Objective To investigate the expression of α7 nicotinic acetylcholine receptor (α7nAChR) in thymic T follicular helper cells (TFH) and its significance in patients with myasthenia gravis (MG). Methods Fifteen MG patients who underwent surgical treatment at the Myasthenia Gravis Comprehensive Diagnosis and Treatment Center of Henan Provincial People’s Hospital from June 2022 to June 2023 were selected as a MG group, including 7 males and 8 females, aged 12-30 years. Twelve patients who underwent partial thymectomy to optimize surgical field exposure during cardiac surgery at Fuwai Central China Cardiovascular Hospital from June 2022 to June 2023 were selected as a control group, including 5 males and 7 females aged 20-35 years. Thymus single cell suspension was obtained by grinding the thymus tissue, and flow cytometry was used to detect the expression of α7nAChR in TFH cells. The thymus cell suspension was purified using density gradient centrifugation, followed by immunomagnetic bead separation to obtain CD4+T cells. CXCR5 antibody and coupled magnetic beads were added to isolate TFH cells. Real-time fluorescent polymerase chain reaction and Western blotting were performed to further investigate the expression of α7nAChR in TFH cells. Results Compared with the control group, the proportion of thymic TFH cells in the MG group was significantly increased (P<0.05), along with significantly decreased mRNA and protein expression levels of α7nAChR within these cells (P<0.01). Conclusion The findings suggest that there is a reduced expression of α7nAChR within thymic TFH cells in MG patients, leading to weakened immunosuppressive function which may indirectly contribute to disease onset and progression.

[Purpose]To analyze the cost-effectiveness of endoscopic screening for upper gastroin-testinal cancer in Yangcheng County of Shanxi Province.[Methods]People aged from 40 to 69 who participated in upper gastrointestinal cancer screening in Yangcheng County in 2018 were se-lected as the study subjects to participate in upper gastrointestinal cancer screening in 2018,and endoscopic examination with iodine staining and indicative biopsy were performed for screening.The detection rates of precancerous lesions and upper gastrointestinal malignancies,and early di-agnosis rates were calculated,and compared among different groups.The data of screening cost were collected;and the per capita screening cost,the average cost of early case detection and ear-ly detection cost index(EDCI)were calculated.[Results]Among 2 950 subjects undergoing en-doscopy,pathological biopsy was completed in 2 073 cases(70.27％),374 cases of precancerous le-sions(12.68％)and 52 cases of malignancies(1.76％)were detected,among which 17 cases were up-per gastrointestinal cancer with a detection rate of 0.58％,there were 44 early cases with an early diagnosis rate of 84.62％.The detection rate of precancerous lesions and positive cases in men was higher than that of women,but the early diagnosis rate of upper gastrointestinal cancer was lower than that of women;the detection rate of positive cases and digestive tract cancer of 50 years and above were higher than those of people aged 40 to 49.The cost of screening for one positive lesion was 25 528.85 CNY,the cost of screening for one early case was 30 170.46 CNY.The EDCI was 0.52,indicating a good cost-effective value.[Conclusion]The study shows that the early diagnosis and early treatment screening program of upper gastrointestinal cancer has achieved remarkable re-sults in Yangcheng County.The follow-up screening work should focus on men and people over 50 years old,and strengthen the publicity of upper gastrointestinal screening for cancer.

[Purpose]To analyze the cost-effectiveness of endoscopic screening for upper gastroin-testinal cancer in Yangcheng County of Shanxi Province.[Methods]People aged from 40 to 69 who participated in upper gastrointestinal cancer screening in Yangcheng County in 2018 were se-lected as the study subjects to participate in upper gastrointestinal cancer screening in 2018,and endoscopic examination with iodine staining and indicative biopsy were performed for screening.The detection rates of precancerous lesions and upper gastrointestinal malignancies,and early di-agnosis rates were calculated,and compared among different groups.The data of screening cost were collected;and the per capita screening cost,the average cost of early case detection and ear-ly detection cost index(EDCI)were calculated.[Results]Among 2 950 subjects undergoing en-doscopy,pathological biopsy was completed in 2 073 cases(70.27％),374 cases of precancerous le-sions(12.68％)and 52 cases of malignancies(1.76％)were detected,among which 17 cases were up-per gastrointestinal cancer with a detection rate of 0.58％,there were 44 early cases with an early diagnosis rate of 84.62％.The detection rate of precancerous lesions and positive cases in men was higher than that of women,but the early diagnosis rate of upper gastrointestinal cancer was lower than that of women;the detection rate of positive cases and digestive tract cancer of 50 years and above were higher than those of people aged 40 to 49.The cost of screening for one positive lesion was 25 528.85 CNY,the cost of screening for one early case was 30 170.46 CNY.The EDCI was 0.52,indicating a good cost-effective value.[Conclusion]The study shows that the early diagnosis and early treatment screening program of upper gastrointestinal cancer has achieved remarkable re-sults in Yangcheng County.The follow-up screening work should focus on men and people over 50 years old,and strengthen the publicity of upper gastrointestinal screening for cancer.

Objective:To determine the efficacy and influencing factors of thymectomy for bulbar myasthenia gravis.Methods:The clinical data of 120 patients with bulbar myasthenia gravis admitted to the Myasthenia Gravis Comprehensive Diagnosis and Treatment Center of Henan Provincial People's Hospital from March 2018 to June 2023 were collected, with 61 males and 59 females. There were 66 patients with thymoma and 54 patients with non-thymoma. The duration of bulbar muscle involvement before operation ranged from 11 days to 108 months. Preoperative AChR-Ab was positive in 105 cases and negative in 15 cases. There were 28 cases with bulbar muscle involvement as the initial symptom and 92 cases as the non-initial symptom. There were 7 cases with crisis and 113 cases without crisis in the past. The postoperative efficacy was evaluated according to the Myasthenia Gravis post-treatment status evaluation program of the American Myasthenia Gravis Society. Univariate analysis and logistic regression analysis were used to analyze the factors that may affect the surgical efficacy. Results:All 120 patients successfully underwent extended thymectomy, there was no perioperative death. The follow-up time was 3-57 months, with a median of 24 months. Twenty-two patients (18.33%) achieved complete durable remission, 1 patient (0.83%) maintained remission, 65 patients (54.17%) had minimal symptoms, and 20 patients (16.70%) improved. No change in 8 cases (6.67%), no aggravation cases (0), deterioration in 2 cases (1.67%), and death in 2 cases (1.67%). 23 cases(19.17%) achieved clinical remission and 85 cases (70.83%) achieved partial remission. Univariate analysis showed that positive AChR-Ab before operation and duration of bulbar muscle involvement before operation were the influencing factors of surgical efficacy in patients with bulbar MG, and the difference was statistically significant ( P<0.05). Logistic regression analysis showed that positive AChR-Ab before operation and the duration of bulbar muscle involvement before operation were independent influencing factors of surgical efficacy. Conclusion:Thymectomy can effectively relieve the symptoms of bulbar myasthenia gravis. Patients with positive AChR-Ab before surgery and shorter duration of bulbar muscle involvement may benefit more from thymectomy.

Objective     To exploring the effectiveness of perioperative application of new surgical clinical classification and staging for myasthenia gravis (MG) in reducing the incidence of postoperative myasthenic crisis (MC). Methods     The clinical data of patients with generalized MG admitted to the Comprehensive Treatment Center for Myasthenia Gravis of Henan Provincial People’s Hospital from January 2018 to June 2022 were retrospectively analyzed, who were scored with myasthenia gravis-activities of daily living (MG-ADL) score and quantification of the myasthenia gravis (QMG) score at the first visit, 1 day before surgery, and 3 days after surgery. The patients were divided into a group A (typeⅡ) and a group B (typeⅢ+Ⅳ+Ⅴ) by the new surgical clinical classification and staging of MG according to the disease progression process, and all patients underwent expanded thoracoscopic thymus (tumor) resection after medication and other interventions to control symptoms in remission or stability. The incidence of MC and the efficiency rate after surgery were analyzed. The normal distribution method and percentile method were used to calculate the unilateral 95% reference range of the QMG score and MG-ADL score. Results     Finally 126 patients were enrolled, including 62 males and 64 females, aged 13-71 years, with an average age of 46.00±13.00 years. There were 95 patients in the group A and 31 patients in the group B, and the differences of the preoperative baseline data between the two groups were not statistically significant (P>0.05). The incidence of postoperative MC was 1.05% (1/95) in the group A and 3.23%(1/31) in the group B (P>0.05). The effective one-sided 95% reference range of the QMG score and MG-ADL score 1 day before surgery was 0-7.75 and 0-5.00, and there was no postoperative death in both groups. Conclusion     The new surgical clinical classification and staging of MG can guide the timing of surgery, which can benefit patients undergoing surgery for MG and greatly reduce the incidence of postoperative MC.

Objective    To investigate the expression of α7 nicotinic acetylcholine receptor (α7 nAChR) in thymocytes of patients with myasthenia gravis (MG) and its effect on cytokine secretion and T cell proliferation. Methods    Patients with MG who underwent expanded thoracoscopic thymectomy in the Comprehensive Diagnosis and Treatment Center of the Henan Provincial People’s Hospital from June 2021 to June 2022 were selected and allocated to a MG group. Patients who underwent partial thymectomy to expose the surgical field during the cardiac disease surgery from June 2021 to September 2022 in the Department of Adult Cardiac Surgery of Fuwai Huazhong Cardiovascular Hospital were selected as the control group. Thymic single cell suspensions were prepared from MG and control groups, and the expression of α7 nAChR in thymocytes of the two groups was detected by real-time polymerase chain reaction and Western blotting. Then CD3/CD28 monoclonal antibody coupled with magnetic beads was used to induce T cell activation, and the levels of cytokines interferon-gamma (IFN-γ), tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4), IL-6, IL-10, IL-17, and IL-21 in thymocytes of the two groups were detected by enzyme-linked immunosorbent assay (ELISA). The activated T cells of the MG group were divided into a blank control group, an α7 nAChR antagonist group, and an α7 nAChR agonist group according to different treatment methods. After 72 hours of culture, IFN-γ, TNF-α, IL-4, IL-6, IL-10, IL-17, and IL-21 expression levels in the culture supernatant were measured by ELISA. Afterwards, CD4-PE and CD8-APC antibodies were added, and the proliferation of T cell subsets was detected by flow cytometry. Results    A total of 10 MG patients were collected, including 3 males and 7 females with an average age of 19.25±6.28 years; and 15 control patients were collected, including 6 males and 9 females with an average age of 26.18±6.77 years. Compared with the control group, the mRNA and protein levels of α7 nAChR in the thymocytes of MG group were decreased, and the expression levels of IFN-γ, TNF-α, IL-4, IL-6 and IL-21 in the supernatant were increased (P<0.05), but there was no statistical difference in the expression of IL-10 and IL-17 (P>0.05). The cell-culture experiment showed that compared with the blank control group, the levels of IFN-γ, TNF-α, IL-6 and IL-21 secreted by T cells in the α7 nAChR antagonist group were increased (P<0.05), while they were decreased in the α7 nAChR agonist group (P<0.05). There was no statistical difference in the secretion levels of IL-4, IL-10 or IL-17 among the three groups (P>0.05). CD4+ T and CD8+ T cells in the α7 nAChR agonist group were significantly less than those in the blank control group and α7 nAChR antagonist group (P<0.001), while they were significantly more in the α7 nAChR antagonist group than those in the blank control group (P<0.001). Conclusion    The expression of α7 nAChR in thymocytes of MG patients is decreased, and α7 nAChR may be involved in the inflammatory response in thymocytes and thus in thymic function.

Objective To investigate the influence factors for immediate outcome after thymectomy for patients with myasthenia gravis (MG). Methods The clinical data of 108 patients with MG who received thymectomy in the Department of Thoracic Surgery, the Second Affiliated Hospital of Zhengzhou University from July 2009 to July 2012 were retrospectively investigated, including gender, age, duration of disease, clinical classification, pathological classification of thymus and anti-acetylcholine receptor antibodies (AChRab). The immediate outcome after thymectomy was also observed. Thirty-two cases of MG who had immediate outcome after thymectomy were enrolled into experimental group, while 76 cases who did not have immediate outcome after thymectomy were regarded as control group. Results The immediate outcome after thymectomy was associated with duration of disease (χ2=98.550, P<0.01), clinical classification (χ2=40.434, P<0.01), pathological classification of thymus (χ2=11.154, P=0.004) and AChRab (χ2=5.590, P=0.018). There were statistically significant differences between the two groups in the one-year (31.3% in the experimental group vs 14.5% in the control group, χ2=4.046, P=0.044), two-year (40.6% vs 21.1%, χ2=4.392, P=0.036) and three-year complete remission rates (46.9% vs 25.0%, χ2=4.995, P=0.025). Conclusion Duration of disease, clinical classification, pathological classification of thymus and AChRab could be influence factors for immediate outcome and complete remission for patients with MG after thymectomy.

Objective To investigate the mental health status of students with foreign nursing spe-cialty and analyze its relationship with stress, coping style and perceived social support. Method The cluster sampling was conducted between students with foreign nursing specialty. The Perceived Social Support Scale (PSSS), Symptom Check List-90 (SCL-90), and self-designed demographic questionnaires including demographic information questionnaire, College Students Stress Scale and Coping Style Questionnaire were employed. Results Students with foreign nursing specialty obtained significantly higher scores in all factors of SCL-90 when compared to the national youth norm,and obtained significantly higher scores in factors of somatization, obsession, anxiety, fear and psychotic diseases when compared to the norm of college students. The multifactor analysis of mental health status in students with foreign nursing specialty showed that soma-tization factors contained personal stress, seeking help, family supports and other supports;obsession factors contained personal stress, negative life events, academic stress and solving problem;interpersonal sensitivity factors contained personal stress, academic stress, solving problem, self-blame, fantasy and retreat; depres-sion factors contained personal stress, academic stress, solving problem, self-blame and other supports;anxiety factors contained personal stress, academic stress, fantasy, self-blame, family supports and other supports; hostility factors contained personal stress, seeking help, retreat, fantasy and other supports; fear factors contained personal stress, academic stress, seeking help, retreat and fantasy; crankiness factors con-tained personal stress, academic stress, solving problem, retreat, self-blame, family supports and friend sup-ports; factors of psychotic diseases contained personal stress, academic stress, solving problem, self-blame and friend supports;and factors of other symptoms contained personal stress, negative life events, academic stress, retreat, self-blame, family supports, friend supports and other supports. Conclusion The mental health status of students with foreign nursing specialty was inferior to the norms of national youths and col-lege students. It was negatively correlated with stress, active coping style, friend supports and other supports;while positively correlated with passive coping style (except escape) and family supports. Therefore, mental health education toward students with foreign nursing specialty should be strengthened in order to reduce their stress, improve their coping style, enhance their social supports, and finally promote their mental and physical development.

Objective To study the effect of S1P on HLF cell fibrosis and its mechanism. Methods (1) The expression of ECM in HLF cells was analyzed by using Western Blot after treatment by S1P(1 μmol/L), FTY720-P(5μmol/L),ponesimod(5μmol/L)and SEW2871(5μmol/L)24 h;(2)The HLF cells were pre-treated using selective S1PR antagonist W146(1 μmol/L),JTE-013(0.2 μmol/L),and TY-52156(1.25 μmol/L)1 h before incubation by S1P and S1PR agonists 24 h and then the expression of ECM was analyzed;(3)The HLF cells were pre-incubated using JTE-013(0.2μmol/L)and TY-52156(1.25μmol/L)for 1 h and then the expression of ECM was analyzedafter being treated by S1P and S1PR agonists 24 h. Results (1)S1P and selective S1P receptor agonist increased the expression of ECM to various extents;(2)The S1P1R antagonist W146 did not affectthe expression of ECM induced by S1P and S1PR agonists and S1P2R antagonist JTE-013 and S1P3R antagonist TY-52156 both decreased the expression of ECM induced by S1P and S1PR agonists;(3)The expression of ECM induced by S1P and S1PR agonists further decreased using both JTE-013 and TY-52156 but not using ponesimod. Conclusion S1P2R and S1P3R are activated under the influence of S1P so as to increase the synthesis of ECM and promote fibrosis gene expression in HLF cells.

Objective To investigate the dementia caregivers' awareness of dementia diagnosis for patients aged≥80 years in veterans community in Beijing.Methods Patients aged 80 years and over who were diagnosed as dementia were selected from Dec.2009 to Jul.2011 in the veterans community in Beijing.A face-to-face interview and questionnaire survey were conducted in dementia caregivers individually,including basic social demographic data (gender,age,educational background),awareness rate of dementia,treatment and drug use situation and their attitude to dementia patients.Results A total of 118 caregivers were investigated individually.The caregivers in this study were mainly the spouse of the patients,and most of them were elderly people.46.6％ (55/118) of caregivers were the spouse of the patients,and 52.5％ (62/118) of caregivers were 65 years old and over.The caregivers' awareness rate of dementia was 32.3％ (38/118) when patients were diagnosed as dementia.There was no correlations of gender,age and educational background with the awareness rate of dementia diagnosis (all P＞0.05).50％ of dementia patients received the dementia treatment,and only 17.8％ (21/118) of patients got the first line drug treatment for dementia (acetylcholinesterase inhibitors and / or memantine).98.3 ％ (116 / 118) of caregivers agreed that the dementia patients should be treated kindly.Conclusions The dementia caregivers are mainly patients' spouse in veterans community and most of them are the elderly.The awareness rate of dementia diagnosis is low among the caregivers.Most patients do not take the formal treatment.The social support for the dementia caregivers should be strengthened.