Objective To establish a experimental autoimmune thyroiditis(EAT) rat model and to observe pathological change levels of CD4 + T lymphocyte infiltration in thyroid tissues under different iodine nutrient conditions.Methods One hundred and thirty-five four weeks old female Lewis rats(body weight about 80 g) were divided into control(NC),model(TG),high iodine-Ⅰ (HⅠ),high iodine and model-Ⅰ (HⅠ + TG),high iodine-Ⅱ (H Ⅱ),high iodine and model-Ⅱ (H Ⅱ + TG) groups according to body weight by random number table.There were 20 rats in NC,HⅠ and H Ⅱ groups,and 25 rats in TG,H Ⅰ + TG and H Ⅱ + TG groups.The rats of HⅠ and HⅠ + TG groups drank deionized water containing iodine 25.7 mg/L; rats of HⅡl and H Ⅱ + TG groups drank deionized water containing iodine 423.3 mg/L; rats of NC and TG groups drank distilled water.Rats of TG,HⅠ + TG and H Ⅱ + TG groups were immunized with 0.1 ml thyroglobulin(Tg,8.0 g/L) in incomplete Freunds adjuvant (IFA),once two weeks for three times.Urine samples were collected after immunization for 8 weeks; after immunization for 15 weeks,rats were killed,blood samples and thyroid tissues were taken.Urinary iodine was determined by arsenic-cerium catalytic spectrophotometry; pathological changes in thyroid tissue were observed by Hematoxylin-Eosin (HE) method ; immunohistochemical method was used to identify the infiltration of inflammatory cells in thyroid tissue.Results The difference of rat thyroid relative quality between groups was statistically significant (F =44.428,P ＜ 0.05).Compared with NC group (0.085 25 mg/g),thyroid relative qualities were increased in experimental groups (TG,HⅠ,HⅠ + TG,H Ⅱ,H Ⅱ + TG groups:0.095 22,0.092 85,0.097 48,0.096 55,0.095 33 mg/g,all P ＜ 0.05).The difference of urinary iodine between groups was statistically significant(x2 =106.4,P＜ 0.05).Compared with NC group(456.45 μg/L),urinary iodine levels in TG,HⅠ,HⅠ +TG,HⅡ,HⅡ + TG groups(800.08,18 633.20,13 869.00,87 889.97,61 661.51 μg/L) were increased(all P ＜ 0.05).The pathological changes of rats in each group were increased with increasing of iodine intake.Rats in NC group had normal thyroid structure; in TG,HⅠ groups,a small amount of lyrnphocytes were found between thyroid follicular; the lymphocytes infiltrated into the follicular in HⅠ + TG group; rats in H Ⅱ,H Ⅱ + TG groups had follicular fusion,and diffused inflammatory cell infiltration.There was a tendency of increased CD4+ T lymphocyte infiltration in rat thyroid with increasing of iodine intake.There was no CD4+ T lymphocyte positive staining in NC group; TG group had a small amount of positive cells; HⅠ group had scattered yellowish-brown positive cells.HⅠ + TG group had a focal lymphocyte infiltration; HⅡ group had follicular expansion obviously; follicular structure damage in HⅡ + TG group was serious,and showed a diffused yellow dye.Conclusion Excessive iodine intake and Tg immunization can induce and aggravate the incidence of autoimmune thyroiditis in rats,and pathological change situation has exacerbated with increasing of iodine intake; excessive iodine intake may also lead to an increased tendency of CD4+ T lymphocytes infiltration in thyroid tissue of EAT rat.

BACKGROUND:At present, a large number of studies have confirmed that reconstruction plate compared to Kirschner wire in the treatment of clavicular fracture showed good effects, but there is no precise report on the specific advantages at present. Clinical randomized controled study is less, and lacks of systematic evaluation. OBJECTIVE:To systematicaly evaluate the efficacy and safety of the treatment of the clavicle fractures with the reconstruction plate and the Kirschner wire by using a meta-analysis. METHODS: We retrieved the MEDLINE, Embase, PubMed, Cochrane library, CNKI, Wanfang database and VIP database from 2008 to 2015 by computer to colect al controled study relevant to reconstruction plate and Kirschner wire in the treatment of clavicle fracture, and screened the literatures that met the inclusion criteria. Al literatures were analyzed in strict quality evaluation. Excelent rate, delayed healing of incision, malunion, postoperative infection, loosening of internal fixation, postoperative fracture displacement, operation time, intraoperative bleeding volume and fracture healing time were selected as the evaluation indexes of a meta-analysis. Meta-analysis was performed with RevMan 5.2 software from the Cochrane Colaboration. RESULTS AND CONCLUSION:Finaly 12 Chinese articles published from 2008 to 2014 were included, with 911 patients. Meta-analysis results showed that compared with Kirschner wire, the reconstruction plate has a certain advantage in improving the excelent and good rate, shortening the delayed wound healing and reducing deformity healing, reducing postoperative infection, preventing the loosening of internal fixation and avoiding postoperative fracture displacement. However, the two surgical methods in the treatment of clavicular fracture were not significant in operation time, intraoperative blood loss and fracture healing time. These results suggest that compared with the Kirschner wire, reconstruction plate fixation for treatment of clavicular fracture had better curative effect. The reconstruction plate can be firstly selected in the permit of patient economic conditions and hospital conditions. Due to the limited sample size in this study, the multicenter, large-sample and long-term clinical randomized controled studies with more strict design are needed to increase the reliability of the evidence.

BACKGROUND:Now a lot of studies have confirmed that in contrast with the dynamic hip screw, the proximal femoral nail anti-rotation has a better therapeutic effect on the treatment of intertrochanteric fractures in the elderly, but there is no definite conclusion on the specific superiority at present. OBJECTIVE:To compare the curative effects of proximal femoral nail anti-rotation and dynamic hip screw in repair of intertrochanteric fracture using a meta-analysis. METHODS: We searched VIP database, Wanfang database, PubMed database and Embase database from 2011 to 2015, and colected randomized controled trials on proximal femoral nail anti-rotation and dynamic hip screw in repair of intertrochanteric fracture. Operation time, intraoperative blood loss, hospital stays, fracture healing time, Harris score, length of incision, bed time walking after the operation were used as evaluation indexes of meta analysis. Data were analyzed using RevMan 5.3 software. RESULTS AND CONCLUSION:In the end, we used 9 literatures, which contained 858 patients of intertrochanteric fractures in the elderly. The time of publication was from 2011 to 2015, and al of them were published in Chinese. The results of Meta-analysis showed that, compared with dynamic hip screw, proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly could effectively reduce operation time, blood loss, hospital stays, fracture healing time, length of incision and the time of walking after the operation was earlier, and it could obtain better recovery of hip function. We can point out that compared with dynamic hip screw, proximal femoral nail anti-rotation has certain advantages in the treatment of intertrochanteric fractures in the elderly. In some conditions, the patients and the hospitals can give priority to choose the proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly.

Objective To evaluate inhibitory effect of Chlamydia trachomatis plasmid-encoded protein pORF5 on HeLa cell apoptosis induced by tumor necrosis factor-alpha(TNF-α). Methods The recombinant lentiviral expression vector containing pORF5 gene and helper plasmids were co-transfected into 293T cells to prepare the recombinant lentivirus. Then, the lentivirus particles were collected and concentrated, and used to infect HeLa cells. Flow cytometric screening identified stable pORF5-expressing HeLa (pORF5-HeLa) cells. Meanwhile, the empty plasmid was transfected into HeLa cells to prepare control HeLa cells. The two cell lines were both divided into two subgroups to be treated with 20μg/L TNF-αand fresh culture medium respectively for 6 hours. Then, Hoechst 33258 staining was performed to observe morphological changes of apoptotic cells, flow cytometry to detect cell apoptosis, real-time PCR to measure the mRNA expression of Caspase3, Bax and Bcl-2, and Western blot analysis to determine the protein expression of Bax and Bcl-2. Results After 6-hour treatment with TNF-α, Hoechst 33258 staining showed variable degrees of karyopyknosis and karyorrhexis, and highly-refractive blue apoptotic bodies in the pORF5-HeLa cells and control HeLa cells. The pORF5-HeLa cells and control HeLa cells both showed significantly higher apoptosis rate in the treated subgroup than in the untreated subgroup (pORF5-HeLa cells:35.5%± 4.5%vs. 9.5%± 1.5%, t=13.53, P<0.01;control HeLa cells:63.6%± 5.8%vs. 7.9%± 0.9%, t=32.36, P<0.01). Compared with treated control HeLa cells, treated pORF5-HeLa cells showed significant decreases in mRNA expression of Bax(72.8%)and Caspase 3(84.5%)(t = 35.29, 42.25, respectively, both P < 0.01), as well as in Bax protein expression(t = 17.58,P < 0.01), but significant increases in Bcl-2 mRNA and protein(6.8 times)expression(t = 87.12, 18.93, respectively, both P <0.01). Conclusion pORF5 plasmid protein can inhibit TNF-α-induced HeLa cell apoptosis likely by increasing the expression of anti-apoptotic protein bcl-2 and decreasing the expression of pro-apoptotic proteins Caspase-3 and Bax.

Objective:To explore whether the limit of "before the equal-diameter period" is reasonable in the current criteria for "Diagnosis of Kashin-Beck Disease" (WS/T 207-2010) in children, and to provide basic data and technical support for revision of the criteria for "Diagnosis of Kashin-Beck Disease" (WS/T 207-2010).Methods:In 2018, the historical Kashin-Beck disease (KBD) areas in Heilongjiang Province were selected as the investigation sites. The right-hand X-ray films of all children aged 7-12 years old were taken. According to the different X-ray manifestations of the growth and development of the phalangeal epiphysis, they were divided into five periods: before the equal-diameter period, equal-diameter period, ultra-diameter period, pre-closure period and closure period. Firstly, after stratifying by basic data such as age and gender, the data were standardized and analyzed. Secondly, the detection rates of metaphysis-epiphysis (CRME) in each period were calculated and compared. Finally, based on the mean value of the detection rate of metaphyseal change in Linkou and Fuyu counties of Heilongjiang Province in 1990, the rates of expected detection and missed diagnosis of metaphyseal changes of KBD among investigated children were calculated and compared under the limitation of before the equal-diameter period, before the ultra-diameter period or age range reduction.Results:A total of 5 019 children were investigated. The proportion of children before the equal-diameter period was 53.94% (2 707/5 019), and that of before the ultra-diameter period was 77.92% (3 911/5 019). The results showed that the equal-diameter period mainly appeared in 7-10 years old, and showed a decreasing trend with the increase of age (χ 2trend = 390.10, P<0.05); the ultra-diameter period mainly occurred in 10-12 years old, showing a decreasing trend with the increase of age (χ 2trend = 65.39, P < 0.05); the pre-closure period mainly occurred in 10-12 years old, with an increasing trend with the increase of age (χ 2trend = 51.86, P<0.05); the closure period mainly occurred in 11-12 years old and increased with age (χ 2trend = 7.58, P<0.05). The CRME of children in ultra-diameter period was 14.78% (158/1 069), however CRME did not occur in children with equal-diameter period. Among children before equal-diameter period, before ultar-diameter period and aged 7-10 years old, the expected detection rates of metaphyseal changes of KBD were 5.90%, 8.53% and 7.42%, respectively. The expected missed diagnosis rates of metaphyseal changes of KBD were 5.06%, 2.45% and 3.52%, respectively. Conclusion:In order to improve the rate of expected detection and lower the rate of missed diagnosis of metaphyseal changes of KBD, children in "equal-diameter period" should be included in X-ray diagnosis and disease monitoring of KBD.

Abstract: The aim of this study was to prepare a high drug-carrying capacity micellar drug delivery system (CTD@Sol) of the polymer zebra tetracycline and to preliminarily investigate the feasibility of this drug delivery system for the treatment of breast cancer. Firstly, CTD@Sol was prepared using sol as the carrier material and CTD as the model drug, and its pharmacological properties such as appearance and morphology, particle size, potential and in vitro release were evaluated. The growth inhibitory and apoptotic effects of CTD@Sol on breast cancer (4T1) cells were investigated by MTT assay and Annexin V-FITC/PI double staining assay; the uptake efficiency of 4T1 to this delivery system was investigated by flow cytometry; and the in vivo tissue distribution of the delivery system and the targeting of tumour tissues were investigated by small animal in vivo imaging technique. The results showed that CTD@Sol appeared as a light pale blue creamy white colour, with an average particle size of (159.73 ± 1.96) nm, a PDI of 0.198 ± 0.006, Zeta potential of –(47.60 ± 1.77) mV, an encapsulation rate of (90.29 ± 1.69)% and a drug loading capacity of (45.00 ± 0. 84)%; the in vitro release and haemolysis experiments showed that the drug release rate of CTD@Sol in acidic environment (pH 5.5) was significantly faster than that in neutral environment (pH 7.4), suggesting that the system is acid-sensitive and has good biosafety under endocytosed pH conditions. Cellular uptake, cytotoxicity and apoptosis experiments showed that CTD@Sol was more lethal to 4T1 cells, and the sol-gel polymer micelles as a drug delivery vehicle could significantly improve the cellular uptake efficiency of the drug; in vivo experiments showed that the delivery system had a significant targeting effect on tumour tissues.In conclusion, this study has successfully produced a CTD@Sol drug delivery system with high drug loading capacity (>45%), good pharmacological performance, strong targeting and biosafety, which has the potential to be used in the treatment of breast cancer.

Objective:To investigate the effects of hypertensive disorders during pregnancy (HDP) on preterm newborns in terms of umbilical cord blood serum ferritin (SF), hemoglobin (Hb) at birth and outcome.Methods:Among inpatients of the First Maternity and Infant Health Hospital Affiliated to Tongji University from October 1, 2015 to December 31, 2016, totally 1 419 cases of preterm newborns were prospectively collected.Preterm infants whose mothers with diagnosis of HDP were recruited as the HDP group.Meanwhile, premature newborns whose mothers without HDP were recruited as the control group.Umbilical cord blood SF levels, Hb levels at birth, outcome of preterm newborns and the basic information for maternity were compared between the two groups.The data of normal distribution between the two groups were compared by independent sample t test.The count data was tested by χ2, and the count data with frequency <5 was tested by Fisher′ s exact test. Results:SF levels of HDP group were significantly lower than the control group [(85.6±67.2) μg/L vs. (103.9±95.5) μg/L]. But Hb levels of HDP group were much higher than the control group [(206.2±33.8) g/L vs. (193.2±31.9) g/L]. The difference between two groups was statistically significant ( t=2.791, 4.825 all P<0.05). Umbilical cord blood SF levels were negatively correlated with Hb levels at birth ( r=-0.120, P<0.001). Moreover, compared to the control group, statistically significant lower incidence of neonatal respiratory distress syndrome (NRDS), pneumonia and bronchopulmonary dysplasia (BPD) in HDP group was observed (all P<0.05). Conclusions:HDP was correlated with umbilical cord blood SF levels and Hb levels at birth in premature newborns.Higher Hb levels and relatively lower incidences of NRDS, pneumonia and BPD were observed in these newborns delivered by mothers with diagnosis of HDP.

OBJECTIVE：To dev elop and apply a parenteral nutrition prescription decision support system for medical institutions and provide theoretical basis for improving clinical parenteral nutrition precision treatment. METHODS ：Based on the review points of parenteral nutrition prescription ，the parenteral nutrition prescription decision support system was designed ；the function points and prescription review logic of each module of the system were discussed ，and the system was also used to review 100 pieces of clinical parenteral nutrition prescriptions. RESULTS ：Information-based parenteral nutrition prescription decision support system included evaluation index management module ，drug management module ，index knowledge management module ， index calculation and evaluation module ，feedback and tracking module. The logic of parenteral nutrition prescription review were based on the evaluation indexes ，and rationality knowledge base ，safety knowledge base and drug attribute base were constructed. Based on the above knowledge bases ，patient information and prescription information call and calculation ，the evaluation result set of safety and rationality of the prescription was finally formed. Based on this design concept ，the parenteral nutrition prescription decision support system realized the automatic review and warning of various indicators in TNA prescription ，and can quickly and efficiently review the safety and rationality of parenteral nutrition prescription. Through manual judgment ，the audit results of 100 prescriptions by the system were all correct. CONCLUSIONS ：The basis of parenteral nutrition prescription review is the formulation of evaluation indexes ，and the technical difficulty lies in considering the individuality and rationality as well as the safety and stability of parenteral nutrition solution at the same time. The application of a well-structured information system will promote the precise and reasonable medication of parenteral nutrition and improve work efficiency of medical personnel.

Objective:To master the status of Kashin-Beck disease (KBD) in 2019, to provide the basis for assessment of KBD control and elimination.Methods:Data of endemic areas basic information collection and children KBD examination were executed in all endemic villages from every endemic county (city, district, banner) of 13 endemic provinces. All children aged 7 - 12 years in endemic villages underwent clinical examination, and X-ray examination was performed for clinically positive children. When both the clinical examination and X-ray reexamination were positive, the diagnosis was KBD.Results:In monitoring of 823 365 7 - 12 years old children, a total of 3 057 children with similar clinical signs of KBD were suspected positive cases. The results of X-ray reexamination showed that the X-ray manifestations of 3 057 children were normal, and no X-ray positive changes were found, that is, there was no case of KBD in children. A total of 16 559 endemic villages in 13 endemic provinces were monitored, and all reached the criteria for KBD elimination. Surveillance of all endemic villages was completed except Tibet Autonomous Region, the KBD elimination rates of endemic villages were 100.00% in 12 endemic provinces and 99.01% (16 559/16 725) in all 13 endemic provinces.Conclusions:No children KBD case is detected in 2019, children KBD stays at its eliminating level throughout the country. And 100.00% endemic villages meet the criteria for KBD elimination in the remaining 12 endemic provinces except Tibet Autonomous Region.

Objective:To investigate the oral medication treatment of adult patients with Kashin-Beck disease(KBD) in China, so as to provide theoretical basis for medication screening of KBD and to provide scientific guidance for clinical treatment of KBD.Methods:Based on the "Endemic Disease Prevention and Control Project of Special Funds for Local Public Health Subsidized by the Central Government" and "Major Public Health Service Endemic Disease Prevention and Control Project", the treatment information of adult patients with KBD in 11 provinces (autonomous regions, referred to as provinces) in China from 2006 to 2017 was collected, and the treatment coverage of adult patients with KBD in different years and regions was analyzed, and the curative effect of patients with different severity was evaluated.Results:From 2006 to 2017, the number of provinces participating in the treatment project was from 2 to 11. The actual total number of people treated in China was 68 061, with a completion rate of 78.10% (68 061/87 149); the annual number of people treated increased linearly; the overall clinical symptom remission rates of adult patients with KBD in all regions reached more than 50%, and the overall treatment effect showed an upward trend year by year; compared with patients with grade Ⅲ, after oral medication, the remission rates of clinical symptoms in patients with gradeⅠandⅡ were higher (the average remission rate of clinical symptoms was 84.13% for gradeⅠ, 80.71% for grade Ⅱ and 72.11% for grade Ⅲ, P < 0.05). Conclusions:Oral medication treatment can effectively alleviate the clinical symptoms of most adult patients with KBD of grade Ⅰ and Ⅱ. Patients of grade Ⅲ should be considered treating with oral medication combined with other treatment methods. A considerable number of patients are still ineffective in taking drugs at this stage, and it is urgent to carry out the screening, research and development of specific medications for KBD.