Objective To compare the effect of laparoscopic thymectomy on immune function and inflammatory factors in patients with myasthenia gravis.Methods 80 patients with myasthenia gravis treated by thymectomy were selected,and they were divided into observation group and control group according to the random number method,each group in 40cases.The observation group was treated with video assisted thoracoscopic surgery,the control group was treated by thoracotomy.All the patients were followed up for outpatient visits in 3 months.The incidences of myasthenia gravis crisis in the two groups were compared and the ratio postoperative humoral immunoglobulin levels and inflammation related factor changes were observed.Results The operation time of the observation group [(118.6±11.3)min] was shorter than (138.5±13.8)min of the control group (t=7.056,P<0.05).The amount of bleeding of the observation group [(96.6±3.8)mL] was less than (125.5±5.6)mL of the control group (t=27.008,P<0.05).The hospitalization time of the observation group [(7.2±0.3)d] was shorter than (10.8±1.1)d of the control group (t=19.969,P<0.05).The incidence rate of myasthenia gravis crisis in the observation group was significantly lower than that in the control group (1 patient vs 9 cases,x2=5.600,P=0.018).The levels of IgM,IgG and IgA in the observation group were (1.65±0.03)mg/L,(9.55±0.12)mg/L,(3.99±0.20)mg/L respectively, which were higher than (1.31±0.02)mg/L,(8.82±0.10)mg/L,(1.81±0.13)mg/L in the control group(t=59.640,29.557,57.800,all P<0.05).The IL-6,TNF-α,IL-1,hs-CRP levels in the observation group were (34.5±6.1)ng/mL,(12±0.2)ng/mL,(0.60±0.1)g/mL,(10.3±1.0)mg/L respectively, which were lower than (153±14.1)ng/mL,(18.1±0.5)ng/mL,(0.92±0.2)g/mL,(31.3±2.0)mg/L in the control group (t=48.784,71.641,9.051,59.397,all P<0.05).Conclusion Laparoscopic thymectomy for myasthenia gravis has short operative time and less bleeding.It has little effect on the humoral immune function of the patients and can significantly reduce the inflammatory response and promote the recovery of the patients.

Idiopathic pulmonary fibrosis(IPF), as one of the chronic and complex diseases, is with high incidence and mortality rate. It is also a difficult to treat disease in modern medicine. Traditional Chinese medicine (TCM) syndrome differentiation and treatment embodies characteristics and advantages. In recent years, the collateral disease theory guiding the prevention and treatment of the chronic and complex diseases has become a hot point and frontier in medical research, and achieved certain effects. This article is to summary the structures and functions of pulmonary collaterals based on the collateral disease theory. Combined with clinical manifestations of IPF, we put forward Fei-Re Luo-Y u as the fundamental role in the pathogenesis of IPF in its acute phase to lay the theoretical foundation to the further exploration of syndrome prevention and differentiation on IPF in its acute exacerbation.

Objective To analyze the restricted usage of TCRβ V/J subfamily and CDR3 repertoire in patients with peripheral T-cell lymphoma unspecified (U-PTL).Methods The total RNA was respectively extracted from lymph node of U-PTL and reverse transcriptase,then multi-PCR was used to amplify the complete DNA sequence(CDS) of TCR β-chain.The recombinant plasmids were sequenced and sequence was analyzed by using online TCR resources.Results There were 9 TCR β chain CDS obtained from four patients.TCRβ-chain presented specific repertoire skewing in patients with U-PTL.There were restricted usage of BV2,BV4S2,BV14,BV29S1 of BV subfamily and BJ1S4,BJ2S3,BJ2S5,BJ2S7 of BJ subfanily.The clonal proliferation T cells had different CDR3 amino acid sequences.Conclusions There are restricted usage of TCR β V/J subfamily in patients with U-PTL.The sequences of CDR3 in different TCR clone proliferation are mostly different.

As a new kind of perioperative management strategy and ideas,enhanced recovery after surgery (ERAS) brings a series of traditional perioperative treatment measures for optimization based on evidence-based medicine.Its primary aim is to decrease surgery-related stress,complications,and also to facilitate recovery with multimodal treatments.The ERAS pathway has been widely applied and proved to be efficient in gastrointestinal,colorectal,orthopedic,thoracic and gynecological surgery.Owing to the complexity of surgical procedure,long operation time and high perioperative complication rate in liver transplantation compared with other surgeries.This new concept has not been widely accepted or recommended in liver transplantation,although some previous studies have validated its safety and effectiveness.This paper overviewed the recent literature on the specific procedures,efficacy,safety and development of ERAS applied in liver transplantation.

This article elaborated the theory of chronic and complex disease treatment based on collaterals. It put forward that complex virtual evil stasis was the common pathogenesis of chronic and complex disease treatment. Combined with articles published in recent 5 years, from the perspective of cytokines and genes, it summarized traditional Chinese medicine (TCM) compound targets in chronic and complex disease treatment. It put forward the transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6), vascular endothelial growth factors (VEGFs), matrix metalloproteinases/tissue inhibitor of metalloproteinase (MMPs/TIMPs) were its high-frequency targets. It provided a basis for future experiment design on chronic and complex disease treatment based on collaterals as well as new drug development.

In medical clinical study, the researchers and the ethics committee members' personal economic in-terests and responsibilities conflicts may produce damage to experimental research and the subjects, may make the study being questioned the authenticity and the objectivity of clinical trial results, also damage to the subjects' rights and interests and damage the credibility of hospital. In order to prevent the happening of the conflict, put forward the strategies:strengthen legislation construction, improve the treatment method, set up a conflict of interest com-mittee, adhere to the principle of open, review and restriction to the personnel, regularly organize researchers and ethics committee members attend the training.

Objective To explore the efficacy and complication of total hip arthroplasty in the treatment of ankylosing spondylitis hip joint ankylosis,and analyze its prognosis.Methods Eighty-two patients with ankylosing spondylitis hip joint ankylosis were divided into observation group and control group by random digits table method,the 42 patients in observation group were given total hip arthroplasty after the diagnosis of early,the 40 patients in control group were given delayed total hip arthroplasty.In the 2 groups,the recovery of hip joint function were observed,postoperative complication were recorded,and the 5-year survival rate situation were followed up.Results The activity of hip joint,degree of hip joint flexion and Harris score after operation in the 2 groups were significantly better than those before operation,there were statistical differences (P ＜ 0.05),the indexes after operation in observation group were significantly better than those in control group [activity of hip joint:175.25° ± 15.52° vs.122.95° ± 16.26° ; degree of hip joint flexion:85.65° ± 5.33° vs.70.78° ± 4.97° ;Harris score:(86.08 ± 5.41) scores vs.(73.92 ± 6.62)scores],there were statistical differences (P ＜ 0.05).Infection occurred in 1 case,dislocation in 0 case,prosthesis loosening in 2 cases in observation group,the rate of complication was 7.14％(3/42).Infection occurred in 5 cases,dislocation in 2 cases,prosthesis loosening in 4 cases in control group,the rate of complication was 27.50％ (11/40).The rate of complication in observation group was significantly lower than that in control group,there was statistical difference (x2 =8.34,P＜ 0.01).The 1,3-year survival rate in observation group was higher than that in control group,but there was no statistical differences (P ＞ 0.05).The 5-year survival rate in observation group was significantly higher than that in control group [90.48％(38/42) vs.70.00％ (28/40)],there was statistical difference (x2 =7.57,P ＜ 0.01).Conclusion Early total hip arthroplasty has significantly clinical effects in the treatment of patients with ankylosing spondylitis hip joint ankylosis,and its early operation curative effect is better than that of delayed operation.

Idiopathic pulmonary fibrosis (IPF) is defined as a specific form of chronic and progressive fibrosing inter-stitial pneumonia. Till now, it is lack of effective and safe treatment. In recent years, more and more clinical trials of traditional Chinese medicine (TCM) have been conducted with different evaluation criteria and indexes. The knowl-edge is disunity and unsystematic. From the perspective of combination of disease and TCM syndrome model, this ar-ticle summarized and organized the current data and medical standards, and then come up with the new evaluation system of clinical effect and describe important indexes and methods. This article was aimed to improve the clinical trial design and provide high quality evidences for evidence-based medicine.

This study was aimed to discuss the anti-inflammatory and immunization properties ofRe-Du-Ning (RDN) injection in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with phlegm-heat stagnated in the lung syndrome. A total of 110 in-patients were collected from January 2012 to December 2013. Cases were randomly divided into the treatment group (basic treatment plan + 20 ml RDN injection + 250 mL of 5% GS injection, once a day, intravenous injection) and the control group (basic treatment plan + 20 ml of 0.9% NS injection + 250 mL of 5% GS injection, once a day, intravenous injection), with 55 cases in each group. The treatment course was 14 days. Observations were made on traditional Chinese medicine (TCM) symptom score, clinical effect, blood routine examination, blood gas analysis and T lymphocyte subgroups before and after the treatment in both groups. The results showed that in the aspects of TCM symptom score and clinical effect, the posttreatment TCM symptom score and total integration in the treatment group were obviously improved compared to the control group except for shortness of breath, dry mouth and thirsty, flushing (P < 0.05). The total effective rate was obviously better than that of the control group. In the aspect of anti-inflammation, the total white blood cell (WBC) count and the normal neutrophil percentage of both pretreatment and posttreatment in the treatment group were obviously decreased compared to pretreatment (P < 0.05). However, there were no statistical differences on WBC count and normal neutrophil percentage compared to posttreatment in the control group. In the aspect of blood gas analysis, the posttreatment PaCO2 and PaO2 of the treatment group were obviously better than the control group (P < 0.05). In the aspect of immune regulation, the posttreatment T lymphocyte subgroups CD3+ and CD4+ of the treatment group were higher than the control group. The expression inhibition / cytotoxic lymphocyte (CD8+) was obviously lower than the control group (P < 0.05). The CD4+ / CD8+ was back to the normal reference level. It was concluded that in the treatment of AECOPD with phlegm-heat stagnated in the lung syndrome, on the basis of western medicine symptomatic treatment plan, RDN injection was assisted to clear heat, relieve toxin and remove phlegm. It can obviously improve patient’s clinical symptoms and increase the clinical therapeutic effects. The treatment was especially targeted to infection-induced respiratory failure patients combined low immunity with possible identified therapeutic effects.

Objective To observe the effect of mPFC neuron synaptic plasticity changes in the formation of morphine related reward memory.Methods 40 SD rats were administered morphine (10 mg/kg,ip) or saline (2 ml/kg,ip)and sacrificed 0,2,4 and 8 h after the treatment.The temporal profile of activity-regulated cytoskeleton-associated protein (Arc/Arg 3.1) expression in medial prefrontal cortex (mPFC) was analyzed.Another 40 rats receiving a single injection of morphine at different doses (0,5,10 or 20 mg/kg),and rats were sacrificed by decapitation 2 h later.In mPFC,changes of Arc/Arg 3.1 protein was analyzed by Western Blot,Arc/Arg 3.1 positive cells was detected by immunohistochemistry (IHC),and number of spines were analyzed by Golgi-cox method.In the second experiment,CPP model was established by 5 mg/kg morphine for 8 days.Arc/Arg 3.1 antisense oligodeoxynucleotide (AS) or the control (CS) was microinjected into mPFC 15 minutes before each morphine injection,then CPP score was evaluated.Results Compared with saline groups,Arc/Arg 3.1 protein,Arc/Arg 3.1 positive cells,number of spines ((1.01±0.04) vs (1.58±0.18),P＜0.01 ; (42.80±7.63) vs (74.47±8.02),P＜0.01 ;(17.27±5.64) vs (39.47±7.56),P＜0.01) were significantly increased 2 hours after morphine administration.All three doses of morphine (5,10 and 20 mg/kg) increased Arc/Arg 3.1 protein expression in the mPFC,and there were no dose-dependent effects.In CPP experiments,compared with microinjection of Arc/Arg 3.1 CS (0.74±0.02),Arc/Arg 3.1 AS microinjection significantly decreased the CPP score (0.51±0.01) in morphine group (P＜0.01).Conclusion It is enough to increase Arc/Arg 3.1 protein content and synaptic plasticity in mPFC by 10 mg/kg,and the changes implied in formation of morphine relative reward memory.