BACKGROUND: Schwann cells play an important role in axonal growth and myelin sheath formation of the peripheral nerve. Whether Schwann cells play the same role in the spinal cord had attracted considerable attention. Microencapsulation technology as an effective immune isolation technique can effectively keep Schwann cell activity to play the repair effect of Schwann cell in the spinal cord.OBJECTIVE: To observe the changes of myelin sheath in the injured transection of rats after transplantation of the alginic acid microencapsulated Schwann cells.DESIGN, TIME AND SETTING: The randomized controlled animal experiment was performed at the Basic Medical School of Nanchang University from March 2005 to February 2008.MATERIALS: Sciatic nerve trunk was obtained from adult rabbits to harvest Schwann cells in vitro using repeatedly differential velocity adherent technique, and to prepare Schwann cell suspension and microencapsulated Schwann cell suspension.METHODS: A total of 146 adult Sprague Dawley rats were used to establish models of right hemi-transection damage at T_(10) level and randomly assigned to four groups: simple injury group (n=44), cell transplantation group (n=44), microencapsulated cell transplantation group (n=44) and normal control group (n=14). At 1, 3, 7,14 and 28 days following surgery, 8 rats were selected from each group at each time point (2 from the normal control group) for perfusion and fixation. Spinal cord tissue was collected to make paraffin section, and then subjected to hematoxylin-eosin staining and Loyez myelin staining. In addition, 2 rats were selected from each group at 2 and 8 weeks. The spinal cord tissue was fixed, embedded in Epon816, stained using uranyl acetate and aluminum citrate, and then observed using an electron microscope.MAIN OUTCOME MEASURES: Neuron number and survival were observed surrounding the damaged region. Structural changes in the myelin sheath from spinal cord white substance at the damage site were measured.RESULTS: At 1 and 3 days following spinal cord injury, spinal neurons were degenerated and necrotic at damaged site, with reduced number of myelin sheath, loose structure, but above-mentioned was rare in the cell transplantation and microencapsulated cell transplantation groups. At 7 days, the reduced number of myelin sheath, with damaged structure was seen. The microencapsulated cell transplantation group was light. At 14 days, number of neurons was increased, with increased cell body, especially in the microencapsulated cell transplantation group. At 28 days, neurons gradually recovered, myelin sheath was gradually complete, with increased number in the microencapsulated cell transplantation group. There were significant differences compared with the simple injury and cell transplantation groups (P < 0.01). At 8 weeks, abundant myelin sheath was repaired, with new myelin sheath in the microencapsulated cell transplantation group.CONCLUSION: Microcapsule has immune isolation effects. Microencapsulated rabbit Schwann cells can promote the repair of rat spinal cord neurons and axonal myelinization.

Objective To identify the critical indicators of nursing practice environment in China, as a reference for related studies. Methods Descriptive systematic review was used to retrieve literature of nursing practice environment, collect all potential indicators and design questionnaires based on those indicators. In the end, 39 potential indicators were identified, for a questionnaire survey of nurses from cooperating medical institutions in 30 provinces in China, with the data subject to statistical analysis in multiple linear regression model. Results Questionnaire items of higher mean score were usually found with a smaller 95% confidence interval, while coefficient of variation tended to be lower. Seventeen indicators were recommended as key indicators for nursing practice environment in China, including proper working hours and intensity, opportunities for nurses to participate in hospital management, good working relationship with doctors within a department,nursing managers′support for nurses′right decisions. The remaining components turned out to be insignificant in the analysis. Conclusions The influencing factors for the nursing practice environment in China are different from other countries. In this consideration, nursing managers should further explore and focus on such special indicators, and proactively improve the quality of nursing practice environment for better nursing service.

Objective To investigate the dynamic changes of microglial polarization at the perihe-matoma area and provide timepoint evidence for interventing microglial polarization as well as studying the polarization mechanism after intracerebral hemorrhage ( ICH ) . Methods Healthy male Sprague Dawley (SD) rats were randomly divided into sham group,ICH-4 h,1 d,3 d,7 d and 14 d groups with 6 in each group. The rats in ICH groups were injected collagenase VII-s into the caudate nucleus to establish the in-tracerebral hematoma model and rats in sham operated group were treated with the same amount of saline. The brains were taken at 4 h,1 d,3 d,7 d,14 d in the ICH group,1 d in sham group. Microglia typeⅠ( M1, CD11b++CD86+) and microglia typeⅡ( M2,CD11b++Arg-1+) were examined by immunofluorescence and the number of M1 and M2 around hematoma were analyzed. Results ( 1) The M1 and M2 were both ob-served at 4 h after ICH and a small quantity of branches were still presented on M1. ( 2) M1 took the main position in acute stage (1~3 d),early subacute stage(3~7 d) and chronic stage (>14 d) after ICH.The number of M2 was elevated transiently in superacute (<24 h) and late subacute stage (7 d).The number of M2 (31.40±1.69) was more than M1 (21.43±1.81) at 4 h after ICH ( t=- 4.085, P=0.002),and the number of M2 (116.25±5.06) significantly exceeded M1 (85.75±7.32) again on day 7 ( t=-0.690, P=0.001). Conclusion M1 is in a dominant position in acute,early subacute and chronic stages after ICH;M2 is dominant in superacute and late subacute stages. Investigating the mechanism of M2 formation at acute period ( such as 4 h) or late subacute stage ( such as 7 d) ,and inhibiting M1 formation in the early subacute stage ( 1~3 d) have important significance for clinical treatment of ICH.

Purpose To investigate the relationship between Epstein-Barr virus (EBV) and lymphoepithelioma-like carcinoma (LELC) of the parotid gland and detect the gene expression products of EBV harbouring in LELC cells. Methods Thirty-two parotid LELCs were collected from the Departments of Pathology, Sun Yat-sen University of Medical Sciences, Guangzhou, China during the period of January 1986 and December 1995. All the 32 formalin-fixed paraffin-embedded blocks had been consecutively re-sectioned again. Immunohistochemical and in situ nucleic acid hybridization methods for detection of EBV gene encoded products were performed. Results (1) 32 LELCs were found out of 125 parotid gland carcinomas, the frequency was 25.6% (32/125). (2) All of the 32 specimens contained a variable number of EBNA-1 and EBERs positive neoplastic cells. (3) Twenty-seven out of 32 specimens (27/32, 84.4%) had a portion of carcinoma cells expressing LMP-1. (4) No ZEBRA positive cell could be found. (5) EA-D, VCA and MA positivity rates for these 32 parotid LELCs reached to 71.9%(23/32), 68.8%(22/32), and 12.5%(4/32), respectively. Conclusions (1) The parotid gland LELC is frequently to be seen in Guangzhou locale of China, where is a high-incidence area of nasopharyngeal carcinoma (NPC). The parotid gland LELC and NPC are co-prevalent in Guangzhou locale. (2) This disease is also consistently associated with EBV infection. (3) The EBV infection of the parotid gland LELCs is essentially the type of latency Ⅱ, expressing EBNA-1, EBERs and LMP-1. (4) The latent infected EBV harbouring in LELC cells could in part be switched over to lytic cycle, producing EA-D, VCA or/and MA.

Objective To compare the long-term effectiveness of anti-interleukin-2 receptor antibodies vs.rabbit antithymocyte globulin as induction therapy in kidney transplantation.Methods Between 2006 and 2010,371 recipients of kidney transplants were treated with calcineurin inhibitors (CNI),mycophenolate mofetil and prednisone.261 patients of them received induction therapy with anti-interleukin-2 receptor antibodies (IL2Ra group),and 88 patients received rabbit antithymocyte globulin (rATG group).All the patients received ganciclovir against cytomegalovirus and SMZ against pneumocystis carinii.The data of delayed graft function (DGF),the rate of acute rejectin (AR) and infection in the first year and patient/allograft long survival rate in two groups were retrospectively analyzed during a follow-up period of 1 to 5 years postoperatively.Results There was no significant difference in the sex,age and causes of end-stage renal disease between the two groups.The rATG group had more kidney transplants from deceased donors (P＜0.01 ) and the cold ischemia time was longer than that of the IL2Ra group (P＜0.01 ).The IL2Ra group and the rATG group had similar incidence of DGF (3.1％ vs.1.8％,P＞0.05).One year after operation,the incidence of AR in IL2Ra group and rATG group was 10.7％ and 2.7％ respectively (P＜0.05),and the incidence of infection in IL2Ra group and rATG group was 14.9％ and 21.8％ respectively (P＞0.05).One-,two- and three-year patient survival rate in IL2Ra group was 98.9％,98.9％ and 98.5％ respectively,and that in rATG group was all 98.2％ (P＞0.05).The one-,two- and three-year allograft survival rate in IL2Ra group was 98.5％,98.1％ and 97.7％ respectively,and that in rATG group was all 97.3％ (P＞0.05).Conclusion rATG is more effective than IL2Ra preventing from acute rejection and does not increase the risk of infection for induction in kidney transplant recipients.

ObjectiveTo investigate the effects of the imbalance between regulatory T cells (Treg) and T helper 17 cells (Th17) in patients with chronic hepatitis B virus (HBV) infection.MethodsThe serum concentration of Treg/Th17 differentiation-related cytokines in 34 patients with chronic hepatitis B (CHB),20 patients with HBV related acute on chronic liver failure (ACHBLF),and 20 healthy controls (NC) were measured by enzyme-linked immunosorbent assay (ELISA) and proportion of peripheral Th17 and Treg cells were analyzed by flow cytometry.Numeration data was analyzed by Fisher's exact propability method and measurement data was tested by one-factor analysis of variance or Turkey multiple comparison.Results The levels of Th17 differentiation-related cytokines,II-1β (3.97±2.85) pg/mL,IL-6 (12.75±-8.87) pg/mL,and IL-21 (360.0±335.7) pg/ mL in patients with ACHBLF were significantly increased than those in NC,which were (1.87 ±0.94) pg/mL(q=4.559,P＜0.01),(5.28±0.72) pg/mL(q=7.309,P＜0.01) and (46.68±20.17) pg/mL(q=6.946,P＜0.01 ),respectively.The proportion of Th17 increased markedly in patients with ACHBLF than that in NC(q=3.972,P＜0.05).However,compared to NC and patients with ACHBLF,the Treg differentiation-related cytokine,TGF-β,in patients with CHB,increased significantly (q=4.536 and 5.323,respectively; both P＜0.01).And the population of Treg also increased markedly in CHB patients.The level of IL-17A which was the characteristic effector cytokine of Th17 was the highest in patients with ACHBLF.The peripheral Th17 cell proportion was positively correlated with the level of serum total bilirubin in patients with ACHBLF (γ=0.74,P＜0.01).Conclusions Th17 and Treg imbalance including cytokine profiles and cell numbers exists in patients with chronic HBV infection.The Th17 are active in patients with ACHBLF and Treg are active in patients with CHB.

Objective To discuss the pathogenesis of the statin-induced rhabdomyolysis in renal transplant recipients.Methods We presented two renal transplant recipients who developed rhabdomyolysis in 2012 in our hospital.The clinical presentation,laboratory results,diagnosis and treatment of the two patients were analyzed retrospectively.The basic immunosuppressive agent of two patients was cyclosporine A.The recipients developed rhabdomyolysis following simvastatin lipidlowering therapy,and one patient suffered acute renal failure simultaneously.Acute tubular injury was confirmed by renal biopsy.Finally,the symptoms of the two patients were relieved completely,creatine kinase (CK) returned to normal after the satins discontinued and saline,sodium bicarbonate and diuretics were given.The renal failure patient underwent plasma exchange and CRRT,and the renal function returned to normal.Results The level of cyclosporine A should be monitored when the renal transplant patient was given statins,especially whose basic immunosuppressive agent was cyclosporine A.At the same time we should pay more attention to the symptoms of the myotoxic side effects and avoid using the drug which was also metabolized by CYP3A4.Conclusion Physicians should be aware of the potential risks of combined therapy of statins which are metabolized by P450CYP3A4 and cyclosporine A in transplant patients.If using it is advisable to begin with small dosage and monitor the CK level.

Objective To investigate the efficacy and safety of different optimal therapy strategies for hepatits B e antigen (HBeAg) positive chronic hepatitis B (CHB) patients with suboptimal response to peginterferon-α-2a (peg-IFN-α-2a) at 24 weeks.Methods This open-label,single-center and prospective clinical observational study was conducted in Department of Infectious Diseases at Shanghai Changhai Hospital between January 2009 and December 2011.The cases of HBeAg-positive CHB with suboptimal response to peg-IFN-α-2a at week 24 were enrolled.Based on virological markers and patient preference,patients were treated with either peg-IFN-α-2a add-on adefovir dipivoxil (ADV) or switch-to telbivudine (LdT).Hepatitis B virus (HBV) virological and serological data were collected at week 12,24 and 48 after the initiation of optimal therapy.Adverse reactions were also monitored.Therapeutic efficacy was compared between two groups of patients before and after treatment by x2 test.Kruskall Wallis test and Mann-Whitney test were used for analysis of continuous variables.Results Among 193 HBeAg positive CHB patients treated with interferon,67 had suboptimal response and were enrolled.Forty five cases received peg IFN-α-2a add-on ADV treatment and 22 cases received switch-to LdT treatment.After 48 weeks of optimized therapy,the total tBeAg seroconversion rate was 25.3 ％.The rates of HBeAg loss,HBV DNA negative and alanine aminotransferase normalization were 26.8％,73.1％ and 83.5％,respectively.The peg-IFN-α-2a switch-to LdT strategy had better HBV DNA inhibition efficiency compared with the peg-IFN-α-2a add-on ADV strategy at week 12,24 and 48 (P=0.00,0.00 and 0.01,respectively).However,there was no significant difference of HBV DNA negative rate between two groups at week 48 (x2 =0.01,P=0.89).The obviously intolerable adverse reaction was not reported in two optimized strategy groups.Conclusions The 48-week optimized treatment for HBeAg positive CHB with suboptimal response to peg-IFN-α-2a at week 24 could achieve a higher HBeAg seroconversion rate.The switch-to LdT strategy may have better HBV DNA inhibition efficiency.Both strategies show satisfactory safety and tolerance.

To investigate the effects of cembrane-type diterpenes extracted from Sinularia flexibilis on the proliferation of PC12 cells and their protective effects on PC12 cells exposed to glutamate.

Objective:To evaluate the clinical efficacy of a single-session implantation of spinal cord electrical stimulation with neurophysiological monitoring a spinal cord electrical stimulator under general anesthesia with neurophysiological monitoring for the treatment of high-risk diabetic foot.Methods:The clinical data of seven patients with high-risk diabetic foot who underwent spinal cord electrical stimulation in neurosurgery ward nine of Tianjin Huanhu Hospital from May 2022 to May 2023 were collected. The operation was performed under general anesthesia with the "C" arm X ray machine guidance and neurophysiological monitoring. The arterial diameter and peak flow rate of lower extremity, lower extremity skin temperature (calf skin temperature, foot skin temperature), visual analog scale (VAS), continuous distance of movement, blood glucose level and toe wound were compared between patients before and after surgery.Results:A total of seven patients with high-risk diabetic foot were included. The diameters and peak flow rates of femoral artery, popliteal artery, anterior tibial artery, posterior tibial artery and dorsal foot artery in both lower limbs were significantly improved after surgery. All patients had different degrees of lower limb pain before operation. After operation, VAS score decreased significantly (1.1±0.9 vs. 6.8±3.4), the pain was significantly relieved, and the calf skin temperature and foot skin temperature were significantly higher than those before surgery [calf skin temperature (℃): 33.3±0.9 vs. 30.9±0.7, foot skin temperature (℃): 31.4±0.8 vs. 29.1±0.6], fasting blood glucose and postprandial blood glucose were significantly lower than those before surgery [fasting blood glucose (mmol/L): 7.6±1.4 vs. 10.5±1.2, postprandial blood glucose (mmol/L): 9.3±2.3 vs. 13.5±1.1], the differences were statistically significant (all P < 0.01). The lower limb movement of all seven patients was significantly improved after surgery, including one patient who needed wheelchair travel before surgery, and one patient who had intermittent claudication before surgery. Among them, one patient needed wheelchair travel and one patient had intermittent claudication before surgery. All patients could walk normally at 2 weeks after operation. Among the seven patients, two patients had the diabetic foot wound ulceration before surgery, which could not heal for a long time. One month after surgery, blood flow around the foot wound recovered and the healing was accelerated. The wound was dry and crusted around the wound, and the wound healed well. Conclusion:For diabetic high-risk foot patients who are intolerant to diabetic peripheral neuralgia and local anesthesia spinal cord electrical stimulation test, one-time implantation of spinal cord electrical stimulator under general anesthesia under neurophysiological monitoring can effectively alleviate peripheral neuralgia and other diabetic foot related symptoms, improve lower limb blood supply, and reduce the risk of toe amputation. Clinical practice has proved the effectiveness of this technique, especially for the early treatment of diabetic high-risk foot patients.