Objective To investigate the clinical effect of methotrexate combined with leflunomide in the treatment of patients with rheumatoid arthritis.Methods 660 patients with rheumatoid arthritis were selected,they were divided into research group and the control group according to the random number method,with 330 cases in each group.The control group was treated with methotrexate alone,while the research group was treated with leflunomide and methotrexate.The clinical effect and adverse reaction of the two groups were compared after 6 months.Results Compared with before treatment,the pain index[(1 .43 ±0.32)vs.(1 .83 ±0.52)],time of morning stiffness [(0.77 ±0.5)h vs.(1 .1 8 ±0.44)h],grip strength[(1 58.65 ±53.45)mmHg vs.(1 33.29 ±44.1 2)mmHg], swelling[(6.81 ±2.32)vs.(9.32 ±2.43)]and the swelling index[(1 .54 ±0.26)vs.(1 .70 ±0.33)]in the two groups after treatment were improved significantly,and the differences were statistically significant(t =3.84,5.24, 3.54,4.05,6.95,4.33,5.22,3.69,2.98,5.64,all P <0.05).And the indices of the research group were significantly better than the control group after treatment,the differences were statistically significant(t =2.36,2.68,3.02,3.22, 2.87,all P <0.05).ESR[(38.56 ±23.67)mm/h vs.(56.78 ±23.45)mm/h],C -reactive protein[(1 2.98 ± 11.89)mg/L vs.(21 .68 ±9.57)mg/L]and rheumatoid factor[(85.67 ±31 .98)IU /mL vs.(1 32.68 ±96.36)IU /mL] of the two groups after treatment were significantly lower than before treatment,in which the indices of the research group were significantly lower than the control group,and the differences were statistically significant(t =3.65,3.02, 4.22,all P <0.05).The disease activities of the research group(32.73%,58.1 8%,83.03%)were significantly better than those of the control group(7.27%,23.64%,34.85%)at 1 ,6,1 2 weeks after treatment,the differences were statistically significant(χ2 =6.35,4.85,5.02,all P <0.05).In addition,the degree of reduction of joint swelling in the research group at three time points was better than the control group,and the differences were statistically significant(all P <0.05 ).The total effective rate of the research group(98.1 8%)was significantly higher than 81 .82% of the control group,the difference was statistically significant(χ2 =8.1 8,P <0.01 ).The adverse reactions such as itching,rash and gastrointestinal discomfort occurred in the two groups,which did no affect the treatment,and no other serious adverse reactions.There was no significant difference in the incidence of adverse reactions between the two groups(χ2 =1 .29,P >0.05).Conclusion Methotrexate combined with leflunomide has good effect in the treatment of patients with rheumatoid arthritis,which can significantly improve clinical symptoms,as well as effectively reduce the related indicators of rheumatoid arthritis in active phase,with good safety,it is worth promoting.

Objective To analyze the MRI features of intracranial ectopic germinomas compared with pathologic findings.Methods MRI manifestations of intracranial ectopic germinomas in 24 cases verified by operation and pathology were retrospectively analyzed.Results Tumors were located at suprasellar region in 5 cases,basal nucleus region in 6 cases,round lateral ventriculus in 2 cases,pellucid septum and lateral ventriculus in 1 case,3 cases suprasellar and pineal region in 3 cases,basal nucleus and pineal region in 3 cases,pineal region and round lateral ventriculus in 2 cases,lateral ventriculus,and third ventricles as well as pineal region in 2 cases.Lesions were showed marked enhancement in 22 cases and 10 cases had cystic degeneration on MRI.Pathologically,18 of 24 cases were seen clear border,cystic degeneration 11 cases,hemorrhage 2 cases and calcification 2 cases.Conclusion Intracranial ectopic germinomas are common in male children and are of MR characteristics,its MRI findings are correlated with pathology.

Objective To investigate the security characteristics of rural young boarding pupils and its influencing factors.Methods 210 boarding and 265 non-boarding rural young pupils of Huojia in Henan were tested by questionnaires,including of a self-developed questionnaire,security questionnaire and adolescent mental resilience scale.Results ①The scores of the interpersonal security (25.99 ± 5.53),the determine control sense factor (24.63 ±6.17) and the total security(50.62 ± 10.37) in the boarding pupils were statistically lower than non-boarding pupils (27.36 ± 6.38,26.00 ± 6.55,53.36 ± 11.77,P ＜0.05).②There were statistically significant difference in the scores of the interpersonal security,the determine control sense factor and the total security among the different grades(P＜0.05),but there were no statistically sex difference in the scores(P ＞ 0.05).③Group regression analysis showed that,no family factors in the young boarding pupils had influence on the score of the security sense factors and the total (P＞0.05),and marital relationship of parents,only child,father' s and mother(')s education background of non-boarding pupils had certain influence on the score of the interpersonal security,the determine control sense factor and the total security (β =-0.43-0.27,P＜ 0.05).④The group regression analysis showed that,the problem solving and self-efficacy,parents'high expectations in mental toughness respectively had some effect on the interpersonal security of boarding and non-boarding pupils(β =-0.15,β =0.25,P＜0.05),and social ability and family care,schools resilience respectively had influence on the determine control sense in boarding and non-boarding pupils (β =-2.91-2.87,P＜0.05),and social ability,parents'high expectations respectively had influence on the total security in boarding and non-boarding pupils (β =-0.17,β=0.22,P＜0.05).Conclusion The security-sense in boarding young pupils are lower than the non-boarding young pupils,and family factors and mental toughness have different effects on security-sense of two kinds pupils.

Objective To analyze current status of research on pulmonary embolism and changes of its knowledge in domestic academic literatures.Methods Totally,2319 domestic papers on pulmonary embolism were collected by computerized retrieval from CHKD system during the period of 1994 to 2006 with a key word of"pulmonary embolism",and were classified and summarized according to their type,contents,author's affiliation.Results Number of papers on pulmonary embolism increased quickly in recent 13 years,especially in the last five years,from 25 papers in 1994 to 430 in 2006.Most of the papers in the early stage were case reports,and the number and proportion of original articles increased obviously after 1997.Contents of the papers were mainly about clinical manifestation and examinations of pulmonary embolism,but papers on its auxiliary examinations,laboratory examinations,clinical nursing care,animal experiments,and so on were all increased.Authors of the papers were from varied departments of hospitals,mainly in the department of internal medicine,especially in the departments of cardiology and respiratory diseases,followed by the divisions of medical imaging,radiation and nuclear medicine.Papers were mainly submitted by authors from affiliated hospitals of medical schools and hospitals at city-level,and papers submitted by gross-roots hospitals such as county hospital and clinic also increased.Conclusion Significant success in diagnosis and treatment of pulmonary embolism has been achieved domestically in recent 13 years,which has been recognized popularly by Chinese physicians.

BACKGROUND:The traditional orthopedic fixation by C-arm positioning surface is completed, but the large C-arm injury on the human body and the long fixed time increase the suffering of patients. OBJECTIVE:To investigate the X-ray fixed in position within the orthopedic implants, navigation and effect. METHODS:Twenty-six New Zealand white rabbits were randomly divided into C-arm machine group and X-ray group, with 13 in each group. Rabbits in both groups were used to simulate soft tissue foreign body localization, intramedul ary nail implantation at distal fracture end and spinal pedicle screw entry point position. In the C-arm machine group, positioning navigation was conducted with C-arm machine. In the X-ray group, X-ray positioning navigation was used. The positioning and navigation effects were compared between the two groups. RESULTS AND CONCLUSION:(1) Compared with the C-arm machine group, the time required for navigation in the X-ray group targeting soft tissue foreign body localization, fracture distal locking intramedul ary nail implantation and pedicle screw spinal needle point location was significantly shorter (P<0.05);navigation displacement and deviation produced were significantly less (P<0.05). (2) These findings suggested that the X-ray positioning for orthopedic fixation method is relatively simple, with high availability, and can obtain a high performance-price ratio. Meanwhile, the X-ray localization can improve accuracy and shorten the fixed time.

Objective To investigate variant types and the image features of MRA of intracranial branch of vertebral artery so that to improve the ability in understanding and diagnosing pons and medulla oblongata diseases.Methods Twenty one cases with the intracranial branch of anomaly vertebral artery were comfirmed by MRA.The anomaly types and MRA features,as well as the clincal symptoms were retrospeetively analyzed.Results MRA features of the intracranial branch of vertebral artery in one sides were as follows:Hypoplasia(n=7),Obliteration of some paragraphes(n=2),Sclerosis or increased tortuous and dilatation(n=9);brain stem compressed by the sclerotic vessel (n=3),angioma(n=3).All paticnts had dysfunction of cranionerves of brain stem in different degree and form.Conclusion MRA was a ideal and no tranmatic method to show the anomaly of the intracranial branch of vertebral artery

Objective To study the expression of copper transport protein 1 in the inner ear of rat and the changes of CTR1 expression after those round window niche copper sulfate and cisplatin infusion .Methods 24 male wistar rats were randomly divided into 4 groups :Group I as the normal control group (nontreatment group);Group II as the round window niche cisplatin infusion group(0 .5 mg/ml);Group III as the round window niche cisplatin infusion group (1 mg/ml);group IV as the round window niche copper sulfate infusion (0 .02 mg/kg) .The CTR1 protein was detected by the immunohistochemical (IHC) otaining and Western-blot ,and the CTR1mRNA expres‐sion levels were detected by RT -PCR .Results The expression of CTR1 protein was observed in the cytoplasm and cell membrane of Corti organ cells ,spiral ganglion cells and stria vascularis in all groups .The average optical densi‐ties of CTR1 protein was a downward trend .The expression of CTR1 protein was observed in four different groups . The optical density analysis of CTR1 showed that the optical densities were 0 .532 ± 0 .031 ,0 .394 ± 0 .024 ,0 .234 ± 0 .030 and 0 .191 ± 0 .015 ,respectively .There was a downward trend ,and there were statistically differences among the groups (P<0 .05) .The CTR1 mRNA was observed in all groups .The optical density analysis of CTR1 mRNAshowed that the optical densities were 0 .508 ± 0 .035 ,0 .391 ± 0 .022 ,0 .240 ± 0 .02 and 0 .186 ± 0 .021 ,respective‐ly .It had a downward trend and were statistically differences among the groups (P<0 .05) .Conclusion The CTR1 protein was abundantly expressed in Corti organ ,spiral ganglion cells and stria vascularis of the cochlea .The round window cisplatin and copper sulfate infusion can change the expression of CTR1 proteins in inner ear .

Objective To investigate the features of brainstem auditoryresponses (BAR) in patients with attention deficit and hyperactive disorder (ADHD), mental retardation and conduct disorder. Methods BAR in children with ADHD ( n =37), mental retardation (MR, n =24) and conduct disorder (CD, n =22), and in normal children ( n =30) were measured by use of Nicolet Spirit electrophysiological instrument delivering stimulation of Clicks. Results The absolute latencies (AL) of wave Ⅲ、Ⅴ recorded from Fz region (WⅢ、Ⅴ/Fz) and wave Ⅲ from Pz region (WⅢ/Pz) as well as the absolute amplitudes (AA) of WⅢ/Fz and WⅤ/Pz were significantly different ( P

Objective: To understand the prevalence of latent tuberculosis infection (LTBI) among college freshmen in Chaoyang District of Beijing from 2013 to 2015, and to provide evidence for prevention and control of tuberculosis in schools. Methods: The latent tuberculosis infection was identified through a tuberculin purified-protein derivative (TB-PPD) skin test. TB-PPD test results of 65 233 college students in the Chaoyang District during 2013 to 2015 were collected and stored, by using descriptive statistical analysis. Results: Among the 65 233 freshmen, 63 135 were effective PPD test results, 11 754 were PPD positive, 2 720 were PPD strong positive, the LTBI status: the PPD positive rate was 18.62% and the PPD strong positive rate was 4.31%. The positive rate and the strong positive rate in male (19.56%, 4.76%) were higher than that in female(17.87%, 3.95%)(χ2=29.37, 24.29), in ethnic minorities were higher than that in Han Nationality (18.25%,4.16%) and in Tibetans (29.45%, 8.69%) were the highest(χ2=102.01, 70.04), among freshmen from the western region (21.88%, 5.11%)were the highest and from Beijing city (16.25%, 3.46%) were lower (χ2=220.63, 99.03, P<0.01), among those with BCG scar (18.94%, 4.34%) are slightly higher than those without BCG scar(16.96%, 4.08%) (χ2=48.46, 10.43, P<0.01). 19 cases of tuberculosis patients were found, the prevalence rate was 29.13/100 000 (19/65 233), of which 68.42% (13/19) were found through the strong positive for PPD. Among the strong positive students (2 707), there were 1 433(52.94%) who received preventive therapy, and during the follow-up two years, 7 were newly diagnosed with tuberculosis, the annual incidence rate was 129.29/100 000 (7/2 707). Conclusion Freshmen from high-risk areas of tuberculosis are the focus of tuberculosis screening, for which we should continue to carry out PPD screening. Those with latent tuberculosis infection are high-risk groups of tuberculosis, and should be paid more attention in the prevention and control of tuberculosis in schools.

Background: Chronic atrophic gastritis (CAG) is a precancerous lesion of gastric cancer.The diagnostic value of serum gastrin-17 (G-17) level for CAG differs substantioulsy, and Helicobacter pylori (Hp) infection may play an important role.Aims: To explore the effect of Hp infection on serum G-17 level, and the diagnostic value of serum G-17 level for CAG under different Hp infection status.Methods: A total of 204 patients with chronic non-atrophic gastritis and 81 patients with CAG from May 2014 to May 2015 at the three different hospitals were enrolled.Gastroscopy was performed, fasting serum G-17 level, postprandial serum G-17 level and Hp-IgG antibody were determined by ELISA.Results: Fasting serum G-17 level was significantly increased in Hp positive group than in Hp negative group (P=0.001), and postprandial serum G-17 level was significantly decreased in CAG group than in non-atrophy group (P=0.002).AUC of fasting serum G-17 level for diagnosing Hp positive and negative CAG were 0.634 (95% CI: 0.537-0.732) and 0.576 (95% CI: 0.478-0.675), respectively, the accuracy were 62.6% and 54.9%, respectively.AUC of postprandial serum G-17 level for diagnosing Hp positive and negative CAG were 0.675 (95% CI: 0.581-0.769) and 0.595 (95% CI: 0.495-0.694), respectively, the accuracy were 61.8% and 53.1%, respectively.Conclusions: Hp infection has impact on serum G-17 level, as a result, the diagnostic value of G-17 level for CAG is different for patients with and without Hp infection.Diagnostic values of fast and postprandial serum G-17 for Hp positive CAG are higher than Hp negative CAG.