Objective To investigate the levels of peripheral blood CD8+ CD28- regulatory lymphocytes and their clinical values in the patients with multiple sclerosis (MS). Method From October 2005 to August 2008, 51 patients with active rehpsing-remitting MS were enrrolled from Department of Neurology of the First Affil-iated Hospital of Wenzliou Medical College. The diagnostic criteria for MS were the 2005 revisions to the "McDon-ald criteria". All the admitted patients received 1 g of methylprednisoione per day intravenously for 5 days, fol-lowed by 60 mg prednisone per day orally for 12 days,and tapered in 6 weeks. Fourteen patients were reevaluated after corticosteroid therapy. Twenty healthy individuals ,as normal controls,matched for age and sex with the MS patients were also enrolled in this study. The percentages of peripheral blood T cells (CD8+ CD28-, CD8+CD28+, CD8+, CD4+ CD8-) were measured by flow cytometric analysis. Parametric statistical analysis were per-formed using standard methods, and linear regression analysis was conducted using Pearson correlation test. Re-sults (1)Compared with controls,the patients with active MS had significantly lower percentage of CD8+ CD28-T cells [(18.48±9.89)% vs. (24.48±4.86)%, P <0.01], and higher percentage of CD8+ CD28+ T cells [(12.23±4.31) % vs. (8.55±3.49) %, P <0.01]. (2)The percentage of CD8+ CD28- T cells was negative-ly correlated with that of CD4+ CDS- T cells (r = -0.488, P < 0.01). (3) After corticosteroid therapy, the per-eentage of peripheral blood CD8+ CD28- / CD8+ CD28+ T cells didn' t significantly decrease or increase in 14 ac-tive MS patients (P > 0.05). Conclusions The decrease of peripheral blood CD8+ CD28- regulatory T cells might be associated with the pathogenesis of MS, and CD8+ CD28- regulatory T cells perhaps played their roles through CD4+ T cells. Corticosteroid therapy could not reverse the levels of CD8+ CD28- T cells.

Objective To analyze the impact of obesity on short-term prognosis in patients who underwent surgery for cirrhotic portal hypertension with hypersplenism.Methods The clinical data of 310 patients with cirrhotic portal hypertension who underwent splenectomy and portaazygous devascularization between Apr.2002 and Jue.2012 were prospectively analyzed.According to the body mass index (BMI),these patients were divided into the non-obesity group (BMI ＜ 28 kg/m2) and the obesity group (BMI ≥28 kg/m2).There were 78 patients in the obesity group (male:female 56:22; mean age 48.7 ± 8.3years).There were 232 patients in the non-obesity group (male:female 166:66; mean age 46.3 ± 6.9years).The postoperative outcomes in the two groups were analyzed.Results When compared with the nonobesity group,there were significant differences in age (48.7 ± 8.3 in obesity group vs 46.3 ± 6.9 years in non-obesity group),perioperative blood transfusion (400 ± 100 vs 200 ± 100 ml),intraoperative blood loss (370 ± 110 vs 240 ±60 ml),operation time (180 ±40 vs 150 ±35 min),serum albumin level after surgery (28.1 ±2.6 vs 31.2 ±2.3 g/L),drainage volume (280 ±70 vs 230 ±60 ml) and hospital stays (10.5 ±3.0 vs 8.5 ± 2.5 days) in the obesity group (P ＜ 0.05).However,there were no significant differences in gender,preoperative level of liver function,platelet counts (preoperative and postoperative) and postoperative deaths (P ＞ 0.05).Conclusion BMI was a significant independent prognosis risk factor for patients with cirrhotic portal hypertension undergone splenectomy and portaazygous devascularization.

Objective To investigate the effects of preoperative nutrition support on postopreative clinical outcome in patients with nutritional risk with pancreaticoduodenectomy.Methods Forty six patients with pancreaticoduodenectomy complicated with malnutrition from June 2011 to September 2013 in Department of Hepatobiliary and Lapoaroscopic Surgery of People's Hospital of Wuhan University were randomly divided into experimental group (n =23) and control group (n =23) with random number table,patients in experimental group received preoperative nutrition support,but patients in control group did not receive preoperative nutrition support.The preoperative and postoperative nutritional status,the incidence of postoperative complications,the length of hospital stay,and the cost of hospitalization in the two groups of patients was compared.Results In terms of intra-operative blood loss and the operative time,experimental group was significantly lower than those in control group [(340 ±90)min vs (420 ± 104)min,(761 ± 100)ml vs (901 ± 150)ml,P＜0.01],on the 1st day of preoperation,the 1st day,7th day and 14th day of post operation,the levels of serum albumin was significantly higher than those in control group [(30.6 ± 1.8) g/L vs (24.6±2.2) g/L on the,P＜0.05];and on the 1st day of pre-operation,the 1st day,7th day of post operation,the levels of transferrin were significantly higher in experimental group than in control group [(3.23 ± 0.65) g/L vs (2.38 ± 0.49) g/L on the,P ＜ 0.05);the rate of post operative complication were significantly lower in experimental group than that in control group (52.2％ vs 21.7％,P=0.000);the postoperative anal exhaust time was earlier in experimental group than that in control group [(6.4 ± 0.6) d vs (9.5 ± 0.6) d,P =0.000),and the length of hospital stay was shorter in experimental group [(20.1 ± 6.5) d vs (26.7 ± 9.5) d,P =0.014),and the cost in experimental group was lower [(99 ± 13) thousand yuan vs (115 ± 13) thousand yuan,P =0.000),however,the cost of nutrition support between the two groups was not significantly different (P =0.210).Conclusions Preoperative nutrition support is helpful to reduce the incidence of postoperative complications,shorten the length of hospital stay,to save medical costs for patients with pancreaticoduodenectomy.

Objective To study the relationship between angiotensin converting enzyme (ACE)gene polymorphism and the risk factors of Binswanger's disease (BD) in Chinese Han nationality.Methods ACE gene insertion/deletion(ID) polymorphism in 111 Chinese Han Nationality patients with BD, 98 patients with hypertension and 102 normal controls were detected by polymorase chain reaction (PCR) technology,serum ACE was measured by colorimetric method,the risk factors of BD and family histories were assessed.Results The DD genotype frequency(0.64) was higher in BD group than in hypertension group (0.31, P

Objective To investigate the effects of low carbohydrate diet in treating non-alcoholic fatty liver disease (NAFLD) patients.Methods 58 male NAFLD patients selected in Renmin Hospital of Wuhan University from September 2010 to October 2012 were divided with random number table into low-carbohydrate diet group (L group,n =31) and medium-carbohydrate diet group (M group,n =27).Waistline,weight,serum glucose level,insulin secretion,glutamic-pyruvic transaminase (ALT),aspartate transaminase (AST)、high-density lipoprotein (HDL),low-density lipoprotein (LDL),total cholesterol (TC),and triglyceride (TG) of the patients were measured.Results Six patients were excluded from this research,2 in L group and 4 in M group.After 6-week's dietary intervention,blood glucose level and insulin secretion were significantly lower in L group than in M group [(4.3±1.4) mol/Lvs.(5.0±0.9) mol/L,P=0.004; (6.1 ±1.5) U/mlvs.(8.9 ± 1.4) U/ml,P =0.001].The levels of ALT and AST in L group were significantly lower than those in Mgroup[(30.23±3.34) U/Lvs.(42.33±4.46) U/L,P=0.003; (31.19±4.13) U/Lvs.(45.21±3.73) U/L,P =0.001].The levels of LDL and TG in L group were also significantly lower than those in M group [(1.13±0.22) mmol/Lvs.(2.71±0.67) mmol/L,P=0.001; (0.99±0.74) mmol/Lvs.(1.42±1.06) mmol/L,P =0.001].Conclusion In NAFLD patients,low-carbohydrate diet can improve blood glucose level,insulin secretion,liver function,and lipid metabolism disorders.

Considerable clinical and experimental evidence supports that liver injury in acute pancreatitis (AP) is a sign for the potential progression to systemic inflammatory reaction.The Kupffer cells,various cytokines and macrophage migration inhibitory factor (MIF) play important roles in the pathogenesis of AP associated liver injury.However,the specific molecular mechanism of the liver damage remains uncertain.Therefore,efforts should be made to clarify the regulatory mechanism and related cell signaling disorders of liver injury in AP,which could not only identify novel therapeutic targets,but also provide new insight into improving the clinical treatment.Here our review discusses the recent research progress on the etiology,pathology and diagnosis and treatments of liver injury in AP.

Objective To investigate the prevention and management strategies of in-hospital complications in the hip replacement in elderly patients(≥80 years old) Methods The data of 42elderly patients with hip replacement between Oct.2004 and Dec.2006 were collected and analyzed.Their age ranged from 80 to 96 years with an average of 84.6 years.Twenty-four cases were associated with severe osteoporosis(Dorr Ⅲ),13 with coronary heard disease,10 with arrhythmia,7with diabetes,5 with cerebral paralysis.Twenty five cases had a cemented stem bipolar femoral head replacement,2 had uncemented stem bipolar femoral head replacement,7 had cemented total hip replacement,3 had revision of total hip replacement. Results No death occurred during operations,1 died postoperatively due to dislocation at the 5th day postoperation.One case had coma for 1 week after general anaesthesia.5 had temporary cognitive handicap,38(90.5%)were able to walk at the aid of walker with easement of pain before discharging. Conclusions To gain good results in elderly patients with hip arthroplasty,less invasive and quick anaesthetic technique and operative procedures are encouraged.Meticulous preoperative preparation.active preventing and treating the intraoperative and postoperative complications should be emphasized.

Objective To induce experimental allergic encephalomyelitis (EAE) in female C57BL/6 mice with the extracellular domain of myelin oligedendroglia glycoprotein(MOG~(Igd)). Percentages of CD4~+ CD25~+ T cell (Tr) were tested , and also normalized expressions of Foxp3. Methods Molecular cloning technology was used to produce MOG~(Igd) fusion protein. The MOG~(Igd)-TrxA fusion protein and TrxA protein were purified by metal chelate affinity chromatography (MCAC). Mice were injected s. c. in the flank with 300 μg MOG~(Igd) in complete Frcund's adjuvant (CFA) supplemented with 4 μg/μl Mycobacterium tuberculosis. H37Rv. Mice received 0.4 ml emulsion of spinal cord homogenate of guinea pigs (GPSCH) in positive control group, and the same volume emulsiom of TrxA in negative control group, while mice served as normal control received only saline/adjuvant. Mice were monitored two times a day for continuously 30 days by double bind. Clinical scores and histopathology were evaluated. Then, mice were sacrificed. The spinal cord and brain were removed and fixed in buffered formalin. Horizontal sections taken from the central nervous system(CNS) were stained with haematoxylin and eosin (HE), and Kluver-Barrera staining. Also, immunohistochemistry was performed. Percentages of CD4~+ CD25~+ T cells were tested through flow cytometric analysis, and real-time PCR was performed to test normalized expressions of Foxp3 mRNA. Then, correlations between the two were performanced. Results Mice in both MOG group and GPSCH group shew chronic non-remitting course. The onset of disease, time when the most severe clinical symptoms happened and the clinical score between the two groups shew no significant differnces (P>0.05). However, neither in TrxA treated group nor in normal control group did animals exhibit clinical signs of EAE. Histologic sections of the brain and spinal cord taken from affected animals shew perivascular infiltration of mononuclear cells, gliosis, and multifocal demyelination. Lesions scattered throughout the CNS including brainstem, spinal cord, cerebellum, and penventricular white matter. There were significant differences between MOG group and TrxA group in the level of lesion-ceutric AQP-4 expression showing up by immunohistochemistry (P<0.05). Percentages of CD4~+ CD25~+ T cells in MOG group and GPSCH group were (4.71±1.61) % and (1.44±0.65) %, respectively, both of which were significantly lower than those in the normal control group or TrxA treated group (P<0.01). And the difference between MOG group and GPSCH group also reached statistics meaning (P<0.01). Normalized expression of Foxp3 mRNA in MOG group was 2.26± 1.97, and was not significantly higher than the 1.44±1.20 level in GPSCH group (P>0.05). However, they beth were statistically lower than that in the negative control group, namely 8.58±3.34 (P<0.01). Percentages of CD4~+ CD25~+ T cells was statistically correlated with expressions of Foxp3 mRNA (P< 0.05). Conclusion EAE induced in C57BL/6 mice with MOG~(Igd) is reproduceable. It shares the similar clinial signs and pathologic features with human multiple sclerosis(MS). Thus, we find a good way to further study the immune mechanisms of MS and also to search for the effective treatments.

Objective:To collect and summarize evidence for improvement of readiness for hospital discharge of patients after PCI.Methods:BMJ Best Practice, UpToDate, Joanna Briggs Institute (JBI) evidence-based health care center database, National Institutes of Health and Clinical Optimization Guidelines Network, Scotland Inter Hospital Guidelines Network, Ontario Registered Nurses Association, International Guidelines Collaboration Network, American Heart Association website, European Heart Association website, Cochrane The literatures about improving the discharge readiness of patients after PCI in library, PubMed, CINAHL, CNKI and Wanfang databases included guidelines, system reviews, best practice information books, evidence summary, expert consensus, and randomized controlled studies. The retrieval time limit was from the establishment of the database to October 2019. Four researchers evaluated the quality of the literature, and extracted evidence from the literature that met the quality standards.Results:A total of 5 articles were included, including 2 guidelines, 2 expert consensus, 1 systematic reviews,3 randomized controlled trials. The best evidence included evaluation of discharge readiness, education of knowledge and skills to patients and caregivers, improvement of self-efficacy of patients and caregivers in disease management, and assurance of social support and health resources for patients and caregivers after discharge.Conclusion:It is suggested that in clinical practice, medical personnel should use the discharge readiness assessment tool to comprehensively evaluate patients after PCI, carry out programmed health education, improve patients' self-efficacy in disease management, and ensure social and medical support for patients and caregivers after discharge as much as possible.

ObjectiveTo observe the effect of acupuncture plus rehabilitation training on the function recovery of patients with post-stroke depression.MethodNinety-eight patients with post-stroke depression were randomized into two groups to receive conventional management and anti-depressants. The control group was intervened by sham-acupuncture plus Fluoxetine tablets and comprehensive rehabilitation training, while the observation group was by acupuncture plus Fluoxetine tablets and comprehensive rehabilitation training. Prior to the intervention and after 8-week treatments, the depression state, motor function and activities of daily life (ADL) were evaluated by using Hamilton Depression Scale (HAMD), Fugl-Meyer Assessment (FMA) and Modified Barthel Index (MBI). The indexes and quality of life were also determined during the 3-month follow-up study.ResultBefore intervention, there were no significant differences in comparing HAMD, FMA and MBI scores (P>0.05). After 8-week treatment, the HAMD, FMA and MBI scores were significantlyimprovedin both groups (P<0.01,P<0.05). After treatment, the HAMD, FMA, and MBI scores in the observation group were significantlydifferent fromthat in the control group (P<0.01,P<0.05). The total effective rate was 90.0% in the observation group versus 79.2% in the control group, and the difference was statistically significant (P<0.05). The 3-month follow-up study showed significant differences in comparing the indexes between the two groups (P<0.05, P<0.01).ConclusionAcupuncture plus rehabilitation training benefits the improvement of depression state, motor function, cognitive function and quality of life in patients withpost-stroke depression, and is worth promotion.