Objective To investigate the relationship between the TRAb-producing cell precursors and different clinical stages of Graves' disease.Methods Peripheral lymphocytes were infected with Epstein-Barr virus,a kind of lymphocyte precursor stimulator,and were stimulated to produce TRAb.Results Of the total wells containing Ig-producing B cell precursors,there were 34.6% and 29.1% from 2 untreated patients,30% from 1 relapsing patient and only 1.3% and 3.8% from 2 healthy controls that secreted TRAb,respectively.As for the wells containing B cell precursors from 2 remission patients with undetectable TRAb in circulation,the percentage (10.7%) of TRAb-containing wells from one was higher than that from the other (5.3%).And the latter had similar percentage of TRAb-positive wells with the controls.The isotype of TRAb in supernatants of our EBV-transformed B lymphocytes was predominantly IgM.Conclusion The frequencies of TRAb-specific precursors were different at three distinct clinical stages of the disease.

Objective To explore the effect of apolipoprotein E (ApoE) on secretions of matrix metalloproteinase-9 (MMP-9),matrix metalloproteinase tissue inhibitor-1 (TIMP-1) and inflammatory factors in spleen macrophages at early stage of experimental autoimmune encephalomyelitis (EAE).Methods In accordance with random number table,20 ApoE knockout (ApoE-/-) C57BL/6J mice were divided into ApoE-/-EAE group and ApoE-/-control group (n=10);and 20 wild type (WT) C57BL/6J mice were divided into WT EAE group and WT control group (n=10).Myelin oligodendrocyte glycoprotein 35-55 (MOG35-55) was used as antigen to induce EAE models in the ApoE-/-EAE group and WT EAE group,and MOG35-55 was replaced by normal saline in ApoE-/-control group and WT control group.The spleen macrophages were isolated from mice after 7th d of modeling and cultured in vitro;the rnacrophages of the ApoE-/-EAE group and WT EAE group were stimulated by MOG35-55,while the macrophages of the ApoE-/-control group and WT control group were treated with equivalent normal saline.Forty-eight hafter that,the contents of MMP-9,TIMP-1,interferon gamma-γ(IFN-γ),tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the culture medium were determined by ELISA.Results The contents of MMP-9,TFN-γ TNF-α and IL-6 in the WT EAE group were significantly higher than those in the WT control group (P＜0.05);the contents of MMP-9,IFN-γ 、TNF-α and IL-6 in the ApoE-/-EAE group were significantly higher than those in the ApoE-/-control group (P＜0.05);the content ofMMP-9,IFN-γ,TNF-cα and IL-6 in ApoE-/-EAE group were significantly higher than those in the WT EAE group (P＜0.05).The TIMP-1 secretion ofmacrophages in WT EAE group was significantly higher than that in WT control group (P＜0.05).Conclusions At early stage of EAE,macrophages secrete high levels of MMP-9 and inflammatory factors,and the deficiency of ApoE further contributes to the secretions of MMP-9 and inflammatory factors by macrophages.ApoE may play a role in protecting the integrity of blood-brain barrier and alleviating the inflammatory response of the central nervous system through the effects on macrophages.

A teaching clinic is an outpatient clinic specialized for teaching, where trainees are responsible for medical activities such as medical history taking, physical examination, and diagnosis and treatment, under the assistance and guidance of teachers. Only a few hospitals in China have built up teaching clinics for standardized training of pediatric residents. This paper summarizes the experience in the operation management of the standardized residency training teaching clinic in Children's Hospital, Zhejiang University School of Medicine. The teaching clinic takes teaching as its core task, adheres to humanistic care, and follows the principle of hierarchical progression. Its operation involves organizational approval, preliminary arrangements, outpatient appointments, the implementation of teaching activities, and other processes, which are carried out under organizational management and quality management. We have explored a preliminary strategy for evaluating the teaching effects of teaching clinics, and proposed some suggestions for the future development of pediatric residency training teaching clinics such as increasing objective evaluation methods and increasing pediatric subspecialty teaching clinics.