Humans ; Interferon-gamma ; metabolism ; Interleukin-12 Subunit p40 ; metabolism ; Meningitis, Bacterial ; blood ; cerebrospinal fluid ; Multiple Sclerosis, Relapsing-Remitting ; blood ; cerebrospinal fluid ; Staphylococcal Infections ; blood ; cerebrospinal fluid

Objective To determine the efficacy and safety of intravenous iron sucrose and oral iron dextran in renal anemia patients. Methods Sixty renal anemia patients were randomized into two groups:intravenous iron group(IV group, 100 mg iron sucrose twice a week) and oral iron group(oral group, 150 mg iron dextran every day). The changes in hemoglobin (Hb),hematocrit (Hct),serum ferritin (SF),and transferrin saturation (TSAT) were assessed on week 4,8, and 12 after treatment. The maintenance dosages of erythropoietin (EPO) after reaching treatment target and the adverse events were also observed. Results Hb increased after treatment in IV group [(79.87 ± 13.19) g/L to (106.11 ± 12.38) g/L] and oral group [(85.41 ± 11.49) g/L to (94.68 ± 10.06) g/L],and compared with that before treatment, there was significant difference in each group(P< 0.01 ). Also significant difference showed in Hb levels after treatment between two groups(P< 0.01 ). SF and TSAT levels were higher after treatment in IV group than those in oral group (P < 0.01 ). The adverse event was lower in IV group (0) than that in oral group (16.7%,5/30).Conclusions Oral iron dextran which has more adverse events and poor efficacy in curing anemia, can not correct anemia ideally. Meanwhile intravenous iron sucrose has positive effects on renal anemia with low adverse events, and it can be used as a long term iron supplementation in hemodialysis patients.

Multiagent chemotherapy has significantly improved survival for childhood ALL.However,the relapse rate with current therapies remains at 20% to 30%.Numerous studies have proved that the minimal residual disease(MRD)is associated with relapse rate.The major methods for the detection of MRD include polymerase chain reaction(PCR)and flow cytometry(FCM).The measurement of MRD in childhood acute lymphoblastic leukemia offers the promise of individualized,risk-stratified treatment and the prediction for post-transplant outcome.

It is important that the oral hospital establish a guarantee system of medical graduation clinical practice quality. Having experienced clinical education for many years,the hospital has formed a system in order to achieve objective management and process management organic unification,which can gradually promote the clinical practice quality.

Objective To investigate.the co-stimulatory pathway of gastric cancer patients by examining the expression of co-stimulatory molecules CD28,CTLA.4(CDl 52)and B7 molecules on peripheral blood lymphocytes(PBLC)in patients with gastric cancer,and to discuss the role of costimulatory pathway in the pathogenesis of gastric cancer.Methods The expression of CD28,CD152,CD3,CD4,CD8 and B7 molecules on peripheral blood lymphocytes and T cell subpopulation were measured by flow cytometry in 56 patients with gastric cancer,and the data was compared and analyzed with that in gastric benign tumor group and healthy control group.Results The expression levels of CD3+,CD4+,CD3+ CD28+,B7-1(CD80),B7-2(CD86)and CD41/CD8+on PBLC in patients with gastric cancer was significantly lower than that of benign stomach tumor group and healthy control group.The expression levels of CD3+ CDl52+ and CD8+ on PBLC in patients with gastric cancer were significantly higher than those of gastric benign tumor group and healthy control group.Conclusion Peripheral lymphocytcs in gastric cancer patients express low level of CD28 and B7 molecules and high level of CDI 52 molecules,which results in dysfunction of B7:CD28/CTLA-4 co-stimulation pathway and in turn affects the capacity of T cell to eliminate tumor cells,which makes tumor cells evading the immune surveillance and metastasizing.

[Objective]To discuss and analyze the effect of the treatment of high-energy Pilon fractures.[Method]Twenty-four patients with R?edi-Allgower type Ⅱ and Ⅲ Pilon fractures(Ⅱ=14,Ⅲ=10) were treated by open reduction and internal fixation.Ten cases were combined with external fixation.Sixteen cases were treated by bone transplantation(spongy bone=10,big pieces of ilium=6).[Result]From June 2003 to December 2007,the restoration of fractures with Burwell-Charnley system was:excellent=16,good=8;the function of ankle joint with Mazur system was evaluated:excellent=12,good=10,fair=2.[Conclusion]In the time of treating Ruedi-Allgower type Ⅱ and Ⅲ Pilon fractures,the bone transplantation with big pieces of ilium is effective to solve the serious bone loss,strengthen the internal fixation and exercise ankle joint earlier.

[Objective]To compare the outcome and complication rates following nonoperative and those after ptate fixation of displaced midshaft clavicular fractures.[Method]Between March 2001 and December 2005,the data of 110 patients with a displaced midshaft fracture of clavicle were retrospective analyzed.Among them,62 patients were treated with plate fixation,including 53 male and 9 female patients aged 33.5 years old averagely.48 patients were treated with closed reduction and a figure-of-eight bandage applied,including 33 male and 15 female patients aged 33 years old averagely.Following enrollment in the study,the patients were seen at six weeks and at three,six,and twelve months.Assessment included standardized clinical evaluation,completion of the Constant shoulder score,complication and plain radiographs.Radiographic union was defined as complete cortical bridging between proximal and distal fragments on radiograph.[Result]All patients completed one year of follow-up.Constant shoulder score were significantly improved in the operative fixation group at all time-points(P

Objective To investigate the diagnostic and predict vaIue of procalcitonin (PCT) in ICU patients with sepsis and the correlation between PCT concentration and positive results of bacterial culture.Methods A total of 278 patients with sepsis were admitted into emergency ICU,general ICU and respiratory ICU from October 2011 to September 2012.Of them,193 patients had definite microbial infection evidence.Serum PCT levels among groups of different pathogens were compared.The analysis of correlation between the PCT concentration of the first assay was got after admission and short-term prognosis was evaluated.The correlation between PCT level and positive results of bacterial culture was also evaluated.Results Spearman correlation analysis showed that serum PCT levels of bacterial infections in patients with sepsis were significantly higher than those of the non-bacterial infections in patients with sepsis (P =0.001).And there was a positive correlation between the PCT concentration of the first specimen after admission and 7-day in-hospital mortality in patients with sepsis due to bacterial infections (r =0.277,P =0.004).The patients with PCT levels greater than 2 ng/ml had high vulnerability to bacterial infection Conclusions The PCT concentration of the first assay after admission was positively correlated to 7-day mortality in ICU patients with sepsis due to bacterial infections.The serum PCT concentration indicated the severity of host response to the bacterial infection.And etiological evidence directly showed pathogenic factors.Both of PCT and etiological evidence related to bacterial infection,reflected different aspects of bacterial infection.

Objective: To investigate the effects of ginsenoside Rb1 on activation and proliferation of murine T lymphocytes in vitro and to elucidate the mechanism of the immunosuppressive effect of ginsenoside Rb1. Methods: Cell suspensions were prepared from murine lymph nodes. T lymphocytes were treated with different concentrations of ginsenoside Rb1 and stimulated with polyclonal activator concanavalin (ConA). Fluorescence conjugated monoclonal antibodies and flow cytometry were used to detect the expression of CD3/CD69 and CD4/CD25. After the staining with CFDA-SE, T lymphocytes were stimulated with polyclonal activator ConA. The proliferation of T lymphocytes, after stimulated by ConA, was detected using the method of MTT. The distribution of the cell apoptosis was analyzed by staining both DIOC and PI. Results: In a dose-dependent manner, ginsenoside Rb1 (5, 10, and 20 μmol/L) could significantly inhibit T lymphocytes activation index (P<0.01) stimulated by ConA and proliferation index (P<0.05) stimulated by ConA. Ginsenoside Rb1 could also reduce the apoptosis of T lymphocytes stimulated by H2O2. Conclusion: Ginsenoside Rb1 can effectively inhibit the activation and proliferation of murine T lymphocytes, and ginsenoside Rb1 is a potential effective immunoinhibitory agent.

Objective To evaluate the diagnostic and predict value of procalcitonin (PCT) levels in patients diagnosis of sepsis with immune system defect in the intensive care unit (ICU).Methods This is a retrospective analysis.We enrolled 278 patients diagnosis of sepsis in Emergency ICU,general ICU and Respiratory ICU in Renmin Hospital of Wuhan University from October 2011 to September 2012.Among them,122 patients have normal immune function and 156 patients have auto-immune system diseases or/and requiring corticosteroids or chemotherapy.According to the APACHE Ⅱ score,patients were divided into low-risk group,middle-risk group and high-risk group,and their PCT levels were compared.Logistic regression analysis of the multiple factors was used to screen independent risk factors for predicting 7 days' mortality.The predictive ability was also evaluated and compared between the first time of PCT concentration after admission and dynamic change of PCT within the first week with area under receiver operator's characteristic curve (ROC curve,AUC).Result The results of Spearman correlation analysis showed that there was a significant positive correlation between the patients' PCT concentration and APACHE Ⅱ score (r =0.979,P ＜ 0.05).And there was a positive correlation between the first PCT concentration after admission and 7 days' mortality in-hospital (r =0.826,P ＜ 0.05).Multiple factors logistic regression analysis indicated that both the first time PCT concentration after admission and APACHE Ⅱ score of patients were independent risk factors for predicting 7 days' mortality (PCT OR =1.77,95％ CI =1.28-3.83,P =0.0023).The warning value of 7 days' mortality for patients with normal immune function was PCT≥7.18 ng/ml and for those with abnormal immune function was PCT ≥ 3.52 ng/ml.Compared to dynamic monitoring of PCT,there was no significant difference in sensitivity but specificity is less than the dynamic monitoring of PCT.Conclusions The diagnostic and predict value of procalcitonin (PCT) levels were not affected by the immuno-suppressive therapy.The first time PCT concentration after admission was an independent risk factor for predict of 7 days' mortality in ICU patients with sepsis.The PCT warning value of the sepsis patients with abnormal immune function was much lower compared to those with normal immune function.