Objective:To investigate the expression and clinical significance of effector T cell (Teff), regulatory T cell (Treg) and their cytokines in patients with vitiligo.Methods:84 patients with vitiligo (38 cases in stable stage, 46 cases in advanced stage) who were admitted to the Dermatology Department of the Dezhou People's Hospital between June 2018 and June 2019 and 30 healthy people (control group) were enrolled in the study. The levels of Teff subsets and Treg cells in peripheral blood were detected by flow cytometry. The levels of Teff subsets and Treg cells-associated cytokines were detected by enzyme-linked immunosorbent assay (ELISA). The relationship between Teff subsets and Treg cells levels in peripheral blood, relationship between Teff subgroups, Treg cells-associated cytokines and course of vitiligo, skin lesion area were analyzed.Results:The levels of T helper cell (Th)17 and Th22 in peripheral blood of vitiligo group were significantly higher than those of control group, while levels of Treg cells were significantly lower than control group ( P<0.05). Compared with the stable vitiligo group, the levels of Th17 and Th22 in peripheral blood were higher and levels of Treg cells were lower in the advanced vitiligo group ( P<0.05). Treg cell level was negatively correlated with Th17 cell level ( r=-0.303, P=0.001), and negatively correlated with Th22 cell level ( r=-0.200, P=0.033). The levels of serum interleukin (IL)-17 and IL-22 in vitiligo group were significantly higher than those in control group, while the level of transforming growth factor-β (TGF-β) was significantly lower than that in control group ( P<0.05). Compared with the stable vitiligo group, levels of serum IL-17 and IL-22 were higher and level of TGF-β was lower in the advanced vitiligo group ( P<0.05). Correlation analysis showed that levels of IL-17 and IL-22 were positively correlated with skin lesion area ( r=0.361, 0.288, P<0.05), and level of TGF-β was negatively correlated with skin lesion area ( r=-0.312, P<0.05). Conclusions:Teff/Treg cells are unbalanced in patients with vitiligo, showing obvious shift to Teff subsets. The progression of vitiligo may be related to Teff subsets and Treg cells-associated cytokines.

Objective To investigate the predictive value of early diffusion-weighted imaging (DWI) for early neurological deterioration (END) after acute isolated basal ganglia infarct.Methods Patients with acute isolated basal ganglia infarct in middle cerebral artery perforators completed head MRI examination at 24 h after onset were analyzed retrospectively.According to the axial DWI revealed lesion size,the maximum diameters were divided into ＜ 15 mm,15-30 mm,and ＞ 30 mm.END was defined as an increase in the National Institute of Health Stroke Scale (NIHSS) score ≥2 or the motor score of NIHSS ≥ 1 at any time within the first 72 h after admission compare with the baseline scores.Results A total of 336 patients were enrolled,including 126 patients (37.5％) with END.There were significant differences in the constituent ratios of the sex (P =0.044),maximum diameter of the lesion (P =0.001),and guilty artery stenosis (P =0.006),as well as baseline NIHSS score (P =0.001),high-density lipoprotein cholesterol (HDL-C) (P =0.033),and C-reactive protein (P =0.039) between the END group and the non-END group.Multiple logistic regression showed that the maximum diameter of the lesions 15-30 mm (odds ratio [OR] 2.360,95％ confidence interval [CI] 1.370-4.066;P =0.002),female (OR 1.660,95％ CI 1.024-2.691;P =0.040),and guilty large artery stenosis (OR 1.713,95％ CI 1.036-2.833;P =0.036) were the independent risk factors for patients occurring END,while the high HDL-C (OR 0.355,95％ CI 0.141-0.894;P =0.028) was an independent protective factor of occurring END.Conclusion Early DWI revealed that the maximum diameter of the lesions may have certain clinical value for prediction of the occurrence of END in patients with acute isolated basal ganglia infarct.

The aquatic therapy is a part of comprehensive rehabilitation. Aquatic therapy may benefit the social interaction, stereotyp-ing and motor learning of children with autism, which may associate with the physical and mental mechanism. The programs applied for the autism include game in water, swimming, physical fitness training in water, etc. The assessment tools include scales and video, and so on.

Objective: To investigate the correlation between sexual dysfunction(SD)and estrogen receptor (ER) gene polymorphism in Chinese Han women with epilepsy (WWE). Methods: A total of 112 married Chinese Han women with epilepsy were collected from outpatients and inpatients of the Affiliated Hospital of Yangzhou University, and 120 matched healthy women were taken as the control group.WWE were treated with antiepileptic drugs (AEDs) for one year or more.The Chinese version of female sexual function index (FSFI) was used to investigate the sexual function of the subjects.The chemiluminescence method was used to detect the sex hormones levels such as prolactin(PRL), follicle-stimulating hormone(FSH), luteinizing hormone(LH), estradiol(E2), progesterone(P) and testosterone(T). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine the ER gene polymorphism.Chi-square test, t-test and binary logistic regression were used for statistical analysis.The differences of the sexual function, sex hormone, ER genotype, and allele frequency were compared between the two groups.And the correlation between SD and ER gene polymorphism was analyzed. Results: (1) The proportion of SD in Chinese Han WWE was 70.5%(79/112), while that was 24.2%(29/120) in the control group.The serum prolactin (PRL) level in the WWE group was significantly higher than that in the control group (t=2.072, P=0.039). (2) The allele frequencies of ER PvuII C and AluI A in the WWE group were significantly higher than those in the control group (P=0.001; P=0.001). (3) Binary logistic regression analysis showed that PvuII CC genotype and serum testosterone level were independently correlated with SD (OR=6.074, 95%CI: 1.257-29.352, P=0.025; OR=0.412, 95%CI: 0.201-0.842, P=0.015). Conclusion ERα PvuII polymorphism may be related to the susceptibility of SD in Chinese Han WWE, and PvuII CC genotype may be the risk genotype of SD in WWE.

Objective To investigate the correlation between sexual dysfunction( SD) and estrogen receptor (ER) gene polymorphism in Chinese Han women with epilepsy (WWE). Methods A total of 112 married Chinese Han women with epilepsy were collected from outpatients and inpatients of the Affiliated Hospital of Yangzhou University,and 120 matched healthy women were taken as the control group. WWE were treated with antiepileptic drugs ( AEDs) for one year or more. The Chinese version of female sexual function index ( FSFI) was used to investigate the sexual function of the subjects. The chemiluminescence method was used to detect the sex hormones levels such as prolactin ( PRL),follicle-stimulating hormone (FSH),luteinizing hormone(LH),estradiol(E2),progesterone(P) and testosterone(T). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to determine the ER gene poly-morphism. Chi-square test,t-test and binary logistic regression were used for statistical analysis. The differ-ences of the sexual function,sex hormone,ER genotype,and allele frequency were compared between the two groups. And the correlation between SD and ER gene polymorphism was analyzed. Results ( 1) The pro-portion of SD in Chinese Han WWE was 70. 5%(79/112),while that was 24. 2%(29/120) in the control group. The serum prolactin (PRL) level in the WWE group was significantly higher than that in the control group (t=2. 072,P=0. 039). (2) The allele frequencies of ER PvuII C and AluI A in the WWE group were significantly higher than those in the control group (P=0. 001;P=0. 001). (3) Binary logistic regression a-nalysis showed that PvuII CC genotype and serum testosterone level were independently correlated with SD (OR= 6. 074, 95% CI: 1. 257-29. 352, P= 0. 025; OR= 0. 412, 95% CI: 0. 201-0. 842, P= 0. 015 ). Conclusion ERα PvuII polymorphism may be related to the susceptibility of SD in Chinese Han WWE,and PvuII CC genotype may be the risk genotype of SD in WWE.

Objective:To evaluate the application value of metagenomic next-generation sequencing(mNGS) for patients with severe pneumonia of unknown pathogen.Methods:The clinical data of 8 patients with unknown pneumonia pathogens who were assisted by the alveolar lavage fluid mNGS technology treated in Affiliated Hospital of Yangzhou University from June 2019 to February 2020 were retrospectively analyzed, including alveolar lavage fluid smear, culture, and the sequencing result.The clinical characteristics and mNGS detection results were comprehensively analyzed.According to the results of mNGS and the judgment of the clinician, the patients were divided into confirmed pathogens group and undetermined pathogens group, and the Simpson's diversity index of two groups was compared.Results:Among 8 cases, there were 5 males and 3 females, and the median age was 62.5 years (ranged from 41 to 71 years). All of them had chronic diseases except 1 case, including diabetes, chronic obstructive pulmonary disease and kidney transplantation.mNGS was positive in 8 patients, and conventional test was positive in 3 patients.The comparison of the Simpson's diversity index between the identified pathogenic group and the undetermined pathogenic group showed statistically significant difference [(0.398 ± 0.222) vs.(0.763 ± 0.061), t=2.709, P=0.035]. The positive results of mNGS were different from that of conventional test in 2 patients.The nucleic acid number in 3 cases of Pneumocystis carinii with mNGS positive results ranged from 120 to 15 580, with genomic coverage rates from 24.6% to 99.8%. Conclusion:mNGS can help physicians acquire information of the pathogenic bacteria quickly and comprehensively, especially for patients with unknown pneumonia pathogenic bacteria.

Antiepileptic drugs (AEDs) are the main treatments of epilepsy, but their use is usually limited by adverse reactions, among them psychiatric and behavioral ones including aggressive behavior. Levetiracetam , perampanel, and topiramate , which have diverse mechanisms of action, have been associated with aggressive behavior. 5-HT and γ-aminobutyric acid (GABA), especially glutamate [via α-amino-3-hydroxy-5-methyl-4-isoxazole-propionate receptor (AMPA) receptor] seem to play key roles. Other mechanisms involve hormones, epigenetics and alternative psychosis. Neurological and/or mental health disorders tend to increase aggressive behavior sensitivity. The adverse reactions caused by AEDs are getting more and more attention. Clinicians may identify and manage this side effect as early as possible, if the risk factors and underlying mechanisms of aggressive behavior induced by antiepileptic we find. This article will explain the possible mechanisms.

Objective To analyze the risk factors of hemorrhage after thrombolysis for mild cerebral infarction and the curative effect of low-dose alteplase.Methods 375 patients with mild cerebral infarction whose onset time was less than 4.5 hours from January 2013 to May 2017 in our hospital were selected as the research objects.Those undergoing low-dose alteplase thrombolysis were included in the thrombolysis group (n =195) while those without thrombolysis were included in the non-thrombolysis group (n =180).The therapeutic effects were analyzed.Patients with intracerebral hemorrhage in the thrombolysis group at 14 days after thrombolysis were included in the observation group while those without hemorrhage were included in the control group.Related data were compared between the two groups.The single factors and independent risk factors of hemorrhage after thrombolysis in patients with mild cerebral infarction were analyzed.Results National Institute of Health Stroke Scale (NIHSS) scores of the thrombolysis group at 1 week,1 month and 3 months after treatment were significantly lower than those of the non-thrombolysis group (P ＜0.05).Serum neuron specific enolase (NSE) and C-reactive protein (CRP) levels in the thrombolysis group were lower than those in the non-thrombolysis group after treatment (P ＜ 0.05).The prognosis of the thrombolysis group was better than that of the non-thrombolysis group after treatment (P ＜ 0.05).In this study,30 patients undergoing thrombolysis had intracerebral hemorrhage within 14 days after thrombolysis,and the incidence of intracranial hemorrhage was 15.38％ (30/195).Univariate and multivariate logistic regression analysis showed that age,history of heart failure,door to needle time (DNT),systolic blood pressure (SBP) in 12 hours after thrombolysis and leukoaraiosis change were risk factors for hemorrhage in patients with mild cerebral infarction after thrombolysis (P ＜ 0.05).Conclusions Using low-dose alteplase for treating patients with mild cerebral infarction can achieve good thrombolytic effects.Age,history of heart failure,DNT,SBP in 12 hours after thrombolysis and leukoaraiosis change are influencing factors of intracranial hemorrhage,which should be paid attention to.

Objective:To explore the application value of next-generation sequencing (mNGS) technology in patients with Herpes simplex pneumonia mixed infection.Methods:The clinical data of pneumonia patients who underwent alveolar lavage fluid mNGS technology and traditional pathogen detection in the Affiliated Hospital of Yangzhou University from June 2018 to January 2021 were retrospectively collected.Results:A total of 41 patients with mNGS Herpes simplex type 1 (HSV-1) test (4 HSV-1 carriers, 37 HSV-1 infections) were enrolled in this study, including 22 males and 19 females. The age ranged from 46 to 83 years old, with a median age of 67 years. The higher proportion of pathogens in 25 cases of HSV-1 co-infection detected by mNGS were Pneumocystis jiroveci (6 cases, 24.0%), Acinetobacter baumannii (4 cases, 16.0%), and Klebsiella pneumoniae (4 cases, 16.0%), and Aspergillus fumigatus (3 cases, 12.0%). The difference in the Simpson's diversity index in the HSV-1carrier group, HSV-1 single infection group and HSV-1 mixed infection group was statistically significant ( P<0.05). Compared with 12 cases of HSV-1 single infection, the time for body temperature to return to normal for 25 cases of HSV-1 mixed infection was [(5.16±2.04)days vs (3.75±1.29)days], and course of antibiotic treatment was longer [(10.60±2.18)d vs (8.92±1.98)d]. Conclusions:The mNGS technology has obvious advantages in identifying HSV-1 mixed infections, which is beneficial to physicians to treat them accurately.

Antiepileptic drugs (AEDs) are the main treatments for epilepsy. Patients with epilepsy will benefit a lot from AEDs. However, AEDs also have a variety of adverse drug effects, including aggressive behavior (AB). It will have important clinical significance of identifying and treating correctly AB since of its dangers, caused by AEDs. This article will review the clinical features, susceptibility factors and mechanisms of AB induced by AEDs.