Objective To discuss the short-term outcomes of uncemented APL stem hip hemiarthroplasty for unstable intertrochanteric fracture in elderly patients.Methods From July 2008 to December 2011,26 cases of intertrochanteric fractures were treated by hemiarthroplasty using uncemented APL stem.There were 10 men and 16 women with a mean age of 82.5 years (range,75-94 years).According to EvansJensen classification system,16 cases were type Ⅱ fractures,the other 10 were type Ⅲ.Results The mean operation time was 56 min (range,48 to 72 min).The average blood loss during the operation was 360 ml (range,240-600 ml).One of the patients died in the perioperative period,2 died during the follow-up.The other 23 patients were followed up with an average of 21.5 months (range,12-42 months).The patients were encouraged to walk with aid about 2-3 weeks postoperatively.Three months after the operation,the walking ability were almost recovered to pre-injury level in 21 cases.The acetabular wear,the prosthetic loosening and subsidence were not found.The complications included 1 case of cerebral infarction,1 case of deep venous thrombosis,2 urinary infection,1 skin ulcer due to the long-term use of cortical steroid and 2 heterotopic ossifications.According to Harris hip score,12 cases were classified as excellent,10 cases as good and 1 case as fair.Conclusion Hemiarthroplasty using uncemented APL stem is an effective way to treat the unstable intertrochanteric fracture in elderly patients.The quality of life of the elderly patients can be improved due to early mobilization after the surgery.

Objective Toinvestigate iodine nutrition,thyroid volume and function of children and women in high water iodine areas,and to discuss the cut-off point of water iodine level where should be defined as iodine excessive areas.Methods In iodine excessive townships in Xiaodian and Qingxu Counties of Taiyuan City,all villages were divided to 4 groups according to the concentration of iodine in drinking water:50 ～ ＜ 100 μg/L (Group A),100 ～ ＜ 150 μg/L(Group B),150 ～ ＜ 300 μg/L(Group C) and ≥300 μg/L(Group D),and 2-3 villages were randomly selected from each group as investigation sites.Two hundred children aged 8-10 and 60 women (20 pregnant women,20 breasffeeding women and 20 women of childbearing age,respectively) were sampled.Drinking water,edible salt and once random urine samples for each studying object were collected,and the iodine content was measured.The goiter volume of children aged 8-10 and triiodothyronine (FT3),free thyroxine (FT4),thyroid stimulating hormone (TSH) of women were determined.Results Totally 708 children and 236 women were selected as respondents who ate non-iodized salt.Iodine content in drinking water of children in groups A,B,C and D was 73.8,144.7,258.5 and 501.0 μg/L,respectively,and that of women was 73.8,144.7,242.7 and 485.9 μg/L,respectively.Median urinary iodine of children in groups A,B,C and D was 274.3,312.8,455.6 and 793.5 μg/L,respectively,and that of women was 238.3,235.2,371.6 and 641.6 μg/L,respectively.The median urinary iodine of children and women increased with increasing water content of iodine.The goiter rate of children was 5.6％ (11/196),13.2％ (25/189),12.6％ (20/158) and 10.9％ (18/165) for each group,respectively,which also increased with increasing water content of iodine.In groups A,C and D,the FT3 and FT4 levels[pmol/L:(3.70 ± 0.59),(14.01 ± 2.44); (3.43 ± 0.57),(12.87 ± 2.12); (3.42 ± 0.47),(12.66 ±1.78)] in pregnant woman were lower than those in breasffeeding women[pmol/L:(4.26 ± ±0.57),(14.73 ± 2.36;(4.28 ± 0.40),(14.77 ± 1.19); (4.36 ± 0.65),(15.66 ± 2.84)] and women of childbearing age[pmol/L:(4.80 ±0.50),(17.47 ± 2.11); (4.21 ± 0.48),(15.83 ± 1.64); (4.26 ± 0.52),(15.53 ± 1.81)].With increasing water content of iodine,FT4 level was decreasing and TSH level was increasing gradually in women.Conclusions When water iodine exceeds 100 μg/L,goiter rate of children has increased significantly.Iodine excessive women and children have appeared one after another with increasing water content of iodine.Women incidence of subclinical hypothyroidism risk has increased with increasing water content of iodine,and the detection rate of subclinical hypothyroidism is significantly higher when water iodine is higher than 300 μg/L.The cut-off point of iodine excessive areas should be descend from 150 μg/L to 100 μg/L.

The peptidyl-prolyl imide bond cis/trans isomerization of Xaa-Pro motif in the peptide and protein plays an important role to influence their conformation and function. Here, a series of model peptides including phosphorylated and its unphosphorylated counterparts were designed and synthesized. Preliminary 1H NMR experiments and molecular dynamics (MD) simulation were used to analyze the peptidyl-prolyl cis/trans imide bond isomerization. The data indicated that the side-chain O-phosphorylation of the Xaa residues preceding proline affected evidently the isomerization and thereby regulated the peptides conformations. The charges of the phosphate moiety as well as their steric effects might be the driving force for the conformational changes of these phosphopeptides.Moreover, the obtained most stable multiple configurations and their statistic cis/trans concentration distribution in MD simulation were basically consistent with the NMR experiments, which demonstrated that phosphorylation increased the cis conformation of the peptide and the maximum cis ratio is given while the phosphate group has no negative charge.

Objective To explore the mid-term efficacy of biological type,long-stem artificial caput femo-ris replacement operation in the treatment of unstable senile intertrochanteric fracture.Methods 73 patients accepted the treatment of biological type long-stem artificial caput femoris replacement operation,and 64 cases were followed. After 3 months of operation,these 64 patients were divided into four groups which marked as A,B,C and D according to the Berg balance scale(BBS).Accordingly,54 patients that in grade A,B and C would be brought into in long-term follow-up study.54 cases include 25 male patients and 29 female patients with an average age of 81.6 years old who aged from 73 to 94 years old.According to Evans-Jensen classification,28 cases were Evans-JensenⅡand the left 26 cases were Evans -JensenⅢ.Results The follow-up period was in the range of 24 to78 months (mean 42months).During this period,except the 9 death cases,there was no case of femoral trochanteric ununited fracture, femoral prostheses loosening or dislocation of hip joint.In total,3 cases occurred with loss of fixing wire,4 cases occurred with acetabular wear,one case was experienced prosthesis adjacent fracture and three cases of heterotopic ossification.According to the Engh standard,all femoral prostheses got osseous fixation.The rate of excellent and good result were 88.9%with in which excellent in 23 cases and good in 17 cases.Conclusion The application of biological type long-stem artificial caput femoris replacement in the treatment of unstable senile intertrochanteric fracture can achieve satisfactory mid-term efficiency.

Objective To investigate the nutritional status of iodine among residents and the goiter disease of children in high water iodine areas in Shanxi Province,and to provide a scientific basis for establishment of longlasting control strategies and measures.Methods In 2012,according to the historical monitoring data,in the 10 high water iodine counties (citys,districts),one town was selected based on its location (east,west,south,north and middle) in each county (citie,district).In county (city,district) with 5 townships or less,all townships were selected.Four villages were selected in each township and fifteen residents in each village were selected to test salt iodine level.In five high water iodine counties (city,district),one or two high water iodine villages were selected,water samples were collected and the iodine content was measured; one hundred students aged 8-10 years old were chosen to examine their thyroid size.Thirty children were chosen from above students to collect their urine samples and to determine the iodine content.Results In 10 high water iodine counties (citys,districts),1 680 salt samples were tested.The rate of non-iodized salt was 85.2％ (1 432/1 680); in six villages of five high water iodine counties (citys,districts),the median of urinary iodine of 256 children aged 8 to 10 was 487.2 μg/L; in three villages which had improved the quality of water,the median of urinary iodine was 271.0 μg/L; other three villages which had not improved the quality of water,the median of urinary iodine was 692.6 μg/L.In those villages which had not improved the quality of water,urinary iodine of children ≥300 μg/L accounted for 85.8％ (139/162); in those villages which had improved the quality of water,high urinary iodine of children accounted for 41.5％ (39/94),and the difference was statistically significant (x2 =53.06,P ＜ 0.05).The thyroid was investigated among 591 children aged 8-10 years old,and the goiter rate was 6.6％(39/591).In those villages which had improved the quality of water,the goiter rate of children was 3.8％ (11/291),but in villages which had not improved the quality of water,the goiter rate of children was 9.3％ (28/300),and the difference was statistically significant (x2 =6.52,P ＜ 0.05).Conclusion The iodine nutrition level of residents in high water iodine areas in Shanxi is excessive,children's goiter disease has not been effectively controlled; water improvement to reduce iodine is the basic way to control the disease of high iodine.

Objective To analyze the effect of adjustments of control strategy on epidemic trend of iodine deficiency disorders (IDD) in Shanxi Province after universal salt iodization (USI),and to provide basis for timely adopting targeted control countermeasure and scientifically adjusting intervention strategy.Methods A method of retrospective analysis was performed to collect data from IDD surveillance at national or province levels after 1995,and from iodized salt surveillance of the province after 2004.According to the statistics and analysis of children's goiter rate,median urinary,median and mean of salt iodine,coverage rate of iodized salt,qualified rate of iodized salt,consumption rate of qualified iodized salt and their relationship.Results Since 1995,the children's goiter rate by palpation and B-ultrasound showed a steady descending trend.The median salt iodine,mean salt iodine and children's median urinary iodine showed a trend of rise→decline→stable→decline.Namely:The three indicators began to rise year by year from 1995 (29.1 mg/kg,31.7 ± 15.0 mg/kg,199.3 μg/L),in 1999 (48.7 mg/kg,53.4 ± 29.4 mg/kg,407.5 μg/L) reached its climax; and then decreased,in 2001 (34.7 mg/kg,36.2 ± 11.9 mg/kg,282.1 μg/L)stoped; which were basically stable from 2001 to 2011; since 2013 (26.0 mg/kg,26.5 ± 6.3 mg/kg,192.0 μg/L),a significant decline began.The rate and edible rate of qualified iodized salt showed a trend of decline→rise→stable.Two indexes began to decline circuitously from 1995 (72.61％,68.25％),and dipped to a low point in 1999 (44.80％,43.67％); then began to rise,until 2002 (94.73％,91.80％) reached basic stability; and remained steady from 2002 to 2013.Conclusions Following the process of prevention and treatment of IDD for more than 30 years in Shanxi Province,with the depth understanding of the range of adequate iodine nutrition,according to the monitoringfeedback mechanism,the strategy of salt iodization has been adjusted several times,the target of continuous elimination of IDD has achieved since 2000 and the levels of iodine nutrition in population are more reasonable.Salt iodization strategy should continue to adhere to.

Objective To study the effect of TLR4 activation with LPS on BMP9-induced osteogenic differentiation of immortalized mouse embryonic fibroblasts ( iMEFs).Methods The activation of TLR4/NF-κB signaling path-way was detected by ICC.iMEFs were treated with LPS,BAY11-7082,Adnovirus GFP and BMP9.The early osteo-genic differentiation capability of iMEFs was detected by ALP staining and quantitative assay .The later osteogenic differentiation capability was detected by alizarin red S staining .The expression of later osteogenic differentiation marker gene OCN and OPN were detected by PCR and Western blot .The change of p-Smad1/5/8 was detected by Western blot.The expression of Runx2 and Dlx5 were detected by PCR and Western blot .Results LPS can effec-tively stimulate TLR4/NF-κB signaling pathway .TLR4 activation inhibited BMP 9-induced osteogenic differentiation . BMP9-induced osteogenic differentiation related gene and Smad 1/5/8 signaling activation were inhibited by TLR4 activation .The inhibition effect was partly reversed by BAY 11-7082 ( P<0.05 ) .Conclusions TLR4 activation with LPS can inhibit BMP9-induced osteogenic differentiation of iMEFs cells via NF-κB signaling pathway .

ObjectiveTo evaluate the long-term outcomes of carotid endarterectomy versus carotid artery stenting for carotid stenosis.MethodsPubMed, EMBASE, and the Cochrane databases were retrieved.The randomized controlled trials of comparing CEA with CAS in patients with carotid artery stenosis were enrolled.The data such as the research basic characteristics and the long-term outcomes including stroke or death combined endpoints, any stroke or any death were extracted.The Stata software was used to conduct statistical analysis.ResultsA total of 7 randomized controlled trials and 8 210 patients were included.The median follow-up time was 2-7.4 years.The overall quality of the included studies was high and the risk of bias was low.The meta-analysis showed that the risks of the combined endpoint of stroke or death (hazard risk [HR] 1.21, 95% confidence interval [CI] 1.04-1.39), any stroke (HR 1.32, 95% CI 1.15-1.51) and ipsilateral stroke (HR 1.26, 95% CI 1.02-1.55) in the CAS group were significantly higher than those in the CEA group;the risks of death (HR 1.06, 95% CI 0.95-1.18), disabling stroke (HR 1.23, 95% CI 0.95-1.60), non-ipsilateral stroke (HR 1.12,95% CI 0.81-1.55) and restenosis (HR 1.18,95% CI 0.91-1.52) were not significantly different between between the CAS group and the CEA group.Conclusions CAS and CEA are associated with similar risks of long-term death, disabling stroke, non-ipsilateral stroke and restenosis.The risks of long-term combined endpoint of stroke or death, any stroke and ipsilateral stroke significantly higher with CAS.These results suggest that CEA remains the treatment of choice for carotid stenosis.

Objective To investigate resident iodine nutrition level in waterborne high iodine areas and prevalence of high iodine goiter in Shanxi Province.Methods In 2014,in Shanxi Province,in all the 10 high iodine counties (cities,districts),the jurisdiction area of each county (city,district) was divided into two blocks,high iodine and not high iodine districts,and in high iodine area of each county (city,area) according to their sub-area positions of east,south,west,north and center,a township was randomly selected (if the number of high iodine area in iodine excessive township ≤5,all townships were selected);four administrative villages in each monitoring township were randomly selected;in each administrative village,the edible salt samples of 15 randomly selected households were collected for detection of iodine content.Five counties (cities,districts) were selected from the province's 10 high iodine counties (cities,districts),water iodine content of 3 counties (cities,districts) was 150-300 μg/L,and 2 were ＞ 300 μg/L,one administrative village was selected from each county (city,area),household drinking water samples were collected to detect iodine content;and 100 elementary school children aged 8-10 were selected from the village where the monitoring stations located in for thyroid volume ultrasound measurement,and 30 of them were randomly selected for urinary iodine content detection.Results ① In the 10 high iodine counties (cities,districts),1 680 households salt samples were detected,and the rate of no iodine salt samples was 89.2％(1 499/1 680).② Fourteen water samples were collected in 5 counties (cities,districts),and the water iodine content was 155.7-467.3 μg/L.③ In the five high iodine counties (cities,districts),197 urine samples were collected from children aged 8 to 10.The median of urinary iodine was 466.5 μg/L;the median urinary iodine was 650.1 μg/L in water iodine≥300 μg/L children group which was significantly higher than that of the group with 150-300 μg/L water iodine content 332.5 μg/L (Z =-6.164,P ＜ 0.05);urinary iodine level of children and the water iodine of the corresponding village was positively correlated (r =0.543,P ＜ 0.05).④ In the five high iodine counties (cities,districts),543 children aged 8-10 were measured with their thyroid volume,the thyroid goiter rate was 6.8％(37/543);the goiter rate of water iodine ≥300 μg/L children group was [9.0％(28/311)] which was significantly higher than that in the iodine content of drinking water 150-300 μg/L group [3.9％(9/232),x2 =5.494,P ＜ 0.05].Conclusion The measurement of stopping iodized salt supply in high iodine areas in Shanxi Province is well implemented,iodine nutrition level and thyroid goiter rate in those areas are still too high,high iodine intervention measures can be focused on changing of the drinking water.

Objective: To evaluate the therapeutic efficacy of acupuncture plus Dang Gui Bu Xue Qu Feng Tang for benign essential blepharospasm (BEB). Methods: A prospective randomized controlled trial was performed. A total of 105 participants were randomized 1:1:1 into an acupuncture group, a herbal medicine group and an acupuncture plus herbal medicine group. Participants in the acupuncture group received manual acupuncture treatment, twice a week. Participants in the herbal medicine group received Dang Gui Bu Xue Qu Feng Tang, oral administration, once a day. Participants in the acupuncture plus herbal medicine group received both treatments. The therapeutic effects of the three groups were evaluated after four weeks of treatment. The primary outcome was the Jankovic rating scale (JRS) score, and the secondary outcome was the blepharospasm disability index (BSDI) score. Results: After four weeks of treatment, the JRS total scores significantly decreased in all three groups versus baseline (P<0.05). A greater reduction in the JRS total score was reported in participants in the acupuncture plus herbal medicine group (P<0.05), but there was no significant difference between the acupuncture group and the herbal medicine group (P>0.05). The acupuncture plus herbal medicine group had a greater decrease in the JRS severity score than the herbal medicine group (P<0.05). The reduction in the JRS frequency score was not significantly different among the three groups (P>0.05). The BSDI scores significantly decreased in all three groups versus baseline (P<0.05), but the reduction in the BSDI score was insignificantly different among the three groups (P>0.05). Conclusion: It is effective in the treatment of BEB either to use acupuncture and Dang Gui Bu Xue Qu Feng Tang alone or in combination. The combination therapy shows a more significant effect than either of the treatment alone.