Objective To provide clues to diagnosis and treatment for diffuse alveolar hemorrhage (DAH)in patients with diffuse connective tissue diseases(CTD).Method To analyze restropeetively the data of clinical features,pulmonary images and bronchoalveolar lavage(BAL)in 32 patients hospitalized in Peking Union Medical College Hospital from April 2004 to June 2007.Results The data from 1O of the 17 (58.8%)patients with microscopic polyangiitis(MPA),19 of the 1267(1.5%)patients with systemic lupus erythematosus(SLE),2 of the 56(3.6%)patients with Wegener's granulomatosis(WG)and 1 of the 570(0.2%)patients with rheumatoid arthritis(RA)were consistent with the diagnosis of DAH.DAH in SLE occurred in younger patients(mean age at the time of diagnosis 27.3±13.1 years)and early in the course of disease(median duration of SLE from onset was 16.7±18.3 months),while these figures in MPA patients with DAH were 50.1±20.7 years and 10.6±18.7 months.At the time of DAH in SLE.the median systemic lupus erythematosus disease activity index(SLEDAI)score was 17.1±6.7 and anti-ds-DNA antibody titer elevated markedly,while the median C3 level was low.The levels of erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)of patients with DAH in MPA,WG and RA showed marked elevation.The titer of antieutrophil cytoplasmic antibody(ANCA,MPO/PR3)in patients with MPA and WG was highly positive.The main clinical manifestations of DAH were hemoptysis,dyspnea and rapid decrease of hemoglobulin and hematoerit(HCT)in peripheral blood.Most patients presented with difluse alveolar infiltration on chest X-ray and hish resolution CT.DAH could be confirmed by bloody bronchoscopic lavage.20 patients(62.5%)had secondary pulmonary infections at the time of DAH;fungus and combined bacterial infection were most frequently seen.The mortalitv 0f CTD with DAH was 59.4%(19 out of 32).12 patients (63.2%)with SLE,5 patients(50%)with MPA and both of the 2 patients with WG died.12 of the lethal cases(63.2%)died of respiratory failure.Conclusions CTD patients presenting with hemoptysis and dyspnea with rapid decrease of hemoglobulin,and diffuse alveolar infiltration on chest X-ray or high resolution CT should be seriously considered to be suffering from DAH.A bloody BAL may confirm the diagnosis of DAH.DAH in CTD is an acute,serious and frequently life-threatening situation resulting in respiratory hilure and pulmonary infection.It is important for CTD patients with DAH to be diagnosed early and treated vigorously.

Objective To evaluate the indication, clinical results, and prognosis after arthroscopic release for treatment of the limitation of elbow joint motion. Methods From December 2003 to May 2005, 17 elbows in 17 patients were treated with an arthroscopic procedure for elbow contracture. All patients had trauma as the cause of limitation of elbow joint motion. Previous injuries included fixation after fracture of the olecranon (7 cases), elbow dislocation (5 cases), fracture of the radial head (2 case), and braking after skin graft for burn of elbow (2 cases), one patient underwent a open synovectomy for synovitis. All patients with elbow contractures underwent the arthroscopic capsular release and arthroscopic debridement. The osteophytes in the olecranon and medial or lateral epicondyle and loose bodies were removed, and full debridement of fibrous tissue in elbow were performed. Complete release of the capsule was necessary to regain good functional motion. Postoperative care began from gentle active and passive range of motion of the elbow under patient controlled analgesia(PCA). All elbows were assessed for increase in range of motion(ROM) and Mayo assessment before and after surgery. Score assessment: ≥90 points,excellent; 75-89 points, good; 60-74 points, fair;

[Objective]To evaluate the results of arthroscopic capsular release for the treatment of idiopathic frozen shoulder.[Method]From January 2004 to April 2005,7 patients with diagnosis of idiopathic frozea shoulder,who had symptoms for an average of 8.0 months(5 to 13months)with failed conservative treatment for at least 4 months,were treated with arthroscopic capsular release combined with rehabilitaticon exercises after operation.Under general anesthesia,all the patients underwent arthroscopic capsular release and manipulation.All patients were strictly evaluated by Constant score,normalized Constant score and the Visual Analog Scale(VAS 1 to 15 points,1 = no pain),before operation,at 3 weeks after operation,3 months after operation and 17.2 months after operation respectively.[Result]All patients were followed up with a mean of 17.2 months(8 to 23 months).The average in-hospital day was 8.1 days(7 to 10 days).All patients had significant improvement in terms of functional gain and pain relief after operntion.The preoperative pain score improved from(5.2?2.4)points to(11.2?2.0),(14.6?0.4)and(14.7?0.4)points at 3 weeks after operation,3 months after operation end 17.2 months after operation respectively.The Constant score improved from(24.5?14.2)to(47.0?18.8),(68.9?9.4)and(70.1?7.9),and the normalized Constant score improvad from(31.0%?17.3%)to(60.1%?24.9%),(87.1%?14.5%)and(89.7%?12.1%).There was no complication in the treatment procedures.[Conclusion]Arthrosenpic capsular release is a safe and effective surgical procedure in the management of idiopathic frozen shoulder unresponsive to conservative treatment.It has advantages of little invasive,better recovery,less operation time and less complications.

Objective To investigate the value of microsurgical management for the diagnosis and treatment of pigmented villonodular synovitis(PVNS)of the knee.Methods Thirty-eight patients with PVNS of the knee that were confirmed by arthroscopy were treated in our unit between January 2002 and April 2006.Among the patients,5 were referred from other hospitals because of postoperative recurrence.Villusectomy was performed in each of the patients by using arthroscopy.In the cases with larage extra-articular lesions,small auxiliary incision was made for complete resection.All the resected masses were examined pathologically after the surgery,and the patients received intra-anticular drainage,local ice therapy,and functional exercises afterwards.Results Unilateral surgery was performed on this group of patients.Under an arthroscope,the synovium showed characteristic yellow-brown color.Patholgocial examination confirmed PVNS in all the cases,including 20 cases of local PVNS and 18 diffused lesions.Open surgery was performed on 6 patients owing to large lesion at the popliteal fossa.According to the International Knee Documentation Committee(IKDC)Scoring Forms,the mean IKDC score increased from 60.4?6.1 to 89.3?7.2 in one year after the operation.The 38 patients were followed up for 1 to 4 years(mean 2.1 years),none of them had recurrence during this period.Two of the patients,who had been treated by open surgery and then were referred to our hospital,could not flex their knees to 90? after the microsurgery.Whereas,all the others achieved normal knee flexion.Conclusions Arthroscopy is reliable for the diagnosis and treatment of PVNS.For large extra-articular lesions,open surgery using small auxiliary incision is necessary for complete resection and avoidance of recurrence.

BACKGROUND: Chinese medicine is rich in recognition and treatment for rheumatoid arthritis(RA) and has achieved attractable progression in researches of recent several years,characterized by variable therapeutic methods, definite therapeutic effects and few toxic side effects. Therefore, it is important scientifically and socially to further search for the effective drugs and methods for the treatment of RA in the field of Chinese medicine. There are few reports on whether Chinese herbs inhibit or block the destruction of cartilage and bone and promote their metabolism and repair for damage or not by variable approaches,targets and links in RA occurrence.OBJECTIVE: To probe into the mechanism of Chinese herbal tongbiling on cartilage destruction.DESIGN: Complete random design and control experimental study based on the experimental animals.SETTING: Golden Chamber teaching and research room of guangzhou university of traditional Chinese medicine.MATERIALS: The experiment was performed in Comprehensive Experimental Room of First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from August 2002 to December 2003,in which,35female Wistar rats were employed,clean grade,weighted(110±20) g,provided by Animal Experimental Room of First Military Medical University of Chinese PLA, with qualified animal No. 2002A041.After 3 days adaptive breeding,Wistar rats were randomized into normal group,model group and total alkaloidal of tongbiling group(TBL group). TBL was extracted in Phytochemistry Room of Tropical Disease Institute of Guangzhou University of Traditional Chinese Medicine.METHODS: The animal model was prepared on rats with collagen-induced arthritis. After treated with gastric infusion in groups,the pathological sections were done on phalangeal joint of rat and chondropathy was observed after routine HE staining. The chondrocytes were cultured. The chondrocytes were stimulated with rrIL-1β in vitro and resulted in matrix decomposition of chondrycyte to prepare pharmaceutical model,TBL of various concentrations added and dexamethasone(DXM) was applied in the control. After 48 hours culture,the upper clear solution if cell was collected and glycosaminoglycan (GAG) content was measured with alcian blue method,and nitric oxygen (NO) content was assayed with method of aqua fortis reduction.MAIN OUTCOME MEASURES:①Primary results: Effect of TBL on phalangeal chondropathy in rats with collagen-induced arthritis and on matrix decomposition of chondrocyte induced by rrIL-1β.②Secondary results: Effect of TBL on induction of NO synthesis from chondrocytes by rrIL-1β.RESULTS:①It was indicated in evaluation on HE pathological section of phalangeal joint: The severity of cartilage destruction in TBL group was less than that in model group(P<0.05).②TBL of various concentrations and DXM inhibited remarkably the decomposition of choncrocyte proteoglycan (P<0.01) and NO synthesis (P<0.01).CONCLUSION: TBL inhibits phalangeal cartilage destruction of rats with collagen-induced arthritis. It is indicated in the results of experiment in vitro that TBL is against the decomposition of choncrocyte proteoglycan,which is probably achieved by inhibiting NO synthesis.

Objective To explore the early-term efficacy of the reconstruction ot acetabular bone loss with porous tantalum acetabular components in total hip arthroplasty.Methods Twenty-one patients (21 hips) were included in this study,which had an acetabular replacement with tantalum acetabular components from August 2009 to April 2012.There were 6 males and 15 females,with the mean age of 55.7±16.2 years (range from 24 years to 78 years).The primary total hip arthroplasty in 5 cases,the revision in 16 cases.The acetabular bone defects were classified as Paprosky classification,which included,type Ⅰ in 9 cases,type Ⅱain 4,type Ⅱb in 5,type Ⅱcin 1,type Ⅲa in 1 and type Ⅲb in 1 case.Results The mean follow-up time was 20.1 months (range,6-40 months).In Paprosky Ⅰ,the Harris hip score was 87.2±7.4 postoperatively,which was significant higher than the preoperative score 41.1±6.3.In Paprosky Ⅱ,the Harris hip postoperative score (79.8±11.8) was significant higher than the preoperative score (38.4±12.5).In Paprosky Ⅲ,the Harris hip postoperative score (79) was significant higher than the preoperative score (24).21 Tantalum components were well fixed by the radiograph imaging.No cases suffered aseptic loosening and migration.Bone ingrowths was obviously performed in 21 hips.But 2 hips had a radiolucent line,1 case occurred in zone 3 and the line was filled 4 months later,the other case still existed at last follow-up without any more widen.No infections or mechanical failures.The survivorship of the tantalum acetabular components was 100％.Conclusion Our short-term results suggest this implants may enhance biological fixation in acetabular defect cases.Porous tantalum cup appears to be an ideal material to facilitate biologic ingrowths in these cases.Long-term follow-up still needs to be confirmed.

Objective: The study was to reveal the inhibition of neovascularization by Tongbiling. Methods: Rat model were established by injecting CFA at the root of the tail and divided into model control group, Indomethacin group and Tongbiling group at random. The serum and paws were collected after seven days treatment. 10ng/L VEGF solution was added I into CAM to stimulate the neovascularization, and to observe the influence of each group of serum on the first and second order new vessels. RT-PCR method was taken to determine the expression of mRNA of VEGF and VEGFR-1 of paws in different groups. Results: The number of vessels in the model control group was significantly more than that in the Indomethacin group and the Tongbiling group (P

Objective To observe the clinical effect of Erteng Tongbi Mixture(ETM) on rheumatoid arthritis(RA). Methods 102 cases of RA were treated with ETM for 3 months. Time of morning stiffness, rest pain, 20m- walking time, hand grip, the number of joint with swelling and tenderness, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), C- reactive protein (CRP) were compared before and after the treatment. Results The total effective rate of ETM was 91.4 % and the ineffective rate 8.6 % . The morning stiffness, rest pain, hand grip and joint tenderness were obviously relieved, while 20m- walking time and the number of joint with swelling remained unchanged. ESR, RF and CRP were decreased to different extent, in particular RF(P

[Objective] To establish the scale of the quality of life for patients with ankylosing spondylitis. [Methods] Initial scale including 58 items was proposed by the research staff. After the preliminary test was performed, 37 items were selected and a confirmed scale of the quality of life for ankylosing spondylitis ( SQOL-AS) was obtained. The feasibility, reliability, validity and sensitivity of SQOL-AS were analyzed. [Results] Statistics showed that SQOL-AS had a good feasibility, reliability, validity and sensitivity. [Conclusion] SQOL-AS can be used to evaluate the quality of life for patients with ankylosing spondylitis.

Objective To observe the chondroprotective mechanism of Tongbi Compound(TC) on adjuvant arthritis(AA) rats.Methods Wistar rats were randomized into the normal group,model group,indomethacin group(2.6 mg?kg-1?d-1),sulfasalazine group(825 mg?kg-1?d-1) and TC group(30 g?kg-1?d-1).Except the normal group,the rats in other groups were given pedal injection of Freund's complete adjuvant(FCA,0.2mg for each rat)to induce AA.After gastric gavage of corresponding medicine for 2 weeks,the pathological changes of the cartilage in the rat ankles and their scores were observed,and the expression of matrix metalloproteinases 3(MMP-3) and tissue inhibitor of metalloproteinase(TIMP-3) in rat cartilage was detected by immunohistochemical method.Results In the model group,pathological score was increased(P0.05),but had less toxic and side effects.Conclusion The therapeutic mechanism of Tongbi Compound for the treatment of ankylosing spondylitis is probably related with the regulation of the balance between MMP-3 and TIMP-3.