Objective To analyze the variation of peripheral blood Th17 cells and Foxp3+CD4+CD25+regulatory T (Treg)cells in patients with ankylosing spondylitis (AS),and to interpret the role of the ratio imbalance of peripheral blood Th17/Treg cells in the pathogenesis of AS.Methods The percentage of peripheral blood Th17 cells and Foxp3 +CD4+CD25+ Treg cells in AS patients and healthy subjects were determined by flow cytometry (FCM).The concentrations of IL-2,IL-10,TGF-β,IL-6,IL-17 and IL-23 in the serum were measured by enzyme linked immunosorbent assay.The correlation between these cytokines and traditional parameters was analyzed.T test,ANOVA,SNK-q and Speannan's analysis were used for statistical analysis.Results Compared with healthy controls,the percentage of Th17 cells in AS patients increased significantly (P＜0.05); Compared with the inactive AS patients,the percentage of Th17 cells in active AS patients increased significantly [(2.10±0.82)％,(2.89±1.77)％,P＜0.05)]; the percentage of Foxp3+CD4+CD25+ Treg cells in active AS patients was markedly lower than healthy controls (P＜0.05).Compared with healthy controls and inactive AS patients,the specific value of Th17/Treg in active AS patients increased significantly(P＜0.05).The concentrations of IL-17 and IL-23 was found significantly higher in patients with AS than that in healthy controls (t=2.203,P=0.032 and t=2.088,P=0.041).The concentrations of IL-17 and IL-23 was found significantly higher in patients with active AS than that in inactive AS (t=2.808,P=0.008 and t=2.242,P=0.020).The correlation analysis revealed that these cytokines and traditional parameters was not relevant except IL-17/BASDAI (r=0.32,P=0.044).Conclusion The increased ratio of Th17 cells and decreased ratio of Foxp3+CD4+CD25+ Treg cells may play a critical role in AS progression.Manipulating the balance of Th17/Treg would provide a new approach for the treatment of AS.

OBJECTIVE: Functional deterioration of the nerves following cerebral hemorrhage is associated with cerebral hemorrhage-induced brain edema and involves multiple pathways of nerve injuries, now recognized as a complex pathophysiological process involving the interactions between multiple factors. Elucidation of the mechanisms of nervous system injury after cerebral hemorrhage may provide theoretical basis for implementing effective rehabilitative interventions for cerebral hemorrhage.DATA SOURCES: A computer-based search in the Medline database for related articles published between January 1991 and December 2003 was conducted using the combinations of the searching words of "emorrhagic stroke, cerebral hemorrhage, brain edema, and nervous system injury", with the language of the articles limited to English. A search in Wanfang database was also conducted using the key words of "cerebral hemorrhage, brain edema, nervous system injury" (in Chinese) for related Chinese articles published between January 2004 and January 2005.STUDY SELECTION: Total 85 original articles were selected after elimination of the irrelevant ones. Inclusion criteria: reports of animal experiments and clinical trials on cerebral hemorrhage following brain edema and mechanisms of nervous system injury were selected, particularly those focusing on brain edema after cerebral hemorrhage.DATA EXTRACTION: Of the 85 articles, 22 were found closely related to the subject concerned and 18 were indirectly relevant. Nine were excluded for duplicated reports, so that 31 articles were finally selected for analysis.DATA SYNTHESIS: Analysis of the literature suggested that secondary edema around the hematoma and nervous system injury were important indicators for poor prognosis of patients with cerebral hemorrhage. Multiple factors participated in the process of secondary brain edema and nerve injuries,such as the hydrostatic pressure during formation of the hematoma and clot retraction, activation of blood coagulation cascade, generation of thrombin,erythrocytolysis and the toxicity of hemoglobin, the activation of the complement system, space-occupying effects, rupture of the blood-brain barrier,secondary ischemia around the hematoma, inflammatory reaction of the neurons around hematoma and cell apoptosis.CONCLUSION: Effective protective interventions for brain edema after cerebral hemorrhage and complex pathophysiological changes may attenuate nervous system injuries following cerebral hemorrhage and improve the prognosis of functional recovery.

OBJECTIVE:To systematically review the efficacy of isotretinoin in the treatment of acne vulgaris,and to provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed, Cochrane Library, Wanfang, VIP and CJFD,randomized controlled trials (RCT) about isotretinoin (test group) versus viaminati,macrolides,tetracyclines antibiotics and other drugs (control group) in the treatment of acne vulgaris were collected. Meta-analysis was performed by using Rev Man 5.2 software after data extract and quality evaluation by Cochrane 5.1.0. RESULTS:Totally 28 RCTs were enrolled,involving 3 534 patients. Results of Meta-analysis showed,the total effective rate of isotretinoin was significantly higher than viaminati [RR=1.56, 95%CI(1.27,1.91),P<0.001],macrolides[RR=1.44,95%CI(1.31,1.58),P<0.001] and tetracyclines antibiotics [RR=3.05,95%CI(2.29,4.07),P<0.001];improvement of skin lesions scores was significantly better than control group [MD=0.33,95%CI(0.04, 0.62),P<0.05],the differences were statistically significant. Dry lips,cheilitis,dry skin and nasal mucosa and pruritus were the main adverse reactions,and no serious adverse reactions were showed. CONCLUSIONS:Isotretinoin has better efficacy and safety than viaminati,macrolides and tetracyclines antibiotics.

At present, the assessment of the same hospital at the same time by different means may lead to different assessment results, viz. there may be a variety (inconsistency) of assessment results. This can be chiefly attributed to the variety of assessment systems, with different assessment indexes and assessment methods, and to the variety of people making the assessments and assessing environments. Integrated measures can be taken in order to render assessment results more accurate: ① refusing to have blind faith in any particular method; ② seeing clearly assessment goals and features; ③ properly selecting index systems for the assessment; ④ correctly fixing the weights for indexes; ⑤ appropriately selecting assessment methods; ⑥ making combined use of various methods; ⑦ pooling the results from different assessment methods.

Objective:This study aimed to develop a Chinese version of Quality of life in Epilepsy Inventory(QOLIE-89) and to confirm its psychometric properties.Methods:The original English version QOLIE-89 was adapted to Chinese language through a translation back-translation procedure. The assessment included 204 patients with epilepsy .The test-retest and internal consistency reliabilities, criterion validity and discriminative validity were assessed.Results:The test-retest reliability (Pearson's correlation coefficient) for Chinese version QOLIE-89 was 0.63-0.95 and internal consistency reliability (Cronbach's alpha) was 0.76-0.92. The confirmatory factor analysis indicated that the Chinese version of QOLIE-89 was composed of three dimensions(CMIN/DF=2.17,GFI=0.98, AGFI=0.90, CFI=0.98,RMSEA=0.061), which were physiology, psychology and social function that including 17 factors obtained by exploration analysis ,which can explained 71.91% of total variance. Spearman's rank correlations between Chinese version QOLIE-89 total score and QOLIE-31 total score was 0.96 and domain scores were from 0.86-1.00.QOLIE-89 items could be discriminated well between patients according to epileptic seizures severity and antiepileptic drug side effects.Conclusion:The psychometric properties of the Chinese version QOLIE-89 inventory are fairly good and similar to the American version and can be applied to assess quality of life for adult patients with epilepsy in China.

The hospital is a dynamic, discrete, flexible, open and complicated system. The paper offered an analysis of the hospital system from the Wuli-Shili-Renli perspective, simplifying the complex process of medical activities into a clear-cut diagram of the system architecture. It also gave an account of the construction of a simulation model of specialized knowledge in hospital management by means of KBS, with the integration of the Wuli-Shili-Renli ideology into the KBS, and expounded the significance of Renli in the model of hospital management.

Objective To evaluate the effect of percutaneous coronary intervention(PCI) on myocardial perfusion in coronary heart.Methods Fourty-two patients with coronary heart disease who were confirmed to have coronary artery steonsis by the coronary angiography were selected.They were checked by myocardial contrast echocardiography of intravenous before and after treatment by PCI.Then we determined quantitatively the perfusion of coronary microcirculation based on the extent of myocardial imaging and recorded it images.The myocardial contrast echocardiography result was compared before and after treatment by PCI for evaluating the situation of myocardial perfusion and effect of PCL So we can estimte the patients' prognosis.Results There were 39 eases of 42 patients with PCI that their lesion vascular were all opening and unblocked.Repeated radiography showed that their TIMI blood flow was the third level.The partial cross sectional area of all the capillaries [A =15.46 ± 3.27) min] blood flow velocity [β =(0.75 ±0.16)min/s],and myocardial blood flow volume[A - β =(12.00 ±4.51 ) min2/s] dependent on myocardial segments all increased more significantly than those before the PCI[A =(6.68 ± 1.76) min,β =(0.40 ± 0.12) min/s、A · β =(2.82 ± 1.38 ) min2/s] (t =37.2527.58、30.65,P ＜ 0.05 ).After PCI three months the EF value of follow-up patients was increased mote than that of before PCI (t =13.77,P ＜ 0.01 )but the scoring index of ventricular wall motion was decreased more than that of before PCI ( t =8.75,P ＜ 0.01 ).Correlation analysis showed that after PCI A,β,A · β all had a strong correlation ( every P ＜ 0.01 ).Conclusion PCI could effectively improve the situation of myocardial perfusion in myocardial infarction patients.It could save ischemia myocardial in infarction field and also improve the function of left ventricular if patients implemented PCI operation as soon as possible.

Lipoprotein-associated phospholipase A2(Lp-PLA2) can rapidly hydrolize and oxidize the oxidized phosphatidylcholine molecules produced in low density lipoprotein and atherogenic lipoprotein (a),generating the soluble proinflammatory and proapoptotic mediatorslyso-phosphatidylcholine and oxidized free fatty acids.It stimulates aggregation and activation of monocyte-macrophage system and induces apoptosis and damages the removal of dead cells.It plays an important role in the development of lipid necrotic core of atherosclerosis.Lp-PLA2 is not an independent risk marker of coronary artery disease and ischemic stroke,but also plays an important role in the development of atherosclerotic plaques.Selective Lp-PLA2 inhibitor reduces the development of necrotic cores.It may play a role in the stabilization of atherosclerotic plaques.At the same time,it may represent a novel target for the treatment of atherosclerosis.

With the improvement of radiation therapy technology and the comprehensive treatment of malignant tumors,the survival time of patients with malignant tumors is gradually extended.In recent years,carotid stenosis and cerebrovascular disease complications after radiation therapy have received increasing attention.Existing studies have shown that carotid stenosis after radiation therapy is not only associated with atherosclerosis,it is likely to be an independent vascular lesion.This article reviews the correlation between head,neck and cerebral ischemic events,characteristics and mechanisms of vascular injury after radiation therapy,as well as the risk factors for carotid stenosis,clinical manifestations,and diagnosis and treatment methods after radiation therapy.

Objective To investigate the changes of urinary brush border membrane enzymes and serum cystatin C (Cys C) in newborns in order to develop early diagnostic indicators for sclerema neonatorum (SN) renal dysfunction.Methods Sixty-night cases with sclerema neonatorum and 30 cases of normal newborns were enrolled in this study.Of all sclerema neonatorum cases,39 cases were mild and 30 cases were moderate to severe sclerema neonatorum.Immunoca talytic assay method was adapted to detect the level of urinary brush border membrane.The levels of serum Cys C,blood urea nitrogen (BUN),creatinine (Cr) and urinary β32 microglobulin (β2-MG) in two groups were also measured.Results The levels of urinary brush border membrane enzyme,β2-MG and serum Cys C in sclerema neonatorum group were (40.09 ± 7.29) U/L,(4.65 ± 1.33) mg/L and (1.84 ± 0.32) mg/L,higher than those in control group ((23.19 ± 5.62) U/L,(2.49 ± 0.77) mg/L and (1.07 ± 0.25) mg/L; t =10.34,7.47 and 10.55,P ＜ 0.01).The levels of urinary brush border membrane enzyme and serum Cys C in moderate to severe sclerema neonatorum group were (42.06 ± 7.59) U/L and (1.93 ± 0.34) mg/L,higher than those in the mild group ((38.57 ± 6.70) U/L,(1.77 s0.29) mg/L;t =2.24,2.11,P ＜0.05).The abnormality rates of urinary brush border membrane enzyme and serum Cys C in sclerema neonatorum group were 79.7％ (55/69) and 72.5％ (50/69),higher than β2-MG abnormal rate (52.2％ (36/69),x2 =12.95,12.11,P ＜ 0.01).In sclerema neonatorum group,urinary brush border membrane enzyme was positively correlated with β2-MG (r =0.560,P ＜ 0.01),and serum Cys C was positively correlated with BUN,Cr (r =0.314,0.287,P ＜ 0.05).Conclusion Renal injury is common in SN.Urinary brush border membrane enzyme and serum Cys C are served as the diagnostic parameters for early detection of renal injury in SN.