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 explore the in vitro anticancer effect of bleomycin (Ble) combined with cisplatin (DDP) on human gastric cancer cells.Methods:CCK-8 experiment was conducted to detect the effect of Ble and DDP alone or in combination on the proliferation of gastric cancer cells; Flow cytometry was used to detect changes in cell apoptosis and changes in reactive oxygen species. Cell scratch test was employed to detect cell migration; Western blot experiment was conducted to detect protein expression.Results:The results of CCK-8 showed that 20 μM DDP could inhibit the proliferation of six types of gastric cancer cells by 40%, while the effect of 20 μM Ble was only about 20%. When used in combination, the inhibitory rate on six types of gastric cancer could reach over 60%, with the strongest inhibitory effect on AGS cells. When 10 μM Ble and 10 μM DDP were combined, the proportion of AGS apoptotic cells reached 75.68%, higher than that of the two drugs treated with 20%, respectively 20 μM processing effect. When 10 μM Ble and 10 μM DDP were used in combination, the number of migrating and invading cells was significantly reduced, and the inhibition rate reached 50%. Compared with single use, the difference was statistically significant ( P<0.05). Flow cytometry results showed that the combination of Ble and DDP promoted cancer cell apoptosis by up-regulating the level of reactive oxygen species in cells; Western blot results showed that the expression of p-JAK2 and p-STAT3 decreased after Ble and DDP were combined, indicating that the JAK2/STAT3 signal pathway was inhibited. Conclusions:The combination of Ble and DDP can inhibit the proliferation and migration of gastric cancer cells, promote the apoptosis of gastric cancer cells, and play a synergistic anti-cancer effect. Its mechanism may be related to the up-regulation of ROS levels in cells, thereby inhibiting the activation of the JAK2/STAT3 pathway.

Objective:To explore the effects of miR-181a-5p on the occurrence and development of gastrointestinal stromal tumors (GIST) through targeting CTDSPL mediating TGF-β signaling pathway.Methods:Surgical treatment of GIST patients in the First People’s Hospital of Shangqiu City from Jan. 2016 to Dec. 2019 were selected as research objects, and tumor tissue and adjacent normal tissue were collected intraoperatively. The clinicopathological data of the patients were analyzed. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the mRNA expression of CTDSPL gene and miR-181a-5p expression. Western blot was used to detect the protein level of CTDSPL and TGF-β signaling pathway related factors. Human gastrointestinal stromal tumor cell lines (GIST-T1) were transfected with miR-181a-5p mimic, miR-181a-5p inhibitor, or CTDSPL overexpression vector. MTT was used to detect cell proliferation activity, Transwell assay was utilized to detect cell invasion, flow cytometry was used to determine cell apoptosis in each group.Results:Compared with adjacent tissues, expression of miR-181a-5p and TGF-β signaling pathway related factors was activated while CTDSPL expression was inhibited. Tumor size, invasion depth and modified NIH grading were related to the mRNA expression level of CTDSPL gene in GIST tumor tissues (All P<0.05) . Compared with Blank group, inhibition of miR-181a-5p or CTDSPL overexpression had the ability to inhibit the cell viability and invasion, induce apoptosis. The effects of miR-181a-5p mimic on GIST-T1 can be saved by CTDSPL overexpression. Conclusion:miR-181a-5p can promote the occurrence and development of GIST by down-regulating the CTDSPL gene level and activating TGF-β signaling pathway.

Objective To assess the predictive value of serum fibroblast growth factor(FGF)23 level and carotid intima-media thickness (CIMT)for the long-term outcome in maintenance hemodialysis(MHD)patients.Methods A total of 88 MHD patients were enrolled,with a median follow-up of 73.2 months(a range from 11.5 to 75.7 months).CIMT and atherosclerotic plaques were measured by Bmode Doppler ultrasound at baseline by an experienced sonographer.Blood samples were collected and stored in the-80℃ refrigerator for measuring serum FGF23 levels.Results The 88 patients were aged(64.2±11.5)years,with 52 males and 36 females,and the mean CIMT was (1.34±0.38)mm.Carotid artery atherosclerotic plaque was detected in 72(81.8％)subjects.Carotid artery atherosclerotic plaques (CASP)were found in 58 (65.9％)patients aged 60 years and over.Compared with non-elderly patients,elderly patients had the characteristics of high incidence of cardiovascular disease and poor nutritional status.During the follow up period,34 patients died and 23 (67.6％) patients died of cardiovascular disease.Kaplan-Meier curves showed that cardiovascular disease-free survival rate was higher in the normal CIMT group than in thickening CIMT group(Log Rank P=0.003).And subjects with low level of FGF23 had a better survival rate than those with moderate to high level of FGF23(Log Rank P =0.043).Multivariate COX regression analysis showed that FGF23(HR=1.056,95％CI:1.007-1.108,P=0.026)and CIMT(HR=1.165,95％CI:1.032 1.315,P =0.013)were independent predictors for cardiovascular mortality.Multivariate COX regression analysis showed that serum calcium (HR =0.022,95％ CI:0.001-0.489,P =0.016),hemoglobin(HR =0.966,95％CI:0.937-0.997,P =0.033),FGF23 (HR =1.071,95％ CI:1.017-1.128,P =0.010) and CIMT (HR =1.202,95％ CI:1.049-1.377,P =0.008) were independent predictors for cardiovascular mortality in elderly MHD patients.Conclusions Serum level of FGF23 and CIMT are the important predictors for cardiovascular mortality in MHD patients.The proportion of elderly patients with cardiovascular disease is higher,in which the factors affecting prognosis are more complex.

Objective To study the correlation between characteristic parameters of photoplethysmography( PPG)and severity of coronary artery lesions.Methods Two hundred and twenty-six CHD patients who underwent CAG in our hospital from August 2018to November 2018were divided into single-vessel lesion group(n=55),double-vessel lesion group(n=74)and multi-vessel lesion group(n=97)according to their CAG.Their stiffness index(SI),crest time(CT),normalized crest time(NCT)and crest time ratio(CTR)were recorded by PPG and analyzed by correlation analysis.Results The SI was significantly different in single-vessel lesion group,double-vessel lesion group and multi-vessel lesion group(6.479±0.819m/s,6.692±1.051m/s and 6.943±1.096m/s,P=0.024).No significant difference was detected in CT,NCT and CTR among single-vessel lesion group,double-vessel lesion group and multi-vessel lesion group(P＞0.05).The SI was positively correlated with the severity of coronary artery lesions(r=0.162,P=0.015).Conclusion The SI is correlated with the severity of coronary artery lesions,which is of a certain value in predicting the severity of coronary artery lesions.

Objective To investigate the level of nurses′preparedness and influencing factors of nurses with low seniority in Anhui province. Methods Totally 295 nurses with low seniority were recruited by convenience sampling method. They were investigated by a self-designed demographic data questionnaire and the Disaster Preparedness Evaluation Tool. Results The score of the disaster nursing ability of the nursing managers was 163.85 ± 32.41, the mean score was 3.64 ± 0.72. Regression analysis showed that the gender, the experience of disaster rescue,disaster training were the influencing factors of disaster preparedness. Conclusions The capacity of disaster preparedness for nurses is not ideal. There is still room for improvement among nurses in Anhui province to enhance disaster preparedness, and improved disaster nursing training system is needed to achieve this.

Objective To study the clinical efficacy of autologous peripheral blood stem cell transplantation for the treatment myocardial infarction,in the same period of coronary artery bypass grafting (CABG).Methods From January 2012 to January 2015,76 patients with myocardial infarction were selected.Patients were divided into transplantation group (n =46) and control group (n =30) on the basis of whether being treated by autologous peripheral blood stem cell transplantation.After myocardial infarction patients were taken to the hospital with the therapy of conventional drug,5 days before CABG,transplantation group was given the autologous peripheral blood stem cell mobilization and expansion,24 hours before CABG,taking autologous peripheral blood stem cell collection.76 patients took CABG with non-cardiopulmonary by pass,transplantation group was given autologous peripheral blood stem cell via transplantation vessels and subepicardial,while the control group was not given the injection of autologous peripheral blood stem cell.The LV morphology,wall motion score index (WMSI) and index of cardiac function before and after the operation in both groups were evaluated by echocardiography.Results Six months after CABG,there was a significant decrease in Left ventricular end-diastolic diameter and wall motion score index,Left ventricular ejection fraction was increased.The indexes of cardiac function in the transplantation group were better than the control group.Conclusion Autologous peripheral blood stem cell transplantation for the treatment myocardial infarction can improve the heart function,and has obvious recent clinical curative effect in the same period of CABG.

Objective Compare the clinical efficacy between anterior cervical decompressions, internal fixation with steel plate and zero profile interbody fusion system (Zero-P) in the treatment of cervical spondylotic myelopathy.Methods From October 2010 to May 2013, a total of 47 patients with cervical myelopathy were included in prospective randomized controlled study.All patients were randomly divided into two groups, respectively using plate fixation (screw plate system group, 26 cases)and Zero-P (Zero-P group, 21 cases).Compared operation time, intraoperative blood loss, postoperation flow and the incidence of postoperative discomfort swallowing.Evaluated the Japanese Orthopaedic Association (JOA) score of nerve function and calculated improvement rate;measured cervical Cobb Angle on X-ray film, observed abnormal activity of surgical clearance, evaluated degree of bone graft fusion and related internal fixation complications.Results The average operation time of screw plate system group was 71.2±26.8 min, which was 53.4±28.6 min in Zero-P group, significant difference was found in two groups.The average bleeding volume was 78.1 ±46.7 ml, and average volume of postoperation drainage was 63.3±37.7 ml in screw plate system group;the average bleeding volume was 77.5±50.4 ml, and the average volume of postoperation drainage was 60.7±28.6 ml in Zcro-P group, no significant difference was found.5 cases in screw plate system group remained swallowing discomfort 3 weeks after operation, but non in Zero-P group.Followed-up lasted for 24-42 months, an average of 23±2.16 months, nerve function were significantly improved at the end of the follow-up of both two groups, the JOA score of screw plate system group was 14.28±2.96, the improvement rate was 68.91％±7.9％, and Zero-P group was 14.32±2.87, the improvement rate was 69.79％±11.2％, there were no significant difference;curvature of cervical vertebrae of screw plate system group was 15.2°±5.7° at the end of follow-up;Zero-P group was 18.1°±7.9°, which with significant difference.Bone graft fusion were found in all patients at the end of follow-up, and no abnormal activities and fixation loosening was found during follow-up period.Conclusion Zero-P compared with traditional fracture-fixation techniques in treating single or double segments of cervical spondylotic myelopathy, can shorten operation time, reduce the incidence of postoperative chronic discomfort swallowing, and maintain in favour of cervical curvature.

Objective To observe the efficacy and safety of endoscopic ultrasonography submucosal resection for treatment of gastric muscularis propria mesenchymal tumor.Methods Endoscopic ultrasonography preliminary diagnosis of 19 cases were diagnosed stromal tumors originating from gastric muscularis propria layer,the endoscopic ultrasonography diagnosis the source,echo,size,blood supply,etc.than treated by endoscopic submucosal excavation.To observe the therapeutic effect and complications.Results Eighteen patients were the full excavation,1 patient was failed.Intraoperative perforation was seen in 2 cases,the wound was healed by the titanium clamp.A small amount of bleeding happened in operation and bleeding was stopped by hot biopsy forceps or argon coagulation.No delayed bleeding happened.Conclusion Submucosal resection for gastric muscularis propria mesenchymal tumors is safe and effective,endoscopic ultrasonography has important value in the strict assessment.