As a novel T cell population,Th17 cells are demonstrated to play an important role in autoimmune diseases,including Crohn' s disease.Several recent studies indicate the specific contributions of IL-23/Th17 axis and cytokines secreted by Th17 cells to the inflammatory bowel disease.This article is dedicated to describe the correlation between Th17 cells and Crohn' s disease.

Fall is a common symptom in the elderly, which could be attributed to the interactions among the physiological, pathological,psychological factors of the older individuals and the environment with hazard factors. However, muscle weakness and balance and gait disorders have been identified as the most important etiology of falls. The intervention strategies should be developed individually and implemented based on the comprehensive assessment of the patient and the environment, to integrate exercise training as the main component for improving functional status. Tai Chi is a meaningful form of exercise which is effective in multi-perspective in preventing falls of the elderly.

BACKGROUND:More and more elderly patients have hip fractures because of diverse reasons, and most of the fractures are unstable fractures combined with the displacement of the lesser trochanter. At present, there are stil many reports about using dynamic hip screw to repair unstable intertrochanteric fractures, and the effect is obvious. However, there are stil great controversies regarding whether lesser trochanter fixation is performed during the repair process. OBJECTIVE:To evaluate the effect of using dynamic hip screw combined with the lesser trochanter fixation to repair intertrochanteric fractures and the occurrence of hip coxa vara after repair through a meta-analysis. METHODS:The PubMed, EMCC, CBM, CNKI, VIP and Wanfang databases were retrieved by computer for randomized controled trials on whether lesser trochanter reduction fixation was performed during the process of dynamic hip screw internal fixation for repair of intertrochanteric fractures. The quality of the included studies was evaluated according to the pre-designated inclusion and exclusion criteria. The available data were extracted and analyzed using the RevMan5.2 software. RESULTS AND CONCLUSION:A total of 10 randomized controled trials involving 604 patients were included. Among them, 298 cases were assigned to the dynamic hip screw combined with lesser trochanter fixation group, and 306 cases to the lesser trochanter unfixed group. The meta-analysis results indicated that hip coxa vara, other postoperative complications, the excelent and good rate of efficacy in the dynamic hip screw combined with lesser trochanter fixation group were al superior to those in the lesser trochanter unfixed group (alP < 0.000 1), and for hip coxa vara, the parameters were odds ratio=0.17, 95% confidence interval (0.07, 0.41),Z=3.99,P< 0.000 1. The operation time and the amount of blood loss in the lesser trochanter unfixed group were superior to those in the dynamic hip screw combined with lesser trochanter fixation group (alP < 0.000 1). These results suggest that the lesser trochanter unfixed therapy has the advantages of relatively simple operation, shorter operative time and less blood loss during the process of dynamic hip screw internal fixation for repair of unstable intertrochanteric fractures. However, the excelent and good rates of efficacy, hip coxa vara and other postoperative complications were superior in patients with intertrochanteric fracture above the Tronzo-Evans III type who received dynamic hip screw combined with lesser trochanter fixation to those who received lesser trochanter unfixed therapy. The results indicate that dynamic hip screw combined with lesser trochanter fixation for repair of intertrochanteric fracture is beneficial to prevent hip coxa vara and other complications.

Objective To analyze the clinical effect of intravascular intervention for treating the severe stenosis of bilateral renal arteries (BRASS).Methods A total of 40 patients with BRASS admitted in Fuwai Hospital from September 2008 to December 2010 were retrospectively analyzed.These patients,23 males and 17 females,aged from 21 to 76 years with average age of (59.75 ± 17.59) years,with luminal narrowing over 70％ in bilateral renal arteries,met the criteria of BRASS evidenced by angiography of renal arteries,and were subjected to renal artery interventional therapy. The etiological factors included arteriosclerosis (34 cases),Takayasu arteritis (3 cases) and congenital fibromuscular dysplasia (3 cases).After percutaneous endovascular intervention,the therapeutic effects were evaluated by lowering the systemic blood pressure and serum creatinine level in 12-month follow-up in average after operation. The data were analyzed with SPSS 13.0 statistical software.ResultsAmong the 80 reual arteries in 40 patients,18 arteries were treated with percutaneous transluminal balloon angioplasty (PTBA),while the other 62 arteries were treated with percutaneous transluminal renal artery stenting (PTRAS).Mter endovascular intervention,the mean systolic blood pressure decreased from ( 165.0 ± 27.0) mm Hg to ( 135.7 ± 25.3 ) mm Hg on the second day after operation ( P ＜ 0.01 ) ; and the mean diastolic blood pressure decreased from ( 88.9 ±15.1 ) mm Hg to (74.8 ± 13.2) mm Hg on the second day after operation ( P ＜ 0.01 ).Accordingly,the kinds of anti-hypertension drug used decreased from ( 3.1 ± 0.9 ) to ( 2.3 ± 1.2) ( P ＜ 0.01 ).Only one patient died suddenly 3 months after intervention,and one died of acute myocardial infarction 7 months after operation.The other 38 patients were followed up for 12 months.At last,the mean systolic blood pressure of patients decreased from ( 165.0 ±27.0) mm Hg to ( 133.53 ± 15.94) mm Hg and the mean diastolic blood pressure decreased from (88.9 ± 15.1 ) mm Hg to (77.37 ± 13.47 )mm Hg. Of all 38 patients,2 were cured (5.3％),27 were improved (71.1％) and 9 failed to treatment (23.7％).Of all 38 patients,76.4％ got hypertension lowered.Moreover,renal function (Scr) was improved in 2 patients (6.3％ ),steady in 21 patients ( 65.6％ ),declined in 9 patients ( 28.1％ ) resulted in azotemia stage.Of 38 patients,71.9％ patients got overall benefit from endovascular intervention in respect of renal function improved.Conclusions The procedure of PTBA or PTRAS offered a minimally invasive,relatively safe and effective technique for BRASS patients to decrease blood pressure and stabilize renal function.

BACKGROUND: Environment pollution due to lead is severe day by day,and the lead-induced developmental toxicity of central nervous system is prominent.OBJECTIVE: To observe the effect of lead at low exposure level on neurobehavioral function of preschool children and provide basis for preventing childhood behavior disorders.DESIGN: Sampling survey.SETTING: Department of Children and Adolescent Health, Public Health College, Sun Yat-sen University.PARTICIPANTS: Totally 211 children of 4-6 years (109 boys and 102girls) were enrolled from a kindergarten of a populated area of Zhuhai City by randomized cluster sampling from September to October 2004.METHODS: 20 mL peripheral blood of finger tip was collected. Blood lead was determined with graphite stove atomic absorption spectrometry.According to the amount of blood lead, the children were divided into high blood lead exposure group (＞100μg/L) and low blood lead exposure group (＜100μg/L). Furthermore, they were also assigned into ＜50 μg/L group, 50μg/L- group, 100μg/L- group, 150 μg/L- group, 250- μg/L group. Achenbach's Child Behavior Checklist (CBCL) and self-designed questionnaire (composed of possibly effective factor on children's neurobehavioral function, such as age, sex, cultivation, family background and so on) were applied, filled by their parents under the instruction of professional staffs. Results and blood lead value were analyzed with first order correlation and multiple factors stepwise regressive analysis.MAIN OUTCOME MEASURES: ①Blood lead level and each factor scores of CBCL, ②correlation analysis between blood lead value and behavioral factor score.RESULTS: A total of 211 questionnaires were sent out, and 211 were retrieved with 211 effective questionnaires. The effective rate was 100%. ①Score on externalizing and behavioral disorder rate in the high blood lead exposure group (13.28±6.26,18.26%) was significantly higher than those in the low blood lead exposure group (9.98±5.46,7.29%)( t=4.067 7,χ2=5.470, P＜0.05). There was insignificant difference in score on internalizing and total score of CBCL between the low and high blood lead exposure groups. ②The behavioral disorder rate of different blood lead level had significance (χ2=13.695,P＜0.01). The behavioral disorder rate in blood lead ≥ 150 μg/L was obviously higher than that of the former 3groups after further pairwise comparison (χ2 were 4.727, 6.261, 5.168;4.503, 5.911, 4.928, P＜0.05), which revealed that the child behavioral disorder rate markedly increased when the blood lead was ≥ 150 μg/L.③Blood lead logarithm value had positive correlation with the scores on hyperactivity, aggression and defiance (r=0.316 4,0.282 8,0.188 6,P ＜0.05), and had no correlation with obesity, desintegration, truculence and sexual questionnaire (r=0.102 4,0.094 2,0.118 3,0.092 6,P ＞ 0.05). ④After the stepwise regression analysis, the scores on hyperactivity, aggression and defiance factors were included in the regression equation. The results suggested that the effect of lead on child externalizing behavior still remained, and kept statistical meaning after confounding factors, such as controlling family and society, etc.CONCLUSION: Low-level lead exposure has adverse effects on externalizing behavior in preschool children.

Objective To observe the therapeutic effects of muscle energy technique combined with joint mobilization on frozen shoulder.Methods Thirty-six patients with frozen shoulder were randomly assigned to:group A (treated with muscle energy technique plus joint mobilization),group B (treated with passive stretching with joint mobilization),and group C (treated with joint mobilization merely),and each had 12 patients.All the patients were treated accordingly for 3 times a week,totally for 4 weeks.The American Shoulder and Elbow Surgeons evaluation system (ASES) was adopted to evaluate clinical effects before and at the end of treatment.Results After 4 weeks of treatment,all patients' ASES scores were improved significantly (P ＜ 0.05).The improvement in the shoulder score index and shoulder range of motion were to a significantly better extent in group A than in the other two groups.Conclusion Muscle energy technique plus joint mobilization could effectively relieve pain increase the shoulder ROM and improve performance in activities of daily living in patients suffering from frozen shoulder.

Objective To investigate the effect of pathoglycemia on the tumor biomarker expression in pancreatic tumor and assess its influence on the diagnostic value of these biomarkers.Methods We recruited 59 patients with malignant pancreatic tumor in total into this study,including 46 cases with pancreatic carcinoma and 13 cases with other pancreatic malignancies.Twenty-seven patients with benign pancreatic diseases were selected as control.All subjects were extracted venous blood and serum samples were separated by centrifugation.Serum levels of CA199,CA125 and CEA were measured by chemiluminescent microparticle immunoassay(CMIA).The positive expression criteria were designated as ＞37 kU/L for CA199;＞35 kU/L for CA125;＞10 μg/L for CEA.Results (1) CA199 showed the highest diagnostic accuracy when the tumor biomarker was used alone.CA199 plus CEA showed the highest diagnostic accuracy when the biomarkers were used pairwisely,even better than three biomarkers used in combination(x2=26.131,P＜0.05).(2)The average rank of all tumor biomarkers were higher in all malignant pancreatic tumor than benign pancreatic diseases,and some of the differences reached statistically significance(CA199,Z=4.682,P=0.000;CA125,Z=1.866,P=0.062;CEA,Z=2.573,P=0.010).(3)When the malignant pancreatic tumor group were further divided into two groups according to their blood sugar level,we found that CA199 were significantly higher in pathoglycemia group than euglycemia group(Z=2.265,P=0.024),while no significant differences were observed in patients with benign pancreatic diseases when compared between patients with different blood sugar levels(Z=4.214,3.224,3.154,Ps＞0.05).Conclusion The combination use of three tumor biomarkers showed no improvements in the diagnosis of pancreatic neoplasm,but with disadvantage of elevated medical expense.CA199 showed the highest diagnostic accuracy when used alone.CA199 plus CEA showed the highest diagnostic accuracy when the biomarkers were used pairwisely.The blood sugar level should be considered when using CA199 in the differential diagnosis of pancreatic neoplasm from benign pancreatic lesions;a new set-point of CA199 should be set by studying the ROC curve and other statistic index to improve the overall accuracy.

Objective To determine the three dimensional motion data of each segment of cervical vertebrae and analyze the characteristics of the intervertebral coupled motion during cervical axial rotation under physiological weight bearing. Methods A total of 16 healthy volunteers (ranging from 22 to 29, median age, 23 years) were recruited to our study. Any cervical spine disorder history, pain or other discomfort and malformations were excluded so as to avoid abnormal neck motion. These subjects underwent CT scans of their cervical segments in a supine position, and 3D models of C1-C7 were constructed. Next, each subject was asked to sit up straight and was positioned in the following sequence:maximal left and right twisting, while double oblique images by DFIS were taken simultaneously at each of the positions. Then, the CT models were matched to the osseous outlines of the images from the two oblique views to quantify the position of cervical vertebraes in 3D at each position. Through local coordinate systems at the center of vertebral bodies, changes of position and angle of each cephalad vertebrae relative to the cauddal one were calculated before and after the axial rotation. Results (1) In the axial rotation of the cervical spine, the contribution of C1/2 accounted for the most of the total cervical rotation range. For the lower levels, axial rotation was found to be maximal at C3/4 and C5/6, minimal at C2/3. (2) In cervical axial motion, C1/2 demonstrated a coupled lateral bending opposite to the axial rotation direction, while each segment of C2-7 demonstrated coupled lateral bending towards the same side of the axial rotation. Among these segments the lateral bending angle of C2/3 was smaller than angles of C3/4, C4/5 and C5/6. Conclusion This study investigated the cervical coupling behavior using the noninvasive 2D-3D matching technique and obtained the motion data at each cervical spinal segment. These findings will help to improve the understanding on physiological cervical spine movement and potential biomechanical mechanism and treatment of cervical spondylosis. Also our data may provide useful reference for the prosthesis design.

Objective To investigate the effects of Yindan Xinnaotong Capsule on the osteoponin(OPN)expression in myocardium tissue of the rats after acute myocardial infarction(AMI)and to clarify the mechanism of Yindan Xinnaotong Capsule in alienating rat AMI.Methods 90 Wistar rats were used to establish AMI models by ligating of the left anterior descending coronary artery.The AMI model rats were randomly divided into AMI model group, highdoseofYindan(16g·kg-1·d-1)group,lowdoseofYindan(0.08g·kg-1·d-1)group,positivedrug control captopril(5 mg·kg-1 ·d-1 )group(n=12);at the same time sham operation group(n=10)was set up, the rats in sham operation group was treated with wearing without ligation. All the rats were administrated for 4 weeks,then the myocardium tissue samples were obtained.The histological changes of myocardium tissue were observed by HE and Masson staining;the DNA fragments of apoptotic cells were detected by TUNEL staining and the apoptotic index(AI)was calculated.The expression of OPN mRNA in non-infarction area was measured by RT-PCR.Results Compared with sham operation group,the AI of the rats in model group was significantly increased (P<0.05);compared with model group,the AI of the rats in Yindan groups and captopril group were markedly decreased(P<0.01 );compared with captopril group, the AI of the rats in high dose of Yindan group was significantly decreased(P<0.05).Compared with sham operation group,the expression level of OPN mRNA in non-infarction area of the rats in model group was significantly increased(P<0.01);compared with model group, the expression levels of OPN mRNA in non-infarction area of the rats in Yindan groups and captopril group were also decreased significantly(P<0.01);compared with captopril group,the expression level of OPN mRNA non-infarction area of the rats in high dose of Yindan group was significantly decreased(P<0.05).Conclusion Yindan Xinnaotong Capsule could obviously alleviate the apoptosis of myocardium tissue of the rats after acute myocardial infarction and decrease the expression of OPN mRNA in non-infarction area of left ventricle, which indicates that Yindan Xinnaotong Capsule may protect myocardium tissue through decreasing the OPN mRNA expression.

BACKGROUND:Epidemiologic reports have indicated that excessive weight-bearing exercise is one of important risk factors for lumbar degeneration, but the effects of weight-bearing activity on normal lumbar motion pattern are stil not clear. OBJECTIVE:To measure the changing characteristics and rules of position at the center of rotation of the lower lumbar spine during a weight-lifting activity of normal person. METHODS: Fourteen asymptomatic subjects with a mean age of (25±5) years were recruited for this study. The L4-5 and L5-S1 segments of each subject were CT-scanned to construct 3D models using dual X-ray imaging system and spiral CT examination combined technology in the aid of computer software. The physiological load and lumbar spinal 3D motion under the loading condition were reproduced when matching the flexion, neutrality and extension in the dual X-ray imaging system and on dual oblique lumbar X-ray image. Coordinate systems were established at the vertebral body of L4-S1 to obtain the center of rotation during flexion-to-neutral, neutral-to-extension and the ful flexion-extension motion. RESULTS AND CONCLUSION: (1) Under physiological load, the center of rotation of L4-5 of normal person was located about 1.0 mm anterior to the central axis of the vertebral body, and the center of rotation of L5-S1 was located about 0.7 mm anterior to the central axis of the vertebral body. (2) With weight loading, the center of rotation of both two segments shifted backward about 0.5 mm. There was no statistical difference between these two loading conditions. (3) When the center of rotation in flexion and extension was calculated respectively, the moving range of the center of rotation at both L4-5and L5-S1 became larger due to taking loads of 10 kg (P < 0.05). In flexion, the center of rotation at L5-S1 significantly shifted forward during a weight-lifting activity (P < 0.05). (4) These results confirm that compared with non-weight-bearing condition, the trajectory of the center of rotation was found to be increased when taking loads, especialy during the flexion-to-neutral motion.