Objective:To investigate the modulatory function of interleukin-7 (IL-7)/CD 127 signaling pathway on CD 8+T cells in patients with myasthenia gravis (MG). Methods:Fifty-seven treatment-naive MG patients who were hospitalized in Department of Neurology, Nanyang Central Hospital between 2017 and 2020 as well as 35 healthy controls were enrolled. Peripheral blood was collected, while plasma and peripheral blood mononuclear cells were isolated. Plasma IL-7 and soluble CD 127 (sCD 127) were measured by enzyme linked immunosorbent assay (ELISA). Membrane-bound CD 127 (mCD 127) percentage in CD 8+T cells was measured by flow cytometry. The differences of above indices between different gender, onset age, afflicting with thymoma, or different Osserman type and their correlation with Quantitative Myasthenia Gravis (QMG) score were analyzed. Purified CD 8+T cells from MG patients were stimulated with recombinant human IL-7 (5 μg/L). Changes of sCD 127 and mCD 127 level were analyzed. Levels of perforin, granzyme B, interferon-γ (IFN-γ), and tumor necrosis factor-α (TNF-α) in the cultured supernatants were measured by ELISA. Immune checkpoint molecules mRNA in CD 8+T cells was semi-quantified by real-time fluorescence quantitative polymerase chain reaction. Results:Plasma IL-7 level was up-regulated in MG patients compared with controls [(293.4±74.7) pg/ml vs (233.8±70.8) pg/ml, t=3.78, P<0.001], while sCD 127 level was down-regulated in MG patients compared with controls [(102.7±13.7) pg/ml vs (131.2±20.9) pg/ml, t=7.91, P<0.001]. Peripheral CD 8+T cells percentage was up-regulated in MG patients compared with controls (35.4%±7.1% vs 30.2%±7.5%, t=3.31, P=0.001), and mCD 127+CD 8+T cell percentage was also elevated (45.5%±7.7% vs 34.7%±11.5%, t=5.44, P<0.001). There were no significant differences of above indices between different gender, onset age, afflicting with thymoma, or different Osserman type. There was no significant correlation between above indices and QMG score. There were no significant differences of sCD 127 in cultured supernatants, mCD 127+CD 8+T cell percentage, or immune checkpoint molecules mRNA expression between CD 8+T cells from MG patients with and without IL-7 stimulation. IL-7 stimulation promoted the secretion of perforin [(208.1±67.2) pg/ml vs (168.8±46.2) pg/ml, t=2.16, P=0.038], granzyme B [(941.8±273.9) pg/ml vs (782.4±137.2) pg/ml, t=2.33, P=0.025], and IFN-γ [(19.1±5.2) pg/ml vs (15.3±4.5) pg/ml, t=2.47, P=0.018] by CD 8+T cells. However, there was no remarkable difference of TNF-α production between CD 8+T cells with and without IL-7 stimulation. Conclusion:Elevated IL-7-mediated signaling pathway enhanced the secretion of cytotoxic molecules and cytokines by CD 8+T cells, leading to increased activity of CD 8+T cells in MG patients.

Objective: To evaluate the safety and therapeutic efficacy of clinical pathways(CP)for cerebral infarction in patients aged 75 years and above. Methods: A cohort of 363 cerebral infarction patients aged 75 years and above after excluding clinical variants were recruited from January 2016 to June 2018 at the neurology department of Nanyang City Center Hospital.Patients were randomly divided into the CP group(n=184)and the control group(n=179). The day-90 modified Rankin scale score(mRS), mortality, incidences of complications, length of hospital stay, total hospital costs and drug costs were compared between the two groups. Results: The proportion of patients with mRS 0-1 was higher in the CP group than in the control group(77.2% or 142/184 vs.55.3% or 99/179, χ²=19.443, P=0.000). The incidences of pulmonary infection(23.9%, 44/184)and deep venous thrombosis(14.7%, 27/184)were lower in the CP group than in the control group(42.5%, 76/179 & 29.1%, 52/179; χ²=14.101, 11.014, P=0.000, 0.001). There was a significant difference in mortality between the two groups[4.9%(9/184)vs.11.2%(20/179), χ²=4.871, P=0.027]. There was no significant difference in the other incidences of complications between the groups(P>0.05). Hospital stay length(18.3±2.9) d, total cost(2.72±0.42)×10⁴ yuan, and drug cost(0.87±0.29)×10⁴ yuan in the clinical pathway group were lower than those in the control group[(22.8±4.4)d, (3.55±0.81)×10⁴ yuan, (1.42±0.29)×10⁴ yuan](t=11.546, 12.168 and 18.335, all P=0.000). Conclusions The adoption of clinical pathways can improve medical quality, shorten hospitalization days and reduce hospitalization costs and medical costs in elderly patients with cerebral infarction.