated with the disease severity in patients with pemphigus. The detection of subclasses and titers of anti-Dsg1 and anti-Dsg3 antibodies may aid in the diagnosis of and monitoring of disease severity in pemphigus.

Objective To investigate the diagnostic value and clinical significance of the three-dimensional contrast-enhanced MR angiography (3D-CE-MRA)in the infantile superficial hemangioma.Methods Forty-four children with superficial hemangioma un-derwent conventional and dynamic contrast-enhanced MRI.MRI scanning was started at the time of inj ection,and four dynamic pha-ses of images were acquired continually.Maximum intensity proj ection (MIP)images were reconstructed to show the blood vessels of the lesions in multiple phases.Results Forty-nine infantile superficial hemangiomas were detected by MRI,including a single le-sion in 41 patients and multiple ones in 3.3D-CE-MRA showed 37 lesions in 32 patients,and other 12 lesions were not found in 12 patients.Conclusion The conventional and dynamic contrast-enhanced MRI can reflect the location,number and the range of the su-perficial hemangioma,and show the relationship between the lesion and the surrounding tissues.3D-CE-MRA directly shows the blood supply of the tumors.

Objective To understand the epidemic situation of Hepatitis B of the children and the situation of Hepatitis B vaccine injection in Maanshan city so as to provide the basis for the development of Hepatitis B vaccination strategy or adjustment in all of the people. Methods Two-stage sampling method was designed to survey 978 children under the age of 15 in 8 villages, with 3～5 ml of venous blood brawn and HBVM detected by ELISA. Results HBsAg positive rate of the children under the age of 15 was 10.12% in 1991 and, compared with the present rate at 0.92%, there was a significant difference. The protection rate of Hepatitis B vaccination was 90.91%. HBsAb positive rate of the children under the age of 15 was 40.49%, and the distribution was balanced among regional, urban and rural areas. With the in crease in age, the trend of Hepatitis B antibody levels declined, but the 1～5 age group had lower peak. The survey rate of Hepatitis B vaccine injection of the children under the age of 15 was 91.82%, and the report rate was 87.89%. The regional difference for them was significant. With the in crease in age, the rate of Hepatitis B vaccine injection declined for the survey and the report in all of the children under the age of 15. Conclusions The effect of Hepatitis B Control for 16 years is very significant in the city. It is necessary to administer charge-free Hepatitis B vaccination for the newborns and to strengthen the Hepatitis B vaccination in flowing children.

Objective To summarize clinical and histopathological features of trauma-triggered autoimmune bullous skin diseases,and to explore its possible pathogenesis.Methods Clinical manifestations,histopathological features and treatment of 3 cases of trauma-triggered pemphigus or pemphigoid were analyzed,and summarized according to related domestic and overseas literature.Results Of the 3 cases,1 was a female aged 62 years,and 2 were males aged 60 and 71 years respectively.They all had a history of skin trauma or surgery before the onset of the diseases,and time intervals from trauma to diseases were 5,5 weeks and 3 days respectively.The 3 cases were diagnosed as bullous pemphigoid (anti -BP180 antibody 109 U/ml,anti-BP230 antibody negative),pemphigus vulgaris (anti-Dsg1 antibody 68.8 U/ml,anti-Dsg3 antibody 219 U/ml) and pemphigus foliaceus (anti-Dsg1 antibody 143 U/ml,anti-Dsg3 antibody negative) respectively.Their lesions were relieved dramatically after oral and (or) topical glucocorticoid treatment.Conclusions Trauma may be a triggering factor for autoimmune bullous skin diseases.For patients with post-traumatic poor wound healing or skin erythema,blisters and erosion,which can hardly be attributed to trauma or surgery itself,autoimmune bullous skin diseases should be considered,and histopathological or immunopathological examinations should be performed timely.

Objective To investigate the suitable mode of cognitive-behavioral therapy for lung transplant recipients during waiting for lung and evaluate the effect to improve patients' physical and mental state.Methods 50 cases were randomly divided into the experimental group and the control group,each group with 25 cases.The control group received conventional treatment.The experimental group received cognitive-behavioral therapy in addition to conventional treatment.SAS and vital signs were measured in the two groups on admission,2 weeks and 4 weeks after admission.Results The SAS score of the experimental group was lower than the control group 2 weeks and 4 weeks after admission and SAS score decreased as the intervention extended.The SBp of the experimental group was lower than the control group 4 weeks after admission.There was no significant difference of DBp between two groups.The heart rate of the experimental group was lower than the control group 4 weeks after admission.The heart rate of the experimental group was lower on 2 weeks and 4 weeks after admission than on admission.4weeks after admission,the respiratory rate of the experimental group was lower than the control group and on admission.Conclusions Cognitive-behavioral therapy can reduce the level of anxiety and keep vital signs stable with good feasibility and effectiveness.

Objective To investigate the relationship between the various factors of traumatic brain injury patients un-dergoing surgery before the results of surgery. Methods A retrospective analysis from June 2011 to December 2014 in our hospital's clinical data line occupancy brain decompression surgery, 92 cases of traumatic brain injury patients,including a good number of surgical outcomes of 56 patients,the number of 36 patients with a poor prognosis cases. By Pearson univariate and multivariate Logistic regression analysis determine factors affecting the surgical results in pa-tients with traumatic brain injury. Results(1)By Pearson univariate analysis,good prognosis group and a poor progno-sis group in age, GCS score, systolic blood pressure, SpO2 respect, the differences were statistically significant (P<0.05);(2) the analysis of the single-factor results to substitute Logistic regression model, ultimately affecting the sur-gical results obtained in patients undergoing brain injury factors age(β=0.419,SE=0.192,Wald=8.293,P<0.05, OR=1.827,95%CI for 1.362~2.209), GCS score (β=0.753,SE=0.368,Wald=9.091,P<0.05,OR=2.238,95% CI of 1.827~3.114), systolic blood pressure(β=0.746,SE=0.273,Wald=7.082,P<0.05,OR=2.372,95%CI of 1.402~4.156),SpO2(β=0.810,SE=0.556,Wald=10.281,P<0.05,OR=2.591,95%CI of 2.211~3.391). Conclusion The factors affecting the brain injury surgical results are mainly age, GCS score, systolic blood pressure and SpO2 levels, preoperative should observe carefully these factors to improve prognosis in patients with traumatic brain injury situation.

Objective To investigate the effect of craniotomy bilateral in treatment of severe traumatic brain injury. Methods Selected 50 patients underwent bilateral craniotomy in treatment of severe brain trauma as research subjects, recorded intracranial pressure changes at the first 1 d, the first 3 d, 7 d after operation, and the follow-up after 6 months, the body recovery scores were compared. Results The intracranial pressure in patients was on a downward trend postoperative 1 d, 3 d, 7 d. Three patients died, accounting for 6.00%;Good recovery in 24 cases, accounting for 48.00%; Moderate disability in 16 cases, accounting for 32.00%; Six cases of severe disability, accounting for 12.00%, in a vegetative state in one case, accounting for 2.00%. Conclusion The bilateral craniotomy should be used early on severe traumatic brain injury patients with bilateral craniotomy indications, it can effectively improve the treatment effect, reduce morbidity and mortality, treatment of severe traumatic brain injury is an effective method, but need to strictly control surgical indications and perioperative good job.

Objective To study the efficacy of rituximab in the treatment of pemphigus vulgaris (PV) and its underlying mechanism. Methods A 38-year-old female with PV presented with refractory, painful oral ulcers and erosions. Since she was poorly responsive to prednisone 80 mg daily, intravenous ritu-ximab of 500 mg once a week was given for successive 3 weeks followed by 5 successive days of intra-venous gamma globulin at a dose of 400 mg/kg per day, and a total of two treatment sessions were conducted. ELISA was used to detect the serum titer of anti-Dsg3 antibodies and their IgG subtypes (IgG1 and IgG4) as well as serum level of interferon-gamma (IFN-gamma), interleukin-4 (IL-4), interleukin-10 (IL-10). Results Three months after the end of two treatment sessions, the symptom was obviously improved, and lesions subsided; alter another 1 month, clinical symptom fully disappeared. During the 1-year follow-up, no lesions recurred. The anti-Dsg3 antibody titer was 253.33 U/mL before treatment, plateaued at 250 U/mL within 4 weeks after the initial infusion, decreased till 3 months after the withdrawal, and reached 26.06 U/mL 7 months after the withdrawal, and remained within normal range till the time of this writing. The serum titer of IgGl subclass of anti-Dsg3 antibodies dropped dramatically fight after the first infusion, but that of IgG4 subclass remained at a high level at early stage of medication, began to decline until 3 months after the with-drawal, and finally reached the normal range following clinical remission. Also, serum level of IFN-garnma and IL-10 correlated with the severity of PV. Conclusions Combined rituximab is effective for the control of PV, likely by eliminating Dsg3-specific antibodies, especially IgG4 subclass of them.

[ ABSTRACT] AIM: To explore whether autophagy is involved in the excessive death of renal tubular epithelial cells in subtotal nephrectomy ( SNx) rats and the relationship between autophagy and necroptosis in the kidney of SNx rats. METHODS:Male Sprague-Dawley rats were randomly assigned to control group ( n=6 ) and SNx group ( n=42 ) .The rats in SNx group were subjected to SNx.Sham surgery was performed in the rats in control group.The rats in SNx group were divided into subgroups at 0, 4, 8 and 12 weeks ( n=6) and the other rats in SNx group were divided into SNx+vehi-cle group, SNx+necrostatin-1 (Nec-1) group and SNx+3-methyladenine (3-MA) group.The expression of RIP1, RIP3, LC3 and beclin-1 at mRNA and protein levels was measured at 0, 4, 8 and 12 weeks by qPCR and immunohistochemistry. The effects of Nec-1 or 3-MA on the protein expression of LC3-I, LC3-II and beclin-1, and production of reactive oxygen species ( ROS) in the rat kidney were determined by Western blot and DCFH-DA staining.The death of renal tubular epi-thelial cells in the SNx rats was observed by TUNEL staining and electron microscopy.Finally, the effects of Nec-1 and 3-MA on blood urea nitrogen ( BUN) , serum creatinine ( SCr) and the pathological changes of the renal tissues were ana-lyzed.RESULTS:The highest mRNA and protein levels of RIP1, RIP3, LC3 and beclin-1 appeared at the 8th week after SNx (P<0.01).Compared with the rats in SNx+vehicle group, the protein over-expression of LC3-II/I and beclin-1, re-nal tubular epithelial cells with typical morphological features of necroptotic cell death and TUNEL-positive renal tubular
cells were decreased in the SNx rats treated with Nec-1 and 3-MA (P<0.01), but 3-MA did not reduce the increased con-centration of ROS.In addition, treatment with Nec-1 and 3-MA obviously reduced BUN, SCr (P<0.05), glomeruloscle-rosis index and tubulointerstitial injury score (P<0.01).CONCLUSION:Autophagy participates in the excessive death of renal tubular epithelial cells in SNx rats.Inhibition of autograph prevents necroptotic cell death of renal tubular cells, and alleviates chronic renal injury in SNx rats.