Objective To observe the effect of high flux hemodialysis (HFHD) combined with artificial kidney on fibroblast growth factor-23 (FGF-23) in patients with maintenance hemodialysis (MHD). Methods Eighty cases who regularly carried out long-term HFHD in nephrology blood purification center of NO.85 Hospital of PLA were enrolled. All the patients firstly received HFHD alone for 1 month, and then according to random principle, they could receive HFHD followed by hemoperfusion (HP) for treatment (HFHD+HP group) or HP followed by HFHD for treatment (HP+HFHD group). These two types of treatment were respectively carried out for 3 months, and then exchanged to proceed the procedure, the interval of exchange being 1 month (in this month, the two groups of patients all underwent simple HFHD treatment). The therapeutic course was 8 months including 2 cycles. The serum samples were taken from patients undergoing simple HFHD before and after the first month of blood purification, and patients in HFHD+HP group and HP+HFHD group before and after the last month for determination of serum creatinine (SCr), calcium, phosphorus, parathyroid hormone (iPTH), FGF-23 levels. Results The SCr level in HFHD + HP group before hemodialysis was significantly lower than that in simple HFHD group (μmol/L:773.45±212.23 vs. 803.27±192.47, P<0.05), there were no significant differences in blood calcium and phosphorus before hemodialysis between HFHD+HP group and HP+HFHD group (all P>0.05). After hemodialysis, the serum iPTH, FGF-23 were dropped significantly in HFHD + HP and HP + HFHD groups compared with those in simple HFHD group (P < 0.05 or P < 0.01). After hemodialysis, there were no statistically significant differences in SCr and calcium levels between the above two groups (both P>0.05). But the levels of serum phosphorus, iPTH, and FGF-23 in HFHD+HP group were significantly lower than those of HP+HFHD group [serum phosphorus (mmol/L):1.47±0.22 vs. 1.60±0.23, iPTH (μg/L):490.12±145.23 vs. 516.34±165.75, FGF-23 (μg/L): 802.11±92.58 vs. 822.39±107.23, P < 0.05 or P < 0.01]. Conclusions In the aspect of elimination of large and medium sized molecules, the effect of combined artificial kidney is much better than that of simple HFHD. The rates of toxin elimination in different types of combined artificial kidney treatment are different, and the HFHD+HP type has greater effect than HP+HFHD type on elimination of toxins with large or medium sized molecules such as iPTH, FGF-23, etc.

Objective To investigate the diagnostic values of ultrasound in rheumatoid knee arthritis and the clinical significance of ultrasonic scoring system.Methods From July 2013 to December 2015,500 cases of patients with rheumatoid knee arthritis in two grade A class 3 hospitals of Lishui City were collected as the observation group and contemporaneous 500 healthy adults were collected as the control group.The knee joint synovial thickness,vascular detection rate in hyperplasia synovium,ultrasound score,rheumatoid arthritis disease activity score,erythrocyte sedimentation rate (ESR),C reactive protein (CRP),suprapatellar bursa effusion,infrapatellar bursa effusion,joint effusion,knee joint cartilage and bone surface were observed in the two groups.Results Compared with the control group,the observation group got a significant increase in knee joint synovial thickness [(0.50±0.19)cm vs.(0.13±0.05) cm,P=0.000)];depth of suprapatellar bursa fluid [(0.62±0.27)cm vs.(0.23±0.05) cm,P=0.000];depth of infrapatellar bursa fluid [(0.58±0.12)cm vs.(0.21±0.04) cm,P=0.000];joint fluid depth [(0.48±0.28)cm vs.(0.12±0.08) cm,P=0.000];ESR [(43.29±12.58)mm/h vs.(12.95±4.39) mm/h,P=0.000)];CRP level [(8.95±3.29)mg/L vs.(3.29±1.54) mg/L,P=0.000)];vascular detection rate in hyperplasia synovium (84.20% vs.13.00%,P=0.000).Moreover the ultrasound score was positively corrected with rheumatoid arthritis disease activity score,CRP level,ESR,suprapatellar bursa fluid depth,infrapatellar bursa fluid depth and joint fluid depth in the patients with rheumatoid arthritis (r=0.583,0.258,0.383,0.219,0.228,0.248;P<0.05).Conclusion Ultrasound has good diagnostic value in the patients with rheumatoid arthritis,and the ultrasonic scoring system can better reflect the severity of the disease.

OBJECTIVE:To investigate the effects of salvianolate combined with bezafibrate on clinical efficacy,inflamma-tory factors and ventricular function of patients with ischemic cardiomyopathy,and the safety. METHODS:A total of 138 pa-tients with ischemic cardiomyopathy selected from our hospital during Mar. 2015-Mar. 2016 were randomly divided into observa-tion group and control group according to random number table,with 69 cases in each group. Control group was given Bezafi-brate dispersible tablets 0.2 g,po,tid. Observation group was additionally given Salvianolate for injection 200 mg added into 0.9% Sodium chloride injection 250 mL,ivgtt,qd,on the basis of control group. A treatment course lasted for 14 d,and both groups received 2 courses of treatment. Clinical efficacies,the levels of serum inflammatory factors (CRP,TNF-α,IL-6, MMP-9,MCP-1),ventricular function parameters(LVESD,LVEDD,LVEF)were compared between 2 group. The occurrence of ADR was recorded. RESULTS:Total response rate of observation group(97.10%)was significantly higher than that of con-trol group(86.96%),with statistical significance(P<0.05). Before treatment,there was no statistical significance in serum lev-els of CRP,TNF-α,IL-6,MMP-9,MCP-1,LVESD,LVEDD and LVEF between 2 groups(P>0.05). After treatment,the lev-els of CRP,TNF-α,IL-6,MMP-9,MCP-1,LVESD and LVEDD in 2 groups were decreased significantly,while LVEF level was decreased significantly;the improvement of observation group was more significant than that of control group,with statisti-cal significance (P<0.05). No serious ADR was found in 2 groups during treatment. CONCLUSIONS:Salvianolate combined with bezafibrate have significant therapeutic efficacy for ischemic cardiomyopathy,reduce serum inflammatory factor level and improve ventricular function with good safety.

Objective To investigate the improving effects of Shenshao decoction on myocardial structure and function in diabetic cardiomyopathy,and its effect on expression of TLR4/MyD88-dependent pathway signal in diabetic cardiomyopathy.Methods Diabetes mellitus was induced in 8-week-old male Wistar rats by a single intraperitoneal injection of streptozotocin.The changes of plasma myocardial enzyme (CK, LDH) and high sensitive C reactive protein (hsCRP) were measured.Cardiac function was measured by left ventricular intubation.Hematoxylin and eosin staining and electron microscopy were used to observe the changes of myocardial morphology and ultrastructure in rats.Expression of Toll-like receptor 4(TLR4), myeloid differentiation protein 88(MyD88), and nuclear factor-κB P65(NF-κB P65) were tested by immunohistochemistry.Results After 6 weeks of treatment, the left ventricular diastolic and systolic functions were obviously improved;the degrees of myocardial fibers and mitochondrial damage were obviously relieved;the content of CK, LDH and hsCRP decreased (P< 0.05), and hsCPR was positively correlated with CK and LDH (r=0.823,r=0.819,P < 0.05).The expressions of TLR4, MyD88, NF-κB P65 were significantly decreased (P< 0.05).There was no significant difference in the above mentioned indicators between the control group and control+Shenshao decoction group (P> 0.05).Conclusions Shenshao decoction can reduce the myocardial injury in diabetic cardiomyopathy and improve cardiac diastolic and systolic functions.The mechanism may be related to attenuated inflammation by TLR4/MyD88 dependent signaling pathway.

Objective To evaluate the efficacy and safety of ultrasound elastography in the diagnosis of pros-tate cancer.Methods 83 patients with prostate cancer were selected and diagnosed by transrectal ultrasound elastog-raphy (TRTE)and transrectal ultrasound(TRUS).The surgical pathology of the patients was used as diagnosis basis, and the efficacy of the two methods was evaluated.Results There were 102 nodules of all the 83 patients,44 patients'surgical pathology were benign,a total of 49 nodules,39 cases were vicious,a total of 53 nodules.47 nodules were gland nodules,accounting for 46.08% and 55 nodules were outer gland nodules,accounting for 53.92% of all the 102 nodules.There were 54 focis,the TRTE detected 36 focis,the detection rate was 66.67%,and TRUS detected 24 focis,the detection rate was 44.44%.The sensitivity,specificity and accuracy rates of TRTE were 66.67%, 68.65% and 67.64%,which were higher than 44.44%,64.58% and 53.92% of TRUS,and the differences were statistically significant (χ2 =10.710,P <0.05;χ2 =3.879,P <0.05;χ2 =4.084,P <0.05).The differences of pathological findings and TRTE,TRUS findings of the benign and malignant prostate nodules were not statistically significant (P >0.05 ).Conclusion It has higher diagnostic sensitivity,specificity and diagnostic accuracy for ultrasound elastography in the diagnosis of prostate cancer,which can improve the clinical diagnostic performance and worthy of clinical application.

Objective To explore colloidal gold method used to detect fecal occult blood tests(FOB)detection capability and establish the laboratory standard operation of detecting FOB limit of blank(LOB),limit of detection (LOD)and quantifica-tion limit (LOQ)according to the CLSI document《Evaluation of Detection Capability for Clinical Laboratory Measurement Procedures;Approved Guideline-Second Edition》(EP17-A2),in order to reduce the false negative rate of the weakly positive samples,and to provide a way of quantitative detection for qualitative detection of colloidal gold method.Methods Detected series of solution of hemoglobin made of dissolved fresh whole blood with the ELISA kit of human free hemoglobin,and es-tablished the standard curve of detection of FOB with colloidal gold method.Detected the blank samples and a series of low concentration samples with the colloidal gold test strip of FOB and measured the color bands by the Nato Checker710.The quantitative results obtained were statistically analysised by SPSS 1 9.0 and calculated blank limit,detection limit and quanti-fication limit.Results The LOB,LOD and LOD were 99.01,340.48 and 354.9 ng/ml according to the methods in CLSI EP1 7-A2 ducument.Conclusion The detection limits established by CLSI EP1 7-A2 document was more scientific in j udge-ment positive or negative to FOB than which used naked eye and can meet the clinical laboratory and clinical doctor require-ment better.Clinical laboratories should be strictly in detection limits of reagents in order to ensure their effectiveness,and should be generaly to other tests based on colloidal gold method.

Objective To systematically evaluate the safety of high dose atorvastatin (80 mg daily) in Chinese patients. Methods Randomized controlled trials (RCTs) investigating 80 mg/ d atorvastatin vs. low-dose atorvastatin or placebo or blank were electionically retrieved in date bases of EMbase, PubMed, the Cochrane Library, WanFang, CNKI and WeiPu. Meta-analysis was performed using RevMan 5. 2 and Stata 11. 0 software. Results A total of 20 RCTs involving 2282 cases were included. The results of meta-analysis showed no significant differences betweent the 80 mg/ d atorvastatin group and the control group in the incidence of gastrointestinal adverse events (RR 1. 53, 95% CI 0. 85-2. 76, P = 0. 16), hepatic adverse events (RR 1. 53, 95% CI 0. 99 - 2. 36, P = 0. 05), muscular adverse events (RR 1. 51, 95% CI 0. 92 -2. 49, P = 0. 10), serious hepatic injuries ( RR 2. 33,95% CI 0. 88 - 6. 20, P = 0. 09) and serious muscular myopathies (RR 1. 40, 95% CI 0. 46 - 4. 30, P = 0. 56). Subgroup analysis by type of cotrast media used and durations of taking 80 mg/ d atorvastatin showed there were higher risks of gastrointestinal adverse events in the 80 mg/ d group when compared to blank control ( RR 4. 22, 95% CI 1. 11 - 16. 04, P = 0. 03). Conclusions The current evidence shows that 80 mg / d atorvastatin may be relatively safe in terms of adverse events in gastrointestinal tract, liver and muscular system, and relatively has risk in causing severe liver injuries and myopathies. With limited quantity and quality from the RCTs available, more high quality RCTs are needed to verify the above conclusion.

Objective To explore the impact of high‐load atorvastatin on T cell subsets in patients with unstable angina (UA) after percutaneous coronary intervention (PCI) .Methods One hundred and eighty patients with UA were randomly divided into high‐load atorvastatin group ,ordinary‐load atorvastatin group and routine group ,60 cases in each group .The ratios of CD4+ T cell , CD8+ T cell and the frequencies of CD4+ CD25+ Treg were detected in 3 groups 1 day before PCI and 1 week ,1 month and 6 months after PCI by flow cytometry analysis .Results Different doses of atorvastatin reduced the ratio of CD4+ T cells and in‐creased the ratio of CD8+ T cells and also the frequencies of CD4+ CD25+ Treg after PCI for 1 week ,1 month and 6 months .The longer the time to take atorvastatin ,the more obvious the effect was(P<0 .05) .The ratios of CD4+ ,CD8+ T cells and the frequen‐cies of CD4+CD25+ Treg after PCI for 1 month and 6 months in high‐load atorvastatin showed significant difference compared with those in ordinary‐load atorvastatin group and routine group(P<0 .05) .Conclusion Atorvastatin could regulate the balance of T cell subsets in patients with UA ,and thus it may reduce the UA onset and the treatment effect of high‐load atorvastatin is more sig‐nificant .

OBJECTIVETo evaluate the therapeutic effect of pedicled muscular flaps combined with partial thoracotomy for treatment of pythorax-resulted wounds and defects.

METHODS35 cases with pythorax-resulted refractory infected wound and dead space, were retrospectively analyzed. The wound and dead space were eliminated with pedicled muscular flaps, including latissimus dorsi muscular flaps and serratus anterior muscle flaps in 21 patients, pectoralis major muscle flaps with rectus muscle flaps in 8 patients, latissimus dorsi muscul flaps and vertical rectus muscle flaps in other 6 patients.

RESULTS34 flaps survived completely except for 1 verticle rectus muscular flap with partial necrosis at distal end. Primary healing was achieved in 29 cases. The other 6 cases were discharged with drainage. Among the 6 cases, 3 cases healed spontaneously, 2 cases underwent reoperation, 1 case need long-term drainage in the fistula.

CONCLUSIONPedicled muscular flap, combined with partial thoracotomy can effectively treat refractory wound and dead space resulted by pythorax.

Combined Modality Therapy ; methods ; Empyema, Pleural ; surgery ; Humans ; Myocutaneous Flap ; transplantation ; Pectoralis Muscles ; transplantation ; Reoperation ; Retrospective Studies ; Superficial Back Muscles ; transplantation ; Thoracotomy ; methods ; Wound Healing

Objective To compare the initial detection rate and the accuracy of qualitative diagnosis of multislice spiral computed tomography (MSCT),gastrointestinal tract radiography,gastroscopy,and endoscopic ultrasonography in the diagnosis of gastric lipoma,with a focus on evaluating the diagnostic value of MSCT.Methods Twenty-six patients with gastric lipoma,6 males and 20 females with a mean age of 61 years (ranging from 41 to 82 years) and confirmed by pathology,were enrolled in the present study.Their clinical,pathologic and imaging findings were retrospectively analyzed.All the patients underwent gastroscopy,and plain and dynamic enhanced MDCT scans.Of them 21 cases underwent endoscopic ultrasonography and 12 cases gastrointestinal tract radiography.Results The detection rate was 88.5％(23/26) and 80.8％(21/26),P＞0.05 for MSCT and gastroscopy,respectively,in the initial diagnosis of gastric lipomas,both higher than that of gastrointestinal tract radiography (41.7％,5/12).The accuracy of qualitative diagnosis of MSCT (100％,23/23) was higher than that of endoscopic ultrasonography (71.4％,15/21),gastrointestinal tract radiography (0％,0/5) and gastroscopy (0％,0/21).The lesions located at the gastric antrum in 18 cases (69.2％,including 10 front wall,6 posterior wall and 2 pyloric canal),the gastric body in 7 cases (26.9％) and the gastric fundus in 1 case (3.8％).All the lipomas presented as round or ovoid nodule with clear boundary on MSCT images,and homogeneous or mixed low density.The CT values,long dimensions and volumes ranged from-50 to-95Hu (mean-72.58Hu),5.7 to 40.7mm (mean 17.67mm) and 0.02 to 7.03cm3 (mean 1.89cm3),respectively.Contrast-enhanced CT scans showed no enhancement in all the lesions.Conclusion MSCT can make accurate locating and qualitative diagnosis for gastric lipomas.