Objective:To observe the expression of BTLA on T cells during activation and further analyze its inhibitory effects on T cell activation in different phases.Methods: T cells from PBMC were enriched by negative selection using magnetic beads.Expression of BTLA,CTLA-4 and PD-1 on freshly isolated human T cells and kinetics expression of BTLA,CILA-4 and PD-1 on CD3 mAb stimulated T cells were examined by flow cytometry.T cells were stimulated by anti-CD3 mAb combined with anti-CD28 mAb in the presence of anti-BTLA mAb 8H9,then T cell proliferation was tested by MTT assay in the different culture time.Immature DCs were generated from monocytes cultured in the medium containing GM-CSF and IL-4, and further driven to maturation by anti-CD40 mAb.Expression of HVEM on DCs was measured by flow cytometry.T cells were co-cultured with DCs in the presence of soluble 8H9 or anti-HVEM antibody to block HVEM-BTLA interaction,T cell proliferation was measured by MTT assay.Results:Freshly isolated T cells exhibited high levels of BTLA expression, but not CTLA-4 and PD-1.After T cell activation, BTLA expression decreased on first 2 days, with rapidly increasing to high levels.Unlike BTLA, expression of CTLA-4 and PD-1 was gradually increased during T cell activation.8H9 significantly inhibited the proliferation of T cell stimulated by CD3 mAb and CD28 mAb.8H9 could still exhibit inhibitory effect on T cell proliferation after 24 h or 48 h of preactivation by CD3 mAb plus CD28 mAb stimulation.HVEM was highly expressed on immature DCs, and down-regulated on mature DCs.Blockade of BTLA by soluble 8H9 or anti-HVEM antibody enhanced DC-mediated T cell proliferation within 48 h.Conclusion: BTLA signal enhances the threshold of T cell activation and plays importantly negative regulatory role in the initiation and early phase of T cell activation.

OBJECTIVE To investigate the clinical distribution and antibiotics resistance of Pseudomonas aeruginosa nosocomial infection after open-heart operation.METHODS The clinical data of 393 patients with nosocomial infection from Jan 2004 to Dec 2007 were analyzed retrospectively.RESULTS There were 57 infected cases caused by P.aeruginosa,and accounted for 14.5% of all infections during period.All infected patients had serious original heart diseases,and received broad-spectrum antibiotic therapy previously.Forty-two patients developed postoperative cardiorespiratory function failure,and 28 patients needed circulatory support.Thirty-six patients prolonged mechanical ventilation time for over 1 week.Results of susceptibility test showed that ciprofloxacin,levofloxacin and piperacillin/tazobactam were the most active antibiotics,followed by tobramycin,netilmicin,gentamicin,meropenem and imipenem/cilastatin.P.aeruginosa presented high resistance to ceftazidime and cefoperazone/sulbactam.CONCLUSIONS P.aeruginosa is one of the most common pathogenic bacteria after open-heart operations in our hospital and presented multidrug resistance.Rational use of antibiotics is important to reduce drug resistant strains.

Objetctive To summarize the associated complications with circulatory support device,and provide reference for chnical practice.Method A total of 8306 consecutive patients who underwent open heart surgery,in Department of Post-operation Intensive Care Unit of the Cardiac Surgery,Anzhen Hospital,Capital Medical University,was retrospectively studied from January 2005 to February 2007.And the clinical data of 246 patients including 63 female and 183 male patients with mean age 56.7±14.2 years supported with various circulatory support devices for perioperative cardiorespiratory function failure in ICU were analyzed.Left ventricular assist device (LVAD) was used in 3 patients by the cannulation of the left alritan and ascending aorta.The extracorporeal membrane oxygenation(ECMO) was established in 48 patients for postoperative cardiorespiratory function failure.The vencarterial bypass was established by cannulation of the right atrium in 41 patients and femoral artery and of venovenons in 2 patients,and of the right atrium and ascending aorta in 5 cases,lntra-aortic balloon pumping(I-ABP)was performed via the femoral artery either percutaneonsly by the Seldinger technique in 195 patients.The cardiac operations included coronary artery bypass grafting (n=170),coronary artery bypass grafting with romoldingof left ventricle (n = 22),coronary artery bypass grafting with valvular operation (n=10),valvular operation (n=27),heart transplantation(n=8),correction of congenital heart defects(n=6),aortic operations(n=2).The duration of circulatory support ranged from 4 to 451 hours.Correlative complications of 3 kinds of circulatory support device were compared and repair of ventricular septal perforation in the wake of acute myocardial infarction (n=1).Results Seventy-eight (31.7%) patients died.Seventy-one(28.9% ) patients devdoped various complications including infection(n=27),renal failure required renal rephcement therapy (n=27),re-exploration for bleeding(n=24),haemolysis(n=6),limb ischemia(n=15),neurological complications(n=6),oxygenator failure(n=7) Conchusions The improvement of management to reduce complications may result in improved outcomes of patients supported with circulatory support devices.

Objective Extracorporeal membrane oxygenation (ECMO) provides a treatment for patients with acute heart-lung failure. However, as an invasive procedure, it associated with high incidence of complications. It is important to a-vert and reduce the complications for improving the success rate in critically ill patients. We investigate the complications associated with ECMO after cardiac surgery and their management. Methods Clinical data from 117 postoperative patients[32 male, mean age (48.7 ± 16.5) years]supported with ECMO in the cardiovascular intensive care unit( ICU) from March 2005 to June 2008 were analyzed retrospectively. The cardiac operations they had undergone included coronary artery bypass grafting (n = 20), coronary artery bypass grafting and remodeling of left ventricle(n =9), coronary artery bypass grafting and valvular operation(n =5), repair of ventricular septal perforation following acute myocardial infarction(n =2), valvular operation( n = 46), heart/lung transplantation (n = 20/1), correction of congenital heart defects ( n = 10), and aortic operations ( n = 4). Venoarterial bypass was established in 110 patients by cannulation of the right atrium and femoral artery, and that of the right atrium and ascending aorta in 5 cases. Left atrial drainage to ECMO was added in 2 cases. Venovenous bypass was established in 2 patients with hypoxemia following cardiac surgery. Heparin was infused for maintaining the activated coagulation time (ACT) at 160 to 200 seconds for centrifugal pump(114 cases),and 200 to 250 seconds for roller pump(3 cases) to avoid thrombotic events until decannulation was achieved. Results The mean ECMO duration was 61 hours (range 3 to 225 hours). 48(41.0% ) patients died, 18 of them died of complications after weaning from circulatory assistant successfully. Complications occurred in 74 (63.2% ) patients included reoperation for hemostasis (n = 24), renal failure requiring renal replacement therapy (n =29), nosocomial infections ( n = 32) , ischemia in the extremities(n = 5), plasma leakage of oxygenators ( n = 29), gastroenteral hemorrhage ( n = 14), hemolysis ( n = 7 ), neurological complications ( n = 4) and centrifugal pump failure (n =1). Conclusion Bleeding is an early complication associated with ECMO support. The risk of nosocomial infection, renal failure and plasma leakage of oxygenators increases with the duration of ECMO support.

OBJECTIVE To investigate the risk factors and treatment of nosocomial pulmonary fungal infection after open heart surgery.METHODS A total of 11040 consecutive patients who underwent open heart surgery were retrospectively studied from Jan 2004 to Dec 2006.And the clinical data of 324 patients with microbiologically documented nosocomial infection were analyzed.RESULTS There were 61 infected cases caused by fungi,accounted for 18.8% of all infections during the same period.Sixteen patients died.All infected patients had serious original heart diseases,and received previously glucocorticoids and broad-spectrum antibiotic therapy.The number of senile and pediatric patients was 28.Forty three patients developed postcardiotomy cardiorespiratory and renal function failures,and circulatory assist was established in 22 patients.Thirty six patients prolonged mechanical ventilation time for over one weeks.Thirty four patients developed hyperglycosemia.Candida albicans was the predominant pathogen(39 strains,63.9%),followed by C.glabrata(15 strains,24.6%).Results of susceptibility test showed that fluconazole,itraconazole and flucytosine presented highly antimicrobial activity.CONCLUSIONS Developments of nosocomial pulmonary fungal infection is closely associated with the severity of preoperative underlying heart diseases,prolonged mechanical ventilation and longer period of broad-spectrum antibiotic therapy.

Objective To assess the condition of left ventricular outflow tract obstruction (LVOTO) under resting conditions and physiological exercise in hypertrophic cardiomyopathy (HCM) patients.Methods A total of 60 patients with HCM and left ventri cular outflow tract gradient (LVOTG) ＜ 50 mm Hg (1 mm Hg =0.133 kPa) at rest were enrolled consecutively,and LVOTG at rest and exercise were measured by echocardiography.Of 51 patients with gradients ＜ 30 mm Hg at rest,26 were latent LVOTO with exercise peak value LVOTG ≥ 30 mm Hg,25 were non LVOTO with exercise peak value LVOTG ＜ 30 mm Hg,and 9 were resting obstruction with LVOTG 30-49 mm Hg.The morphological characteristics of different types of obstruction were analyzed.Results Patients with latent LVOTO were more likely to have SAM(73.1％ vs 8.0％),narrow of LVOT(46.2％ vs 4.0％),higher resting gradients [(16.9 ±7.2) mm Hg vs (7.1 ± 4.3) mm Hg] and mitral regurgitation grade at rest than patients with non-obstructive (all P values ＜ 0.05).The distribution of septal hypertrophy were different in the two groups (P ＜ 0.05).Multivariate logistic regression analysis showed independent predictors of latent LVOTO were SAM (OR 6.431,95 ％ CI 2.323-291.112,P =0.002) at rest and distribution of septal hypertrophy (OR 0.011,95％ CI 0.001-0.179,P =0.008).Conclusions Approximately half of patients with nonobstructive HCM at rest have latent LVOTO.SAM and distribution of septal hypertrophy may be useful to identify patients with latent obstruction.

Objective To investigate the correlation between decoy receptor (DcR) 1,DcR2,osteoprotegerin (OPG) gene polymorphisms and susceptibility of Crohn's disease (CD) in Han population in Zhejiang province.Methods From April 2008 to July 2017,at the Department of Gastroenterology of The Second Affiliated Hospital of Wenzhou Medical University,The First Affiliated Hospital of Wenzhou Medical University,Central Hospital of Wenzhou and Renmin Hospital of Wenzhou,285 patients diagnosed as having CD were enrolled,and during the same period 572 healthy individuals who received health checkup at the Second Affiliated Hospital of Wenzhou Medical University were collected as healthy control.The single nucleotide polymorphism (SNP) of DcR1 (rs12549481),DcR2 (rs1133782) and OPG (rs3102735) were examined by SNaPshot technique.An unconditional logistic regression analysis was performed to analyze the differences in each SNP mutation alleles and genotype frequencies between CD group and control group.Furthermore,their correlation with clinicopathological features of CD and the efficacy of corticosteroid and infliximab was also evaluated.Results The frequencies of mutant allele A and genotype GA + AA of DcR2 (rs1133782) of CD group were 11.93％ (68/570) and 22.81％ (65/285),respectively,which were higher than those of healthy control group (8.22％,94/1 144;and 15.91％,91/572;odds ratio (OR) =1.513,95％ confidence interval (CI) 1.088 to 2.104,P =0.013;OR =1.562,95％ CI 1.094 to 2.230,P =0.014).However there was no statistically significant difference in the mutant allele and genotype frequencies of DcR1 (rs12549481) and OPG (rs3102735) between two groups (all P ＞ 0.05).The frequencies of mutant allele C and genotype TC + CC of DcR1 (rs12549481) in patients with stricturing CD were 13.89％ (25/180)and 27.78％ (25/90),respectively,which were lower than those of patients with non-stricturing,non-penetrating CD (27.68％,62/224 and 48.21％,54/112),and the differences were statistically significant (OR =0.421,95％ CI 0.252 to 0.705,P =0.001;OR =0.413,95％ CI 0.229 to 0.747,P =0.003).Besides,the frequencies of mutant allele A and genotypes GA + AA of DcR2 in patients with penetrating CD were 7.23％ (12/166) and 13.25％ (11/83),which were lower than those of patients with non-stricturing,non-penetrating CD (15.62％,35/224 and 30.36％,34/112),and the differences were statistically significant (OR =0.407,95％ CI 0.205 to 0.809,P =0.009;OR =0.350,95％ CI 0.165 to 0.743,P =0.005).In addition,there was no statistically significant difference in the frequencies of mutant allele and genotypes of OPG (rs3102735) among subtypes of CD with different features (all P ＞ 0.012 5).Moreover,the DcR1 (rs12549481),DcR2 (rs1133782) and OPG (rs3102735) polymorphisms were not correlated with the efficacy of corticosteroid and infliximab (all P ＞ 0.05).Conclusions DcR1 (rs12549481) mutation may be correlated with stricturing CD.DcR2 (rs1133782) mutation may be correlated with CD,especially with penetrating CD.However,the gene polymorphism of OPG (rs3102735) is not correlated with the risk of CD susceptibility.And the above gene SNP may be independent of the efficacy of corticosteroid and infliximab.

OBJECTIVETo explore the central mechanism of postoperative fatigue syndrome by detecting the expression of NMDA receptor and tryptophan metabolism.

METHODSAfter being numbered according to the weight, ninety-six male SD rats were randomly divided into control group (bowel loop was flipped after laparotomy and received intraperitoneal injection of saline at a dose of 1 ml/kg), POFS model(70% of the length of small intestine was resected and received intraperitoneal injection of saline at a dose of 1 ml/kg), and NMDA antagonist groups(70% of the length of small intestine was resected and received intraperitoneal injection of MK801 at a dose of 1 ml/kg). Each group was divided into subgroups by postoperative 1, 3, 5 and 7 d, with 8 rats in each subgroup. The hippocampus was removed at each time point after open field test (OFT) to detect the mRNA expression levels of NMDA receptor 1 and kynurenine aminotransferase III((KATIII() by real-time PCR. Protein level of NMDA receptor 1 was detected by Western blot. High performance liquid chromatography (HPLC) was used to measure the concentrations of tryptophan (TRP), kynurenine (KYN) and kynurenic acid(KYNA). Ultra-structural changes of hippocampal neurons were observed by transmission electron microscopy(TEM).

RESULTSAs compared to control group, exercise score decreased(P<0.05), rest time and central panel residence time prolonged, periphery/central panel ratio increased (all P<0.05), mRNA and protein expressions of NMDA receptor 1 increased (P<0.05), mRNA expression of KAT III( decreased (P<0.05), KYN/TRP ratio and KYN/KYNA ratio decreased (all P<0.05) in POFS group on postoperative day 1 and 3. As compared to POFS group, central panel residence time and periphery/central panel ratio decreased on postoperative day 1, and mRNA and protein expressions of NMDA receptor 1 decreased on postoperative day 1 and 3 (all P<0.05) in antagonist group. TEM revealed that degenerated neuron was found in the hippocampus of POFS rats, while such damage was improved in antagonist group.

CONCLUSIONThe increased expression level of NMDA receptor may play an important role in POFS. NMDA receptor antagonist MK801 may improve the POFS.

Animals ; Fatigue ; Hippocampus ; Humans ; Injections, Intraperitoneal ; Male ; Postoperative Period ; Rats ; Rats, Sprague-Dawley ; Receptors, N-Methyl-D-Aspartate ; Signal Transduction ; Transaminases

Objective To investigate the clinical application of self-made snare in laparoscopic appendectomy. Methods The clinical datas of 197 cases who were acute appendicitis under laparoscopic appendectomy in the first people's hospital of Fuyang in Hangzhou from June 2015 to June 2017 were collected, then they were divided into self-made snare group (85) and Hem-o-lok group (112). Variations of operation time, operation bleeding, first postoperative anal exhaust time and length of stay above two groups were analyzed. Variations of incision infection, abdominal abscess and intestinal obstructionabove two groups were analyzed. Results Two groups of patients were compared with operation time [self-made snare group(43. 71±5. 54)min: Hem-o-lok group(42. 29±5. 34)min], operation bleeding[self-made snare group(l 1. 60±2. 44)mL: Hem-o-lok group(l 1. 00±2. 56)mL],first postoperative anal exhaust time [self-made snare group (10. 01±2. 27)h: Hem-o-lok group(9. 60±2. 32)h] and length of stay[self-made snare group(5. 19±0. 95)d: Hem-o-lok group (4. 99±0. 85)d], the differences were not statistically significant(P＞0. 05). Two groups of patients were compared with incision infection[self-made snare group 2 cases(2. 35％): Hem-o-lok group 3 cases(2. 68％)], abdominal abscess [self-made snare group 1 case(1. 18％): Hem-o-lok group 2 cases (1. 79％)] and intestinal obstructionabove [self-made snare group 3 cases(3. 53％): Hem-o-lok group 5 cases(4. 46％)], the differences were not statistically significant(P＞0. 05). Conclusion Self-made snare in laparoscopic appendectomy is safe and feasible.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.