Objective]Summarizing the thinking and experience for pediatric diseases of Zhi Yu QiaoKe. [Method]Analyse and induce the contents of“Clear-headed of Pediatric”, which was written by Zhi Yu QiaoKe ,elaborating his characteristics in treating pediatric diseases features.[Results]Zhi Yu QiaoKe amended the treatments and academic point of views, which were not conformed to the medical principles and practice proved to be errors, proposed“the differentiation of infantile convulsion of error theory”,“not hungry theory”; he considered that clinical cure, then pathogenesis diagnosis was accurate;medication must be care of primordial qi and spleen and stomach;in addition, we still should also focus on nursing and adhere to the taboo. [Conclusion]The Clear-headed Pediatric with precise arguments and appropriate classification reflects the author ’s advanced medical theory and excellent medication principle of dialectical thinking, rigorous medication principle and exquisite nursing technique, the clinical diagnosis and treatment rules and characteristics of a certain reference value for the modern clinical, worthy of promotion.

Objective To approach the correlation between the bone density measured by quantitative CT and the blood sugar level of the aged patients with non-insulin-dependent diabetes mellitus,and observe the effects of the blood sugar level on the bone density.Methods The lumbar bone densities and the blood sugar levels of 160 aged patients with non-insulin-dependent diabetes mellitus (hyperglycemia group 80 cases,euglycemia group 80 cases ) and the healthy aged people (80 cases) were detected by quantitative CT and serum biochemical detection; the correlation between the blood sugar level and the bone density and the osteoporosis occurrence status of aged people in various groups were analyzed.Results The bone density in the non-insulin-dependent diabetes and hyperglycemia group was lower than those in normal(control) group and non-insulin-dependent diabetes and euglycemia group (P

Objective To explore the expression of COX-2 and p38MAPK in patients with trauma MODS. Methods Forty MODS patients were evaluated. The levels of peripheral blood mononuclear cells COX-2 and p38MAPK in MODS patients and 40 normal controls was detected by enzyme linked immunosor-bent assay (ELISA). RT-PCR was used to measure the COX-2 mRNA and p38MAPK mRNA expression of in PBMCs. ANOV and correlation analysis were used in statistical analysis. Results The levels of COX-2 and p38MAPK of PBMCs and the mRNA expression in MODS group were higher than in control group (all P <0.05). The levels of COX-2 and p38MAPK of PBMCs and the mRNA expression in dead group were higher than in survival group( all P <0.05). The levels of COX-2 and p38MAPK of PBMCs were positively correlated, (r =0.6 147, P<0.01). The expression of COX-2 mRNA, p38MAPK mRNA of PBMCs and APACHE I scoring were positively correlated (r1 =0.5 009, P1 <0.05,r2 =0. 5 316, P2 <0. 05). Conclusions COX-2 and p38MAPK of PBMCs take part in the onset of MODS, and may service as index to judge the prognosis of MODS.

Objective To evaluate the effects of dexmedetomidine on the expression of phosphor-cAMP response element binding protein (p-CREB) in isoloated hippocampal neurons of fetal rats.Methods SpragueDawley rats on 16-18 days of gestation were sacrificed and the fetal rats were obtained.The hippocampi of fetal rats were isolated and hippocampal neurons were seeded in culture medium for 8 days.The cells were then divided into 4 groups (n =12 each) using a random number table:control group (group C),dexmedetomidine 0.001 μmol/L group (group D1),dexmedetomidine 0.010 μmol/L group (group D2),and dexmedetomidine 0.100μmol/L group (group D3).In D1.3 groups,dexmedetomidine with the final concentrations of 0.001 μmol/L,0.010 μmol/L,and 0.100 μmol/L was added to the culture medium,respectively,and then the cells were incubated for 3.5 h.The apoptosis in hippocampal neurons was detected by flow cytometry.The expression of p-CREB in hippocampal neurons was determined by RT-PCR and Western blot.Results Compared with group C,apoptosis rate was significantly decreased and the expression of p-CREB was up-regulated in D1.3 groups.Conclusion Dexmedetomidine inhibits apoptosis in isolated hippocampal neurons of fetal rats by up-regulating the expression of p-CREB.

Objective:To investigate the role of alloreactive T cell in clonal deletion and regulatory T cells ( Treg) in transplant tolerance.Methods:F1 mice were bred by crossing female BALB/c mice and male C57BL/6 mice.Within 24 h,newborn C57BL/6 mice were inoculated with F1 spleen cells via the orbital branch of the anterior facial vein.Six weeks later,the mice were subjected to F1 skin grafting to evaluate their tolerance.Proliferation,flow cytometry and adoptive transfer assay were used to analyze clonal deletion of alloreactive T cells and the expression of CD4+Foxp3+T cells in neonatal treated mice.Results: Newborn C57BL/6 mice injected with F1 splenic cells could induce transplantation tolerance,the level of tolerance was associated with the dose of splenic cells.3×107 splenic cells from F1 mice could induce long-term skin graft acceptance in C57BL/6 mice ,1×107splenic cells significantly prolonged the survival of F1 skin grafts,but the grafts completely rejected within 50 days.The mixed lymphocyte reaction ( MLR) experiment in vivo showed that alloreactive T cell in long-term tolerant mice was deleted completely,but a certain amount of reactive T cells existed in the low-dose group mice.Flow cytometry ( FCM) analysis showed that the expression of CD4+Foxp3+T cell in the high-dose group and low-dose group mice had no obvious difference compared with the naive mice.When alloreactive T-cells were injected into tolerant mice,the skin graft rejection was observed,and Treg cells upregulated in graft-rejected mice.Conclusion:The degree of transplantation tolerance depended on the clonal deletion of alloreactive T cells,instead of on the expression of CD4+Foxp3+Treg cells.CD4+Foxp3+regulatory T cells upregulated in graft rejected mice,which may be served as a negative feedback mechanism to control the intensity of rejection.

Objective:To analyze the effect of comprehensive nursing education on anxiety, depression, quality of life and survival of patients with hepatocellular carcinoma (HCC) after surgery.Methods:A total of 136 HCC patients were randomly divided into two groups: general nursing education group and comprehensive nursing education group. The comprehensive nursing education group carried out 12 months of health belief education, psychological care, care activities and telephone condolence. The routine nursing group received basic education for 12 months. The changes of anxiety and depression were assessed by hospital anxiety and depression scale (HADS). The quality of life (QOL) of participants within 12 months was assessed using the European research and treatment cancer quality of life questionnaire (QLQ-C30). The 3-year survival of the two groups was compared.Results:There was no significant difference between the two groups in baseline data. At the 9th and 12th month, the HADS-A score of the comprehensive nursing education group was significantly lower than that of the general nursing group ( P< 0.05). In the 12th month, the overall health of QLQ-C30 in the comprehensive nursing education group was better than that in the general nursing group ( P<0.05). The QLQ-C30 function score of the comprehensive nursing education group at the 12th month was better than that of the general nursing group ( P<0.05). There was no significant difference in QLQ-C30 symptom scores between the two groups at all time points ( P>0.05). The overall survival of the patients in the comprehensive nursing education group was better than that in the general nursing group ( P=0.026). Conclusion:the comprehensive nursing education can reduce the anxiety and depression of HCC patients after surgery, and can improve their quality of life and survival.

Objective To estimate the activity of the phosphatidylinositol3-kinase (PI3K) signaling pathway in peripheral blood T cells from patients with atopic dermatitis (AD),and to investigate its clinical significance.Methods T cells were isolated by using the Rosettsep T cell purification kit from the peripheral blood of 38 patients with AD and 38 healthy human controls,and classified into several groups to be treated with anti-CD3 monoclonal antibody,anti-CD28 monoclonal antibody,and LY294002 (an inhibitor of PI3K) respectively.The activity of PI3K signaling pathway in T cells was estimated by immunoprecipitation and enzyme-linked immunosorbent assay (ELISA).Western blot was performed to measure the expressions of total Akt and phosphorylated Akt in T cells,methyl thiazolyl tetrazolium (MTT) assay to examine the proliferation of T cells,and ELISA to determine the levels of interleukin 6 (IL-6) and IL-10.Results The activity of PI3K and Akt was significantly higher in freshly isolated patient-derived T cells than in control-derived T cells (both P ＜ 0.05).However,the difference in the activity of PI3K and Akt between patient-derived and control-derived T cells disappeared (both P ＞ 0.05) after 24-hour in vitro culture.The activity of PI3K and Akt in control-derived T cells was significantly increased after 24-hour incubation with sera from the patients with AD (both P ＜ 0.05).In addition,compared with patient-derived T cells treated with patients' sera or anti-CD3/CD28 monoclonal antibody alone,those treated with the combination of LY294002 and patients' sera or anti-CD3/CD28 monoclonal antibody showed a significant decrease in the proliferative activity (63％ ± 11％ vs.123％ ± 25％,125％ ± 22％ vs.195％ ± 28％,both P＜ 0.05),supematant levels of IL-6 ((168 ± 33) vs.(265 ± 46) ng/L,(431 ± 64) vs.(823 ± 128) ng/L,both P＜ 0.05) and IL-10 ((56 ± 14) vs.(98 ± 25) ng/L,(120 ± 21) vs.(213 ± 35) ng/L,both P＜ 0.05).Eczema area and severity index (EASI) was unassociated with the activity of PI3K or Akt in fresh T cells from patients with AD (both P ＞ 0.05).Conclusions The PI3K signaling pathway is abnormally activated in peripheral blood T cells from patients with AD,which is associated with the proliferation of,as well as secretion of cytokines by,T cells,suggesting that there exist serum factors activating this pathway in peripheral blood of patients with AD.

Objective To evaluate the efficacy and safety of single intra-articular etanercept injection in patients with rheumatoid arthritis (RA) and spondyloarthropathy (SpA) who had knee arthritis.Methods This was a randomized, single-blind, parallel, controlled clinical trial. The subjects were the RA or SpA patients with the knee arthritis without deformity, moderate or severe bone erosion and obvious joint space narrowing in radiography in the target knees, who had taken at least 6-week therapy with routine dosage of disease modifying anti-rheumatic drugs (DMARDs) before the study. The subjects were randomized in 2:1 ratio to receive either single intra-articular 25 mg etanercept injection or 2 ml compound betamethasone to the target knees joint after their synovial fluid being drawn away at baseline. They were followed up four weeks after injection. The primary end-point was the 4-week change in the modified Hospital for Special Surgery (HSS) knee score for the target knee. Results Forty-seven subjects in the experimental group and twenty-three subjects in the controlled group were included in the trial. The modified HSS knee score for the experimental group was baseline mean 65.6 ± 14.0, follow-up 84.3 ±11.1 (P ＜0.0001 ), the controlled group baseline mean 68.2 ± 11.4, follow-up 79.4 ± 15.5(P =0.0015). A mean (34.9 ±38.9)% improvement on the modified HSS knee score was achieved in the experimental group, while ( 17.9 ±24.5)% improvement on the modified HSS knee score was achieved in the controlled group (P =0.0467). Adverse events were observed in eight patients (19.0% ) in the experimental group and eight patients (44.4%) in the controlled group. No serious adverse event had been observed. Conclusions Single intra-articular 25 mg etanercept injection had a better efficacy than 2 ml compound betamethasone. It was an effective and safe therapeutic option for SpA and RA patients who had knee arthritis without obvious change in radiography.

ObjectiveTo investigate the ratios of peripheral blood CD4+CD25highFoxp3+ regulatory T cells of systemic lupus erythematosus(SLE) patients,and explore its association with disease activity and nephropathy.MethodsPBMC lymphocytes in 42 patients with SLE and PBMC in 40 normal healthy donors were evaluated for the proportion of Treg cells,as a percentage of the total CD4+ cells,by flow cytometric analysis.Levels of mRNA for Foxp3 were measured with a real-time quantitative PCR.The proportion of Treg cells and its association with SLEDAI,nephropathy,serum anti-dsDNA antibody,and C3 levels were analyzed.Statistical analysis was conducted with t-test and Spearman's correlation analysis.ResultsPatients with active disease had statistically significantly lower levels of CD4+CD25highFoxp3+ Treg than normal controls [(4±3)％ vs (7±4)％,P＜0.05],while no significant difference could be found between patients with nonactive disease and normal controls(P＞0.05).The percentage of peripheral blood CD4+CD25highFoxp3+ Treg/CD4+ in patients with active disease was significantly lower when compared to patients with non-active disease [(9±6)％ vs (10±6)％,P＜0.05],and it was related to the disease activity.SLE patients with nephropathy had significantly lower levels of CD4+CD25highFoxp3+ Treg and CD4+CD25highFoxp3+ Treg/CD4+ than patients without nephropathy(P＜0.05).Foxp3 mRNA levels were lower in PBMC from active disease patients than those in non-active disease.In addition,there was a negative correlation between the populations of CD4+CD25highFoxp3+ and SLEDAI(r=-0.5892,P＜0.05).There was a negative correlation between the percentage of CD4+CD25highFoxp3+/CD4+ and SLEDAI (r=-0.4962,P＜0.05),while there was a positive correlation between the percentage of CD4+CD25highFoxp3+/CD4+ and C3(r=0.3867,P＜0.05).There was a positive correlation between the populations of CD4+CD25highFoxp3+ and Foxp3 mRNA(r=0.6142,P＜0.01 ).ConclusionThese suggest that the decrease of CD4+CD25highFoxp3+ Treg and Foxp3 mRNA expression may play a crucial role in the pathogenesis of SLE.

BACKGROUND:There are many methods to treat thoracolumbar fractures However,it remains unclear whether a simple operation to treat a thoracolumbar burst fracture can decrease the trauma and obtain better effect to avoid the enlargement of operation.OBJECTIVE:To investigate the clinical outcome of posterior short-segmental transpedicular screw system internal fixation in treatment of single-level thoracolumbar burst fracture without nerologic deficit.METHODS:A total of 186 patients with single.level thoracolumbar burst fracture but without nerologic deficit treated in the First Affiliated Hospital of Soochow University between September 2003 and January 2008,including 152 males and 34 females,aged18 10 65 years.were treated by posterior pedicle screw The intraspinal bone fragments were treated with indirect decompression.All patients were checked with radiography and CT scan before/after operation as well as before implant removal.The correction of anterior vertebral body height and the ratio of bone fragment to cross section area of spinal canal were measured.RESULT AND CONCLUSION:Compared with normal.the anterior vertebral body height was 42%before operation,98%after operation,and 98%before implant removal The ratio of bone fragment to cross section area of spinal canal was 34%before operation,13%after operation.and 8%before implant removal.Internal posterior short-segmental transpedicular screw fixation treating single-level thoracolumbar burst fracture without nerologic deficit can obtain stability of spinal column,and it is beneficial to recovery of body height,physiologic postu ral contour and canal volumn .