Objective To study the initial etiology of Kashin-Beck Disease (KBD). Methods Three past etiological hypotheses, biology-earth-chemistry hypothesis (selenium deficient hypothesis), water organic compound poisoning hypothesis and food fungi toxin poisoning hypothesis were studied, together with the virus hypothesis we have developed synchronously to explore the initial etiology of KBD. Results Biology-earth-chemistry hypothesis (selenium absent hypothesis), water organic compound poisoning hypothesis and food fungi toxin poisoning hypothesis were not to be found the initial etiology of KBD. The etiology mode of KBD should be the biologic toxin poisoning under certain environmental condition. The human parvovirus B 19 infection under selenium deficient condition is significantly correlated with KBD. Conclusion The initial etiology of KBD may be the human Parvovirus B 19 infection under selenium absent condition.

Through analyzing the characteristics of inpatients in the hospitals of universities, this paper dis-cussed the importance of doctor-patient communication and humanistic care in the construction of harmonious doc-tor-patient relationship, and then put forward the ethical consideration of improving the doctor-patient relation-ship. It should strengthen humanistic care, improve the consciousness and ability of doctor-patient communica-tion, play the role of echelon, and actively carry out health education and health care service.

The Kashin-Beck disease is a kind of unknown cause disabling arthropathy.In recent years,many experts and scholars have done in-depth studies in Kashin-Beck disease.There is a series of research achievements having been made.In this paper we reviewed the latest progress in the condition,etiology and pathogenesis of Kashin-Beck disease.

Objective:Study on the expression of Fas and Fas ligand (FasL) in gastric cancer and its possible significance.Methods:Fifty-eight paraffin-embedded gastric cancer tissues and twenty-six non-cancer tissues were tested for the expression of Fas and FasL protein by immunohistochemistry.Results:The positive rate of Fas in cancer cells of gastric cancer tissues was significantly lower than that in gastric epithelial cells of the control tissues(19.0% and 61.5%,respectively;?~2=14.918;P=0.000).The positive rate of FasL showed no significant difference between cancer cells of gastric cancer tissues and gastric epithelial cells of the control tissues(63.8% and 53.8%,respectively).Conclusion:The Fas-FasL system is unbalanced.It may be related to the carcinogenesis of gastric epithelial cells and might be responsible for the immune excape of these cells.

Objective In order to observe the efficacy of low-dose in the third injection of hepatitis B vaccine. Methods 126 children aged 5～9 years were enrolled in a double-blind, place-controlled and randomized field trial. They were randomly divided into 10μg and 20μg dose group, and were redivided into 2μg, 5μg, 10μg, 20μg or non-in jected subgroups when the third booster injections were given. Results During the 9 years follow-up, the differences of the anti-HBs levels(GMT) among the groups were not significant at every time (P ＞ 0. 05). The GMTs at the ninth year(T108) were 7. 0, 6. 4, 9.9, 6.1, 9.7, 5. 4 and 7.4, respectively (P＞ 0. 05). The HBV infection rates among the groups had no significant difference (P ＞ 0. 05). The protective rates in the groups were all higher than 75％ at T108. Conclusion According to the data, it can be concluded that the third injection with low-dose has no influence on the vaccine efficacy(either short-term or long-term efficacy).

Objective To study the effects of Jiangu tablet on articular chondrocyte apoptosis in T-2 toxin poisoning rats. Methods According to random number table, fifty weaning male SD rats were divided into two groups by body mass, i.e., 10 for normal control group and 40 for T-2 toxin group (intragastric administration of distilled water or T-2 toxin 200 ng·g-1·d-1) for 30 days. Then the T-2 toxin group was divided into T-2 toxin group, Jiangu tablet low-dose group, middle-dose group and high-dose group treating with 3 ml of T-2 toxin 200 ng or different concentration of Jiangu tablet (contain 1.562 5, 3.125 0 and 6.250 0 g Jiangu tablet active compound). Each group had 10 rats and was given T-2 toxin or different amount of Jiangu tablet for 30 days. Then the rats were killed. The articular cartilage was removed from rats and RNA was extracted from the articular cartilage by Trizol. The mRNA expressions of p53, Bax, Bcl-2 and cysteinyl aspartate specific proteinase(caspase)-3 were detected by real-time PCR. Results The mRNA expressions of p53, Bax, Bcl-2 and caspase-3 in normal control group, T-2 toxin group, Jiangu tablet low-dose group, middle-dose group and high-dose group were: 1.00 ± 0.98, 200.37 ± 30.39, 180.19 ± 28.14, 120.25 ± 15.35, 50.34 ± 10.12;1.00 ± 0.98, 185.37 ± 10.15, 152.59 ± 15.23, 108.46 ± 9.14, 57.18 ± 1.31; 1.00 ± 0.99,0.22 ± 0.03, 0.28 ± 0.06, 0.43 ± 0.08, 0.58 ± 0.04; 1.00 ± 0.97, 209.55 ± 25.64, 152.38 ± 15.46, 120.14 ± 11.52 and 49.24 ± 8.69, respectively. Compared with the normal control group, the mRNA expressions of p53, Bax and caspase-3 were up-regulated in T-2 toxin group, low-dose group, middle-dose group and high-dose group while the mRNA expression of Bc1-2 was down-regulated(all P < 0.05). The mRNA expressions of p53 and caspase-3 in Jiangu tablet high-dose group and middle-dose group were significantly decreased than those in T-2 toxin group (all P<0.05). The mRNA expressions of Bcl-2 in Jiangu tablet high-dose group and middle-dose group were significantly increased than that in T-2 toxin group(all P<0.05). The mRNA expression of Bax in Jiangu tablet high-dose group was significantly decreased than that in T-2 toxin group(P<0.05). Conclusion The Jiangu tablet can significantly inhibit the apoptosis of articular chondrocyte in T-2 toxin poisoning rats.

Objective: To study the expression of Fas, Fas ligand (FasL) and IFN ? in gastric cancer and its possible significance. Methods: Fifty eight gastric paraffin wax embedded cancer tissues and fifty three normal tissues adjacent gastric cancer were tested for the expression of Fas and FasL protein by immunohistochemistry and IFN ? mRNA by in situ hubridisation respectively. Results: The positive rate of Fas in cancer cells of gastric cancer tissues was significantly lower than that in gastric epithelial cells of the tissues adjacent cancer(19.0% and 64.2%, respectively; ? 2=23.46, P = 0.00). The positive rate of FasL in cancer cells of gastric cancer tissues was significantly higher than that in gastric epithelial cells of the tissues adjacent cancer(63.8% and 45.3%,respectively; ? 2=3.83, P =0.05). The positive rate of IFN ? in cancer cells of gastric cancer tissues was significantly lower than that in gastric epithelial cells of the tissues adjacent cancer(0.0% and 49.1%,respectively; ? 2=37.16, P =0.00). Conclusion: The Fas-FasL system was unbalanced, and the expression of IFN ? was low in gastric cancer cells in this study. These may be related to the carcinogenesis of gastric epithelial cells and might be responsible for the immune escape of these cells.

Objective To investigate the relationship between Kashin-Beck Disease(KBD) and Human Parvovirus B19(HPVB19).Methods HPVB19DNA was detected in 55 sera of KBD patients and 52 healthy in adjacent non-endemic area and 35 healthy sera in normal area using PCR and then linked the HPVB19DNA to pGEM-T vector.The nucleotide sequence was analyzed and compared with HPVB19 nucleotide sequence published by Genebank and another in Journal of virology.Results HPVB19DNA was found in 16 of 55 sera in KBD patients,and the HPVB19DNA position rate(29.09%) is significantly higher than that of the two healthy control groups(11.54%、11.42% respectively)(P＜0.05).The nucleotide sequence homologies compared with the two published nucleotide sequence were 97.75%、97%,respectively.The putative amino acid homologies compared with the tow published were 93.5%.The amino acid variation was greater than the nucleotide sequence variation because of a base insertion.Conclusion There was a close relationship between HPVB19 infection and Kashin-Beck Disease.

Objective To investigate the relationship between erythrocyte immune function and selenium (Se)level. Methods Forty-nine Kashin-Beck patients in endemic area aged 13- 16 years were divided into two groups and were orally given either selenized yeast or sodium selenite to provide 200 μg selenium per day for 12 weeks. Erythrocyte selenium level, glutathione peroxidase activity, the rosette formation rates of red blood cells complement receptor type Ⅰ(CR1), the immune function of red blood cells, and circulating immune complexes(CIC) were determined. Results After supplementing with selenium for 12 weeks, erythrocyte selenium level, glutathione peroxidase activity, the rosette formation rates of red blood cells CR1 were significantly increased. But the difference in rosette formation rates of IC and CIC content was not significant between before and after Se supplementation. Conclusion The increase of the immune function of the erythrocyte by selenium-supplement may be one of the effective mechanisms for the prevention of Kashin-Beck disease.

Objective To investigate the expressions of matrix metalloproteinases(MMPs) in Kashin-Beck disease(KBD) cartilage as well as in a KBD rat model of T-2 toxin poisoning under selenium deficient conditions, and to investigate the effect of T-2 toxin on MMP-13 expression in human chondrocytes in vitro in order to determine a possible mechanism underlying KBD. Methods Samples of articular cartilage were divided into 2 groups:controls(samples from 5 normal children, traffic accident or operation), and KBD(samples from 5 children with KBD, auctopsy). Thirty-two Sprague-Dawley rats were divided into two groups by body weight using random number table: normal diet group(n = 16) and selenium-deficient diet group(n=16). The selenium level in normal diet was 101.500μg/kg, and in selenium-deficient diet was 1.118μg/kg. Rats were fed for 4 weeks with selenium-deficient or normal diet, respectively. After successful build up of the low selenium rat model, normal diet group was then subdivided into 2 sub-groups: normal group(n = 8) and normal diet plus low T-2 toxin group(n = 8);and selenium-deficient diet group was also subdivided into 2 sub-groups: selenium-deficient group ( n = 8 ) and selenium-deficient diet plus T-2 toxin group ( n = 8 ) . T-2 toxin of 100 μg·kg-1·d-1 was administered by intragastric administration for 30 days. Then the rats were sacrificed, and their knee joints were processed for histopathological evaluation. MMP-1 and MMP-13 locations in cartilages were performed by inmmunohistochemistry. Human chondrocytes C28/I2 were cultured in vitro. The experiment was divided into 4 groups: empty vector plasmid group, MMP-13 promoter plasmid group, MMP-13 promoter plasmid plus 20 μg/L T-2 toxin group and MMP-13 promoter plasmid plus 40 μg/L T-2 toxin group. MMP-13-luciferase reporter plasmid and vector plasmid were transiently transfected into C28/I2 cells for 24 hours, and then treated with 20 - 40 μg/L T-2 toxin for 24 hours. Transactivation of human MMP-13 promoter was analyzed using luciferase reporter constructs containing sequences spanning-1602 to+20 bp in C28/I2 chondrocytes. Results The percentages of chondrocytes staining for MMP-1 in the superficial and middle zones of KBD samples [(29.73 ± 10.12)%, (28.27 ± 0.91)%] were significantly higher than those of controls[(2.47 ± 0.11)%, (0.00 ± 0.00)%, all P < 0.05]. The percentages of chondrocytes staining for MMP-13 in the superficial and middle zones of KBD samples [(13.21 ± 4.32)%, (41.85 ± 6.32)%] were significantly higher than those of controls[(5.72 ± 0.31)%, (0.00 ± 0.00)%, all P<0.05]. The percentages of chondrocytes staining for MMP-13 in the superficial and middle zones of rats fed with selenium-deficient diet plus T-2 toxin group[(13.21 ± 4.32)%, (61.85 ± 8.68)%] were significantly higher than those of the normal and selenium-deficient groups[(2.43 ± 0.22)%, (5.89 ± 0.69)%, (3.03 ± 0.29)%, (25.99 ± 0.57)%, all P < 0.05]. Moreover, T-2 toxin activated the MMP-13 promoter detected with luciferase reporter assays in C28/I2 cells. The luciferase activities in MMP-13 promoter plasmid plus 20 μg/L T-2 toxin group and MMP-13 promoter plasmid plus 40μg/L T-2 toxin group(0.082 78 ± 0.008 40, 0.103 35 ± 0.013 19) were significantly higher than those in empty vector plasmid group and MMP-13 promoter plasmid group(0.024 19 ± 0.000 96, 0.040 32 ± 0.003 56, all P < 0.05). Conclusions These data suggest that T-2 toxin induces cartilage matrix degradation through up-regulation of MMP-13 promoter expression. Increased MMPs staining intensity in KBD cartilage and the rat KBD model of T-2 toxin poisoning under selenium deficient conditions suggest that matrix degradation appear to be driven by MMPs activity.