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.

To explore the regulation of eIF4E, we screened the protein interacting with eIF4E from human cDNA library by using yeast two-hybrid system. Several clones interacting with eIF4E were identified. One of them was homologous with HUWE1 (HECT, UBA and WWE domain containing 1, also named as ARF-BP1, HECTH9 or HUWE1). Cell co-immunoprecipitation showed that eIF4E could bind to HUWE1 in mammalian cells. We also found that HUWE1 bearing the HECT domain is necessary for its association with eIF4E.

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 study the influencing factors of postoperative cognitive dysfunction ( POCD) in elderly patients after knee joint replacement. Methods 165 cases of elderly patients undergo-ing knee replacement surgery were recruited in the study. According to whether there was POCD,the patients were divided into POCD group (35 cases) and non POCD group (130 cases).The gender,age,educational level,medical history,physical exercise,operation mode( cruciate-retaining total knee arthroplasty and poste-rior stabilized total knee arthroplasty) ,operation time,blood loss,preoperative depression score and postoper-ative pain score were recorded and compared.The logistic multiveariate regression analysis was conducted to analyze the risk factors of POCD in elderly patients with knee replacement. Results (1)There were statis-tically significant differences in the total score of MoCA, visual space and executive function,naming and de-laying recall between non-POCD group and POCD group after the operation ( Z=-5. 327, P=0. 000;Z=-3.140, P=0.002;Z=-2.910, P=0.004;Z=-3.333, P=0.001). (2)The results of logistic multiveariate regression analysis showed the age>70 years old ( OR=3.708,95%CI =1.037-13.261, P<0.05) ,hyperten-sion ( OR=5.250,95%CI =1.787-15.423, P<0.05),diabetes ( OR=6.560,95%CI =1.418-30.345, P<0.05) ,preoperative depression ( OR=4.648,95%CI =1.290-16.744, P<0.05) and postoperative pain score>4 ( OR=3.149,95%CI=1.072~9.251, P<0.05) were risk factors of POCD,and physical exercise ( OR=4.330,95%CI =1.294-14.488, P<0.05) and CR-TKA( OR=0.187,95%CI =0.045-0.781, P<0.05) were the protective factors of POCD. Conclusion The overall level of cognitive function in elderly patients after knee replacement surgery is low. The advanced age,hypertension,diabetes,lack of physical exercise,choice of operation method,postoperative pain and preoperative depression are important influence factors of POCD.

Objective To analyze the results of one-stage combined anteroposterior surgery in lateral position for serious thoracolumbar fracture dislocation. Methods A retrospective review was performed for surgically treated thoracolumbar fractures from October 1998 to September 2005. Of all the 192 patients, the 34 serious cases were treated with one-stage combined anteroposterior surgery. There were 25 males and 9 females, 34.2 years old on the average (ranging from 18 to 56 years). Segments involved: T11 in 2 cases, T12 in 5 cases, L1 in 11 cases, L2 in 8 cases, L3 in 5 cases, L4 in 2 cases and L4,5 in 1 case. According to the Classification of Magerl, there were 12 cases of type A3, 2 cases of B1, 2 cases of B2, 12 cases of C1, 4 cases of C2 and 2 cases of C3. During the operation the patients were in lateral position. Laminectomy and pedical screw insertion were performed posteriorly first; anterior corpectomy, reduction and strut graft were accomplished through an additional anterior approach. The final fixation was finished by clapping the strut graft with pedical screw system. Operative notes, preoperative and postoperative neurological status, ASIA scales, radiographs, CT scans, and follow-up records were reviewed. Results All these surgeries were performed successfully without any neurological deterioration. 32 of 34 patients were followed-up for 6 to 60 months (13 months on average). Neurological status improved at least 1 ASIA grade in 24 patients with preoperative incomplete paraplegia. 6 patients complained intercostals nerve injury symptom which alleviated with conservative treatment. During follow-up, lumbar physical lordosis was reconstructed and no evident correction loss, pseudoarthrosis or implant failure was noted. Conclusion One-stage combined anteroposterior surgery can be accomplished in a lateral position. It was proved to be an effective treatment for serious thoracolumbar fracture dislocation.

Objective To analyze the results and indications of anterior, posterior or combined surgery for thoracolumbar burst fractures. Methods A retrospective review of surgically managed thoracolumbar burst fractures from 1998 to 2003 was performed. There were 76 males and 13 females, and the age of the patients were from 17 to 51 years with an average of 36.8 years. The fractures were located at T11 in 10, T12 in 21, L1 in 29, L2 in 18 and L3 in 11. According to Magerl classification, type A fractures were 68, and type C were 21. Of the 89 patients, 41 received posterior surgeries, 40 anterior surgeries, and 8 combined anterior and posterior surgeries. Operative notes, preoperative and postoperative neurological status, radiographs, CT scans, and follow-up records were reviewed. Results All of the 89 cases had successful surgery. Seventy-eight patients were followed-up for 6 to 48 months (average 12 months). Neurological status improved at least 1 ASIA grade in all of the 65 patients who had preoperative incomplete paraplegia. In the posterior surgeries, pedicle screws broken in 2 cases, deep infection in 1 case which was cured after debridement. The correction of anterior vertebral body height and Cobb's angle averaged 9.4 mm and 14.8? postoperatively, and the correction loss averaged 0.5 mm and 7.5? respectively at 6 months after surgery. And the correction loss was most evident at the above disc spaces, then the below disc spaces. In the anterior surgeries, leakage of cerebrospinal fluid in 2 cases which cured with dressing change, the other cured after debridement, implant removal and posterior fixation. The spinal canal was enlarged, and the spine recovered normal curvature. No evident correction loss, pseudoarthrosis or implant failure was noted at follow-up. Conclusion The choice of anterior, posterior or combined surgery for thoracolumbar burst fractures depends on neurological status and column stability. The vertebral compression, canal encroachment, posterior column stability and concomitant displacement should be considered in the choice of appreciate surgical approach.

In order to maintain and develop the overall advantages and distinguishing features of medicine in Shanghai, the citys health system implemented the program of constructing centers for clinical medicine. The program involved not only the optimization and integration of health resources in the whole city but also the structural readjustment and resources regrouping within the citys health system and each individual hospital. After more than two years construction, 33 centers for clinical medicine have been set up in the city, resulting in primary achievements in expertise improvement, effect of scale, and quality benefits. By analyzing the hardware and software construction process, it can be seen that the centers for clinical medicine have made primary achievements in such aspects as ideological construction, work efficiency, interdisciplinary cooperation, academic status enhancement, medical quality improvement, and reform in the system of personnel distribution.

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 judge the hospital crisis and to provide the approaches and strategies to avoid the hospital crisis. Methods To conduct specific diagnosis of important risk factors of hospitals using expert diagnostics and crisis identification. Results Combined with the index system and weight affecting public hospitals' crisis, to focus on preventing risk factors directly, which had severe affection and put great weight on hospital crisis. To raise up the containments, managing strategies and mechanisms for public hospitals' crisis. Conclusions It is an effective method to warn and prevent hospital crisis by the way of establishing public hospital crisis value with fuzzy comprehensive evaluation system.

Objective To study the causes, epidemiology and control measures of outbreak of MRSA nosocomial infections. Methods The epidemiologic survey was carried out for 7 cases infected with MRSA within short term in the department of neurosurgery. The risk factors and epidemiological trends was analyzed. Results Some measures, such as strengthening training of health worker with MRSA prevention and control knowledge, enhancing their awareness of infection prevention and control, and controlling patients infected with MRSA effectively using warning mechanisms of MRSA infection outbreaks, should be taken to control the outbreak and spread of MRSA promptly. Conclusions Nosocomial MRSA infection is preventable and controllable.