Pathogenesis and staging treatment for non-specific low back pain based on the meridian sinew theory / 中国针灸

Based on the physiological and pathological characteristics of meridian sinew theory, the staging treatment of non-specific low back pain (NLBP) is explored to provide the reference of clinical practice. The twelve meridian sinews of the human body communicate with the bones and joints of the whole body, which governs the movement, body protection and defense, and meridian regulation. Physiologically, the meridian sinew maintains the functions of the lumbar region. In pathology, the meridian sinew may encounter stasis and pain, contraction and spasm or "transverse collateral" formation. According to the pathological staging of meridian sinew disorders, the progress of NLBP is divided into 3 phases and the corresponding treatments are provided. Mild stimulation and rapid analgesia is suggested to promote tissue repair at the early phase; muscle spasm is relieved to adjust muscular status at the middle phase; and the "cord-like" muscle foci is removed at the later phase of the disease.

A familial case of Blau syndrome caused by dual NOD2 genetic mutations / 中华实用儿科临床杂志

Objective To provide the diagnostic proof for a suspected Chinese family with BS,and NOD2 gene mutation types and clinical features were analyzed in this study.Methods Nine members (4 males and 5 females) of this family were enrolled.To clarify the genotype,the whole exome sequencing by next-generation sequencing from the proband and his parents was performed,and all members were subjected to Sanger sequencing.For the newly discovered NOD2 missense mutation,its pathological predictions were conducted online by adopting polyphen software.Clinical data of affected cases diagnosed by NOD2 analysis were collected to analyze illustrate the clinical features.Results (1)The proband of the family was a 5-year-old Chinese Han boy,who had the clinical triad of dermatitis,polyarthritis and uveitis.The body temperature and C-reactive protein (CRP) was normal.Besides the proband,2 members were diagnosed as BS by means of NOD2 analysis.The coexistence of 2 missense mutations was detected.One novel mutation was c.1981G ＞ C,p.A661 P,and another previously reported one was c.2006A ＞ G,p.H669A.(2) Mutations identified in the male proband were inherited from his father.Tracing the other pedigree members,it was disclosed that his grandmother had the heterozygous dual NOD2 mutations.The proband displayed a phenotype featuring the symptom triad of granulomatous dermatitis,symmetric arthritis,and recurrent uveitis,with normal temperature and CRP level.Conclusions The coexistence of A661P and H669A mutations in NOD2 caused BS in a Chinese pedigree,which derived from the proband's grandmother.This is the first report of A661P mutation in NOD2 in a Chinese pedigree of this disease.The proband has multi hydatoncus surrounding multi-joints,but no persistent fever and no elevated CRP,which may help to differentiate BS from other inherited autoinllammatory diseases in clinical settings.

Roles of CD4 + CD25 + regulatory T cells and T helper 17 cells in the pathogenesis of Kawasaki disease / 中华实用儿科临床杂志

Objective To observe the changes in CD4 + CD25 + regulatory T cells(Treg) and T helper 17 cells (Th17) cells' proportions in the peripheral blood in children with Kawasaki disease(KD) before and after the treatment,and to analyze the role of Treg/Th17 cell imbalance in the pathogenesis of KD.Methods Fifty-two children with acute KD(KD group) and 34 age-matched healthy children(healthy control group) were selected at Jiangxi Provincial Children's Hospital from April to December of 2014.Morning peripheral vein blood was collected from 2 groups:one before the treatment by Immunoglobulin and Aspirin,and the other 3 days after defervescence treatment.Flow cytometry was used to detect proportions of Treg cells and Th17 cells in the peripheral blood.The enzyme linked immunosorbent assay was used to detect the levels of interleukin(IL)-6,IL-10,IL-17,IL-23 and transforming growth factor(TGF)-β.Results Proportion of Treg cells in the acute KD group was remarkably lower than that in the healthy control group [(1.48 ± 0.21) ％ vs.(5.13-± 0.32) ％,t =28.41,P ＜ 0.05],but it was significantly increased after treatment,and there was a significant difference [(4.71 ± 0.36) ％ vs.(1.48 ± 0.21) ％,t =-23.32,P ＜ 0.05].Proportion of Th17 cells in the acute KD group was markedly higher than that in the healthy control group [(8.06 ± 0.48) ％ vs.(2.65 ± 0.50) ％,t =-23.47,P ＜ 0.05],which was significantly decreased after treatment [(3.04 ±0.35) ％ vs.(8.06 ± 0.48) ％,t =25.55,P ＜ 0.05].Compared with the healthy control group,the levels of serum IL-6,IL-17,IL-23 in the acute KD group were significantly increased before treatment,and there were significant differences [(34.53 ± 0.53) ng/L vs.(10.88 ± 0.83) ng/L,t =-72.36;(57.05 ± 0.78) ng/L vs.(14.29 ± 0.98)ng/L,t =-55.29;(45.18 ± 1.52) ng/L vs.(18.25 ± 1.08) ng/L,t =-43.27;all P ＜ 0.05],but after treatment the levels were significantly decreased [(14.94 ± 1.06) ng/L vs.(34.53 ± 0.53) ng/L,t =49.63;(27.64 ± 0.91)ng/Lvs.(57.05±0.78) ng/L,t =26.49;(24.50-±1.13) ng/L vs.(45.18-±1.52) ng/L,t =32.17;allP＜0.05].The levels of serum IL-10,TGF-β in the acute KD group significantly decreased than those of the healthy control group,and there were significant differences [(14.29-± 0.64) ng/L vs.(29.57 ± 0.87) ng/L,t =42.24;(16.88 ±-0.90) ng/L vs.(38.83 ±0.84) ng/L,t =53.51;all P ＜0.05],but after treatment the levels were significantly increased,and there were significant differences [(23.01-± 0.61) ng/L vs.(14.29-± 0.64) ng/L,t =-29.54;(33.47±-0.82) ng/Lvs.(16.88±-0.90) ng/L,t=-40.68;allP＜0.05].Conclusion Imbalance betweenTreg cells and Th17 cells may be an important cause for the immune disorder of KD,the changes in related cytokines are involved in the pathogenesis of KD.

Efficacy of Tocilizumab in the treatment of systemic juvenile idiopathic arthritis / 中华实用儿科临床杂志

Objective To explore the efficacy and safety of Tocilizumab in the treatment of systemic juvenile idiopathic arthritis (sJIA)in children.Methods Twenty-four sJIA patients were collected who were hospitalized at the Department of Rheumatology and Immunity,Jiangxi Provincial Children's Hospital from October 2015 to May 2016,and they received Tocilizumab combined with Methotrexate (MTX) treatment for 12 weeks.The clinical laboratory and physiological indices,including routine blood,liver and kidney function tests,number of joints with active arthritis,number of joints with limited range of motion,physicians and patients assessment of disease activity,childhood health questionnaire,erythrocyte sedimentation rate(ESR),C-reactive protein (CRP),and compliance rates of Pediatrics of American College of Rheumatology(ACR Ped) 30,50,70 were observed after 4,8 and 12 weeks of treatment,and the adverse reactions were recorded.Results After 4 weeks of treatment,the levels of white blood cells,platelet,ESR and CRP in 24 cases of sJIA significantly decreased compared with those of the patients before treatment [(15.1 ± 2.7) × 109/L vs.(24.2 ±3.5) × 109/L,(277 ±73) × 109/L vs.(368 ± 62) × 109/L,(25 ± 12) mm/1 h vs.(75 ± 15) mm/1 h,(20 ± 13) mg/L vs.(64 ± 1) mg/L],and the differences were statistically significant (t =10.08,4.65,70.71,26.78,all P ＜0.05);the hemoglobin was increased dramatically[(110 ± 12) g/L vs.(98 ± 10) g/L],and the difference was statistically significant(t =-3.76,P ＜ 0.05).The compliance rates of ACR Ped 30,50,70 after 4 weeks of treatment were 82％,74％,68％,and they were continuously improved after 8 weeks of treatment (90％,82％,78％)and 12 weeks of treatment (98％,93％,92％),and the differences were all statistically significant (F =7.11,7.29,8.86,all P ＜0.05).The levels of IL-6 after 12 weeks of treatment had no significant change compared with those of the patients pre-treatment [(10.8 ±2.5) ng/L vs.(12.7 ±3.0) ng/L,t =1.96,P ＞0.05].Conclusion Tocilizumab is effective and safe in the treatment of sJIA patients,which can improve the symptoms,signs and laboratory inflammatory activity indexes of sJIA in a short time.

Innate immune cell-derived IL-l7 mediating organ ischemia reperfusion injury / 国际儿科学杂志

IL-17,as a pro-inflammatory cytokine,is one of the early initiation factors of the inflammato-ry response induced by T cells.It can induce and regulate multiple immune responses.Recent studies have re-vealed that myeloid neutrophils,macrophage,mast cell and other innate immune cells all can secrete large a-mount of early responding IL-17 in organs suffering ischemia/hypoxia,and in turn can activate,amplify and re-cruit neutrophils to the reperfusion-damaged tissue to release large amount of free radicals and lysozyme that cause IRI.Researchers have also provided evidence that appropriate administration of anti-IL-17 mono-antibody to neutralize IL-17 during early reperfusion stage would reduce the tissue damage.The purpose of this review is to summarize the research progress of the effects of IL-17 produced by innate immunocyte on organ reperfusion injury.

Effect of Qianlean Pill on IL-1β, IL-10, and TNF-α in Prostate Tissues of Chronic Nonbacterial Prostatitis Rats / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of Qianliean Pill (QP) on inflammatory factors such as IL-1β, IL-10, and tumor necrosis factor α (TNF-α) in chronic nonbacterial prostatitis (CNP) model rats, and to explore its therapeutic mechanism.</p><p><b>METHODS</b>CNP rat model was established by castration and estradiol benzoate injection. Totally 50 rats were randomly divided into 5 groups, i.e., the model group, the positive medicine group, the high dose QP group, the medium dose QP group, and the low dose QP group, 10 in each group. Besides, 10 normal rats were recruited as a normal control group. Since the 8th day of castration, Pulean Tablet (PT) at 10. 80 g/kg was administered to rats in the positive medicine group by gastrogavage. QP at 11.00, 5.50, and 2.75 g/kg was administered to rats in high, medium, and low dose QP groups by gastrogavage. Distilled water at 2 mL/100 g was administered to rats in the model group and the normal control group by gastrogavage, once daily for 30 successive days. After 30 days of medication all rats were sacrificed and their prostate tissues were extracted. The prostatic index was calculated. Pathological changes of rat prostate were observed under light microscope. Meanwhile, levels of IL-1β, IL-10, and TNF-α were detected using enzyme linked immunosorbent assay.</p><p><b>RESULTS</b>Compared with the normal control group, the prostate index obviously decreased, levels of IL-1β, TNF-α, and IL-10 in the prostate tissue significantly increased in the model group (P < 0.01). Compared with the model group, the prostate index obviously decreased in high and medium dose QP groups, and the positive medicine group (P < 0.01); levels of IL-1β, TNF-α, and IL-10 obviously decreased in each QP group and the positive medicine group (P < 0.01). Compared with the positive medicine group, the TNF-α level decreased more obviously in the high dose QP group (P < 0.05). Compared with the normal control group, inflammatory reactions occurred obviously in rats' prostate of the model group. Compared with the model group, inflammatory reactions were milder in rats' prostate of each QP group and the positive medicine group, and their degrees were improved to some extent.</p><p><b>CONCLUSION</b>QP could treat CNP, which might be achieved by regulating local immune state of the prostate, relieving inflammatory reactions of the prostate, and lowering levels of IL-β, TNF-α, and IL-10 in the prostate tissue.</p>

The clinical significance of nuclear factor-κB activation in peripheral blood mononuclear cells, serum level of interleukin-17 and serum levels of other correlated inflammatory cytokines in infant muggy syndrome / 中国小儿急救医学

Objective To investigate the clinical significance of nuclear factor ( NF)-κB activation in peripheral blood mononuclear cells (PBMCs) and the serum levels of correlated inflammatory cytokines in children with infant muggy syndrome(IMS).Methods Blood samples from 100 patients with IMS and those from 32 healthy infants( control group)were detected by ELISA for amount of NF-κB activation in PBMCs and for serum levels of interleukin ( IL ) -17,IL-6,tumor necrosis factor ( TNF ) -α and IL- 10 respectively from Jan 2008 to Jan 2011.At the same time,blood samples from 46 out of the above 100 patients with IMS and those from the 32 controls for positive rate of activation of NF-κB in PBMCs were detected by flow cytometry as well.The relationship between all the data and multiple organ dysfunction syndrome( MODS ) were analyzed respectively.Results As compared with that of control group,the percentage of activated NF-κB in PBMCs in 100 patients with IMS detected by ELISA [ ( 11.042 ± 6.792 ) ％ vs ( 4.528 ± 1.378 ) ％ ] and the positive rate of NF-κB activation in 46 patients with IMS detected by flow cytometry [ ( 28.780 ± 13.820 ) ％ vs (7.078 ±5.395)％ ] were both significantly higher ( P ＜0.01 ).The serum levels of IL-17,IL-6 and IL-10were also significantly higher in patients with IMS than those in control group( P ＜0.01 ).The serum level of TNF-α was higher in patients with IMS than that in control group but without significance( P ＞ 0.05 ).The percentage of activated NF-κB [ ( 14.591 ± 7.626) ％ vs ( 8.576 ± 4.851 ) ％ ],the positive rate of NF-κB activation [ ( 36.087 ± 12.056) ％ vs ( 23.590 ± 11.263 ) ％ ],and the serum levels of IL- 17,IL-6,TNF-α and IL-10 were all significantly higher in IMS patients with MODS than those in IMS patients without MODS ( P ＜ 0.01 ).Conclusion The inflammatory factors of NF-κB activation in PBMCs and the high serum levels of IL-17 and IL-6 are potent to cause inflammatory damage in IMS patients,and the serum level of IL-10 is not able to compensate the damage.The activation of NF-κB and high serum levels of IL-17,IL-6 and TNF-α are correlated with MODS.

Telomerase Expression in Peripheral Blood Mononuclear Cells in Children with Acute Kawasaki Disease / 实用儿科临床杂志

Objective To study the telomerase expression in peripheral blood mononuclear cells(PBMCs) in children with acute Kawasaki disease(KD) and its clinical significance.Methods The PBMCs of 64 children with acute KD [25 cases of them with coronary artery lesions(CAL),while the rest without] from 2 months to 6 years old admitted into Jiangxi Children's Hospital from Mar.2005 to Dec.2008 and those of 52 sex-age-matched healthy children (healthy control group) from 5 months to 7 years old were all assayed by Roche telomerase polymerase chain reaction enzymelinked immunosorbent assay(PCR ELISA).WBC,ESR and CRP were also detected.SPSS 11.0 software was used to analyze the data.Results The telomerase expression frequency of PBMCs in children with KD was 32.8%(21/64 cases),while that in healthy control group was only 15.4%(8/52 cases),the difference between the 2 groups was significant (?2= 4.65,P0.05).There were no significant difference of WBC,ESR and CRP between the telomerase of PBMCs positive group and negative group.Conclusions The higher frequency of telomerase expression in peripheral blood lymphocytes might be related to the development and progression of KD.

Nuclear Factor-?B Activation in Peripheral Blood Mononuclear Cells during Acute Kawasaki Disease / 实用儿科临床杂志

Objective To explore the significance of nuclear factor-?B(NF-?B)activation in peripheral blood mononuclear cells(PBMC)during acute Kawasaki disease(KD).Methods Peripheral blood was collected from children with acute KD(n=30)and healthy age-matched children(n=20).PBMC were cultured in vitro and divided into 3 groups:naturally cultured blank control group,protein kinase C(PKC)activator stimulated phorbol 12-myristate 13-acetate(PMA)group and PMA plus NF-?B inhibitor treated PMA plus pyrrolidine dithiocarbamate(PDTC)group.Percentages of NF-?B activation were detected by immunohistochemistry.Results Under natural culturing,the percentage of cells with activated NF-?B was significantly higher in acute KD blank control group than that in healthy blank control group.The percentage of cells with activated NF-?B was significantly higher in acute KD PMA group than that in acute KD blank group and that in normal control PMA group,respectively(Pa0.05).Conclusions NF-?B activation in PBMC during acute KD is markedly increased,which suggests that NF-?B activation plays an important role in the formation of vasulitis and CAL in this disease.NF-?B activation in PBMCs in children with KD is regulated by the PKC signaling pathway and PDTC obviously inhibits the activation of NF-?B.J Appl Clin Pediatr,2009,24(1):35-37