Objective To detect the expression of T helper cells 9 (Th9) in the peripheral blood and the level of interleukin (IL)-9 in the plasma of rheumatoid arthritis (RA) patients,and to analyze the relationship between Th9 and clinical characteristics,and their possible role in the immunological pathogenesis of RA were explored.Methods Thirty-six patients with RA and 22 healthy controls were included.RA patients were divided into high disease activity group (n=22) and moderate disease activity group (n=14).Th9 cells were obtained from RA patients and healthy controls and detected by flow cytometery.The levels of IL-9 in RA patients and healthy controls were detected by ELISA tests.T-test and Spearman's correlation were used for statistical analysis.Results The expression of Th9 and the level of IL-9 of RA patients [(0.99±0.50)％,( 1.06±0.42 ) pg/ml,respectively] were significantly higher than normal controls[ (0.21±0.08)％,(0.69±0.13)pg/ml,respectively,all P＜0.01 ].Meanwhile,the expression of Th9 and the level of IL-9 in high disease activity group [ ( 1.18±0.52 )％,( 1.37±0.47 ) pg/ml ] were higher than those of the moderate disease activity group [ (0.69±0.25)％,(0.94±0.30) pg/ml ].There were positive correlations between Th9 and disease activity score(DAS) 28,erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),the number of tender joints,the number of swollen joints and rheumatoid factor (RF),the level of IL-9 respectively.There were positive correlations between IL-9 and DAS28,ESR,the number of tender joints,and the number of swollen joints.Conclusion High expression of Th9 and level of IL-9 maybe involved in the pat-hogenesis of RA,and is associated with disease activity.These results indicate that the abnormality of Th9 may play an important role in the pathogenesis of RA.

Objective To investgate the expression of Tfh and Th9 in the peripheral blood of rheumatoid arthritis ( RA),and to analyze the relationship between those cells and disease activity,organs of involvement,ect.,and to underly the possible immunological mechananism of RA.Methods Peripheral blood Tfh cells and Th9 cells,define as the CD4+ CXCR5 + ICOS+ and CD3 + CD8+ IL-9+ population,were examined by flow cytometry in 36 patients with RA and 22 case of age-and gender-matched health controls.According to 28-joint Disease Activity Score (DAS28),patients were divied into two groups:high disease activity(n=22),moderate disease activity(n=14).And then to analyzed the correlation among the Tfh,Th9 and clinical data of RA,such as ESR,CRP,RF,the number of tender joints,the number of swollen joints and bone destruction,etc..While to analyzed the correlation between Th9 and Tfh.Results The expression of Tfh (Z=-6.082,P=0.000) and Th9 (0.989±0.498 vs 0.213±0.084,t=13.063,P =0.000 )in PBMCs of RA was significantly higher than normal controls.Meanwhile,the expression of Tfh ( 3.880 ±1.255 vs 2.678±1.022,t=2.990,P=0.005 ) and Th9( 1.181 ±0.523 vs 0.686±0.254,t =4.043,P=0.000) in high activity of group were higher than those moderate.The percentage of Tfh and Th9 in the two groups were all signifieantly higher than controls(P＜0.01 ),There was a positive correlation with Tfh and DAS28 ( r =0.571,P=0.000),ESR ( r =0.375,P =0.029),CRP( r =0.357,P =0.032 ),the number of tender joints ( r=0.598,P =0.000 ),RF ( r =0.421,P =0.023 ) and anti-CCP ( r =0.421,P =0.023 ).There were no relationship with Tfh and course,morning stiffness,the number of swollen joints,bone erosion and the abnormal of EKG.There was a positive correlation with Th9 and DAS28( r=0.461,P=0.005 ),ESR(r=0.347,P=0.042),CRP(r=0.384,P=0.210),the number of tender joints(r=0.341,P=0.042),the number of swollen joints (r =0.347,P=0.038 ) and RF( r =0.379,P =0.025 ) respectively.There were no relationship with Th9 and course,morning stiffness,CCP,the abnormal of EKG,bone erosion.There was a positive correlation with Tfh and Th9 (r=0.727,P =0.000),Conclusion The expression of Tfh and Th9 were increase significantly,which those cells were close relationship with the disease activity and some data,These results indicate that the abnormality of Tfh and Th9 may play an important role in the pathogenesis of RA.

Sepsis is defined as that a variety of pathogenic microorganisms(including bacteria,fungi,viruses and protozoa) invade the blood circulation,produce toxins and cause systemic infection.The early symptoms of neonatal sepsis are atypical.Neonatal sepsis is urgent and progresses quickly,especially in preterm infants,and it is easy to prone to septic shock which is life-threatening.Therefore,early identification,accurate diagnosis,and active intervention for neonatal sepsis and septic shock is essential to reduce mortality and improve prognosis.

To study the effect of oxygen enrichment of room air on the change of hemorheology of soldiers after high altitude hypoxia and exhaustion exercise at 3700 altitude, the oxygen concentration was increased to 24 0%～25 0% in the rooms at 3700m altitude, the change of hemorheology in 10 soldiers after they had 12h rest and sleep in the oxygen enrichment room was examined in no oxygen enrichment resting state and in oxygen enrichment state as well as after exhaustion exercise in no oxygen enrichment room and in oxygen enrichment room.Hematocrit (HCT), blood viscosity (?b), reduction viscosity (?r) and viscometric aggregation index (VAI) were higher after exhaustion exercise in no oxygen enrichment room as compared with those in no oxygen enrichment resting state, the difference was very significant or signifant ( P 0 05),?b, Plasma viscosity (?p), ?r were decreased after exhaustion exercise in no oxygen enrichment room ( P

Objective To investigate the mastery of clinical students' doctor-patient communi-cation skills and to assess the teaching effectiveness about the doctor-patient communication, and then propose some improvement ideas. Methods We conducted a study in students of clinical medicine of Nanjing Medical University in Grade 2009, using Objective Structured Clinical Examination (OSCE) after internship, which included graduation assessment of doctor-patient communication skills. Then we analyzed the doctor-patient communication skills and related scores of students trained in different clinical medical programs. Results The average score of doctor-patient communication skills of 549 students was (82.72±4.23), of which, the average score of 329 five-year students of clinical medicine was (81.88±4.23) and the average score of seven-year students was (83.96±3.91) in. The average score of seven-year students of clinical medicine was significantly higher than five-year students (P=0.000). Moreover, there was a significant positive correlation between the total score of OSCE and the score of doctor-patient communication skills in both five-year and seven-year students of clinical medicine (five year program students' score correlation coefficient was 0.520, P=0.000;seven year pro-gram students' score correlation coefficient 0.416, P=0.000). Conclusion The teaching effectiveness of doctor-patient communication has proved to be quite effective, and it is definitely of great significance in improving clinical students' doctor-patient communication skills. The score of the assessment of the doctor-patient communication reflects not only the training effectiveness of the communication skills, but also the comprehensive capacity.

Objective To explore the efficacy of pushen capsule on blood lipid and atherosclerosis in patients with ischemic stroke.Methods One hundred and twenty patients with ischemic stroke were randomly divided into three groups,treatment group (pushen capsule and rosuvastatin calcium),control group-1 (pushen capsule) and control group-2 (rosuvastatin calcium).There were 40 patients for each group.The course of treatment was 6 months.Data of serum total cholesterol (TC),triacylglycerol (TG),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C),homocysteine (Hcy),high sensitive C reactive protein (hs-CRP),nitric oxide (NO),endothelin-1 (ET-1),the number and size of carotid plaques,and changes of intima-media thickness (IMT) were detected before and after treatment in three groups.The incidences of adverse cerebrovascular events and adverse events were observed in the three groups.And the therapeutic effects for dyslipidemia were evaluated in three groups.Results The treatment indicators were obviously improved after treatment in three groups (P ＜ 0.05).There were no significant differences in treatment indicators before treatment between three groups.The levels of TG and NO increased,the level of LDL-C,the size and thickness of carotid plaques decreased after treatment in control group-2 than those of control group-1.Levels of TC,LDL-C,Hcy,hs-CRP,ET-1,IMT,and the number,size and thickness of carotid plaques were significantly lower in treatment group than those of control group-1 (P ＜ 0.05),and the level of NO was higher in treatment group than that of control group-1 (P ＜ 0.05).Compared with control group-2,levels of TG,LDL-C,hs-CRP and the number,size and thickness of carotid plaques were significantly lower,and levels of HDL-C and NO were significantly increased in treatment group (P ＜ 0.05).There were no significant differences in the incidences of adverse drug reactions and adverse cerebrovascular events between the three groups (P ＞ 0.05).The total effective rate was higher in treatment group than that of control group-1 (P ＜ 0.05).There were no significant differences in total effective rates between treatment group and control group-2,and between control group-2 and control group-1 (P ＞ 0.05).Conclusion Pushen capsule combined with rosuvastatin calcium can obviously improve blood lipid metabolism in patients with ischemic stroke,which shows obvious antiatherosclerosis effect and good safety.

Objective:To investigate the Foxp3 expression in murine model of type 1 diabetes mellitus and the effects of Foxp3 in the pathogenic mechanism of type 1 diabetes mellitus.Methods:Type 1 diabetes mellitus of mouse was induced by STZ.The Foxp3 expression in the spleen cells was detected at the mRNA level by RT-PCR and at protein level by Western blot.The percentage of CD4+CD25+ Treg cells in the spleens were detected by Flow cytometry.Results:The expressing levels of Foxp3 mRNA and scurfin in the model group was higher than those of control group within the first week after induction,but the expressing level of Foxp3 mRNA and Scurfin began to decrease on day 7 and were lower than those of control group on day 30.The percentage of CD4+CD25+ Treg cells in model group was similar with that of control group within the first week after induction,but after day 7,the percentage of CD4+CD25+ Treg cells in model group began to get lower than contol group.Conclusion:The expressing level of Foxp3 is decreased,then the proportion of CD4+CD25+ Treg cells is decreased accordingly,which may contribute to the pathogenic mechanism in type 1 diabetes mellitus.

ObjectiveTo establish an ultra high performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for detecting the bile acid expression in serum and to explore the relationship between the bile acid spectrum and the obesity.Methods After pre-treatment through solid phase extraction,serum samples were chromatographed by gradient elution on an UPLC HSS T3 column,and then mass spectrometric analysis of bile acid was performed by multiple reaction monitoring ( MRM ) mode with negative electrospray ionization (ESI).And its methodology performance, including specificity,linearity,sensitivity,imprecision and recovery,were verified according to the guideline of State Food and Drug Administration (SFDA).Furthermore,serum samples from 10 simple obesity subjects and 10 healthy controls were analyzed with this establishedmethod, and ranksum test was used for statistical analysis.Results This established UPLC-MS/MS method could simultaneously quantify 14 bile acid subgroups in serum sample,its analytical linear range was 10 - 20 000 nmol/L.For different bile acid subgroups,the limit of detection (LOD) was 0.02 - 7.90 nmol/L,limit of quantitation (LOQ) was 0.07 -44.20 nmol/L; and its within-day coefficient of variation (CV) was 0.35％ - 12.41％,between-day CV was 1.11％ - 13.04％ ; the relative recovery ratio of this method was 89.8％ - 114.6％.Some differenceswere observed in chromatogram between obesity and control subjects,and both free bile acid and conjugated bile acid concentrations in obesity subjects [ 0.49 ( 0.45 - 1.90 ),1.44 ( 0.84 - 3.72 ) μmol/L ] were lower than them in control subjects [0.98(0.53 -3.06),1.99(0.67 -2.88) μmol/L],but the difference was not significant ( Z =- 0.958,- 0.801,P ＞ 0.05 ).ConclusionsThis established UPLC-MS/MS method can efficiently differentiate and quantify 14 bile acid subgroups,and is characterized with broad analytical measurement range,good analytical sensitivity and precision.This method can be applied for the free and conjugated bile acid analysis in clinical specimens.

Objective To explore the value of the application of vascular enhancement technology (VET) in the diagnosis of Budd-Chiari syndrome (BCS) and the evaluation of the therapeutic efficacy of interventional therapy.Methods B-mode ultrasound,color Doppler and VET were performed on 93 patients with BCS for the systematic detection of intrahepatic vessels and the inferior vena cava (IVC),with the static and dynamic images of these vessels stored prior to interventional therapy.Subsequent to the operation,the same procedures were repeated on the vessels concerned and the images were recorded.The definitions of B-mode and VET images of the detected vessels were compared by two sonography experts.Regarding DSA as standard,the diagnostic accordance rate of VET and B-mode imaging of the diseased vessels was compared.Results Of the 613 vessels detected prior to intervention therapy,440 vessels images were distinct by B-mode and 533 by VET(P<0.05).VET demonstrated 37 intrahepatic collaterals which were invisible by B-mode.Regarding DSA as the gold standard,the diagnostic accordance rate of affected vessels of B-mode and VET was 69.2% and 92.5%,respectively(P<0.05).In total 103 therapeutic vessels,B-mode sonography and VET revealed 81 and 95 distinct vessels,respectively(P<0.05).Conclusions VET can improve the definition of veins and venous stents.The combination of VET and color Doppler can improve the clinical value of ultrasound in the diagnosis of BCS and evaluation of the therapeutic efficacy of interventional therapy.

Objective To investigate the effect of salvia mihiorrhiza on spinal cord ischemia reperfusion injury after surgical treatment in patients with cervical canal stenosis. Methods Retrospective analysis of 64 cases had cervical canal stenosis in the last 5 years in our hospital. Sixty-four cases were randomly divided into the salvia mihiorrhiza group(31 cases)and the control group(33 cases). The therapeutic effect was assessed using JOA grade system. Results In the salvia mihiorrhiza group,the JOA average score was 8. 8 ±2. 6 before surgical treatment, after two weeks of surgical treatment it was 13. 7 ± 2. 4. The JOA improvement ratio was (61. 5 ± 2. 9) % . In the control group,the JOA average score was 9. 1 ±2. 2 before surgical treatment,after two weeks of surgical treatment it was 13. 4 ± 2. 3. The JOA improvement ratio was (60. 5 ± 2.2)% .The JOA improvement ratio in the salvia mihiorrhiza group was significantly higher than that in the control group (P < 0. 05) . Conclusions Salvia mihiorrhiza has protective effect on spinal cord ischemia reperfusion injury.