Objective To review and analyze unreasonable medicine use of TCM injections in inpatient prescriptions in our hospital; To provide reference for reasonable clinical medicine use. Methods According to instructions and requirements in “basic principles for TCM injections in clinical use”, 132 cases (01. 2013-05. 2013) of TCM injections following the doctors’ advice in the hospital were reviewed and analyzed. Results Problems in unreasonable medicine use of TCM injections mainly concentrated in incompatibility, unsuitable solvent, and unsuitable indications, etc. Conclusion TCM injections in clinical use in the hospital showed some cases containing unreasonable medicine use. Therefore, effective intervention should be taken to regulate medicine use and promote TCM injections in clinical application, in order to make it safer, more reasonable, and more effective and reduce the occurrence of adverse reactions.

Objective To evaluate the efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in patients undergoing inguinal hernia repair.Methods Forty ASA Ⅰ or Ⅱ patients,aged 18-79 yr,with body mass index ＜ 30 kg/m2,scheduled for elective unilateral inguinal hernia repair combined spinal-epidural anesthesia,were randomly divided into 2 groups (n =20 each):control group (group C) and ultrasound-guided TAP block group (group B).The ultrasound-guided TAP block was performed at the end of surgery and 20 ml of 0.375 ％ ropivacaine was injected in group B,while the equal volume of normal saline was given in group C.Tramadol was injected intravenously when VAS score ≥ 4 after surgery.VAS scores at rest and during activity were recorded at 4,6,24 and 48 h after surgery.The warm block plane on the blocked side was measured at 24 and 48 h after surgery.The overall satisfaction on analgesia was scored and the time when the patients passed the flatus was recorded.TAP block-related side effects were recorded.Results Four patients required tramadol in group C,while no patients required rescue analgesic in group B.Compared with group C,VAS scores were significantly decreased,the overall satisfaction scores were increased (P ＜ 0.05 or 0.01),and no significant change was found in the time when the patients passed the flatus in group B (P ＞ 0.05).The rate of warm plane block on the blocked side was 80％ at 24 h after surgery and there was not warm block plane in patients at 48 h after surgery in group B.There was not warm block plane in patients at 24 and 48 h after surgery in group C.TAP block-related side effects were not found in group B.Conclusion The efficacy of ultrasound-guided TAP block for postoperative analgesia is better in patients undergoing inguinal hernia repair and the safety is higher.

Objective To explore the influence of allergic rhinitis (AR) on patients with systemic onset juvenile idiopathic arthritis (SoJIA).Methods The study involved 44 cases with SoJIA from Department of Pediatrics,Renji Hospital affiliated to School of Medicine of Shanghai Jiaotong University from July 2008 to November 2013.The Clinical and laboratory data of all patients were recorded respectively.This was a retrospective cohort study.According to the diagnosis of allergic rhinitis (AR),children were subdivided into AR group (16 cases) and Non-AR group (28 cases).ACR Pediatric criteria (ACR Pedi) 30/ 50/70 and related indicators of SoJIA between the two groups were compared.In the AR group,the correlation between AR scores and DAS28 was analyzed.When SoJIA of the two groups relapsed,the AR group (the treatment group) received anti-rheumatism for arthritis as well as nasal spray and oral antihistamines for AR.The non-AR group (control group) only received the anti-rheumatism for arthritis.The improvement of SoJIA between the two groups was analyzed.The continuous variables were analyzed by Student's t-test or the MannWhitney U-test as appropriate.Categorical data were compared between different groups by the Chi-square test.Correlations were determined by Pearson or Spearman's ranking.Results ① In the retrospective analysis:the physician's and patients'/parents' general assessment on a 10 cm visual-analogue scale (VAS),number of joints with res-triction of movement,number of swollen joints,ESR,serum ferritin(SF) and childhood health assessment questionnaire (CHAQ) score were significantly elevated in the AR group compared with Non-AR group at the disease onset [(6.7±1.0) cm vs (4.8±1.9) cm; (6.5±1.4) cm vs (3.2±1.5) cm; 4.1±2.7 vs 2.7± 1.7; 3.4±2.4 vs 1.4±1.5; (87±35) mm/1 h vs (61±40) mm/1 h; (888±1 043) μg/L vs (311±324) μg/L; 1.6±0.5 vs 0.7±0.3,respectively; all P＜0.05].At the 3 and 6 months follow-up after disease onset,the proportion of patients who reached ACR pedi 50,70 in AR group were lower than the Non-AR group,while the cumulative glucocorticoid dose was higher in the AR group than that of those without AR [at 3 months 38％ vs 71％; 13％ vs 46％; (76±35) mg/kg vs (43±36) mg/kg,respectively; at 6 months 25％ vs 71％; 19％ vs 64％; 127±57 vs 67±58,respectively,all P＜0.05]; In the AR group,at the disease onset,3 and 6 months follow-up after disease onset,the scores of AR was positively correlated with DAS28(r=0.741,0.703,0.680,respectively; all P＜0.05).② In the prospective study:when SoJIA was relapsed,systemic feature score,the physician's and patients' /parents' general assessment on a l0 cm VAS,number of joints with restriction of movement,number of swollen joints,ESR,SF and CHAQ score were significantly elevated in the treatment group compared with the control group [3.8±1.5 vs 2.1±1.1; (5.6±1.5) cm vs (4.5±1.6) cm; (4.6±1.9) cm vs (3.1±1.5)cm; 3.9±1.9 vs 2.5±1.4; 2.4±0.9 vs 1.5±1.2; 92±27 vs 53±37; 565(339,1 192) μg/L vs 171(85,284) μg/L; 13(0.8,1.6) vs 0.7(0.5,1); respectively; P＜0.05].The improvement rate of the physician's and patients'/parents' general assessment on a 10 cm VAS,number of swollen joints,number of joints with restriction of movement,ESR and CHAQ score at the follow-up 3 months were higher in treatment group than the control group [71(55,86)％ vs 46(0,75)％; 67(45,81)％ vs 28(-4,62)％; 92(77,96)％ vs 70(27,88)％; 65(48,81)％ vs 0(-17,67)％; 100(46,100)％ vs 42(0,100)％; 67(49,85)％ vs 37(0,75)％; P＜0.05].At the follow-up 6 months,the improvement rate of ESR,patients'/ parents' general assessment on a 10 cm VAS,number of joints with restriction of movement and CHAQ score were higher than control group [94(85,96)％ vs 73(33,85)％; 89(65,99)％ vs 63(5,85)％; 100(100,100)％ vs 100(0,100)％; 91(69,100)％ vs 72(11,91)％; respectively,P＜0.05].Conclusion AR may exert an adverse influence on SoJIA.SoJIA patients who are treated with combined with AR may have better outcome than those who are only treated for arthritis.

Juvenile idiopathic arthritis is a disease characterized by autoimmune disorders and immune imbalance. In recent years,immune tolerance has become a hot issue in the pathogenesis of juvenile idiopathic ar-thritis. In this article,cytotoxic T lymphocyte associated-antigen 4,programmed death-1,Treg cells and apoptotic cells in the pathogenesis of juvenile idiopathic arthritis are summarized.

With acute lymphoblastic leukemia in skeletal muscle symptom,part of these patients may be misdiagnosed as juvenile idiopathic arthritis. How to distinguish these children has significance for the timely and proper treatment and good prognosis. This article from the history and routine laboratory examination and ima-ging examination put forward early in the disease through the analysis of joint symptoms from juvenile joint pain,blood and imaging characteristics and preliminary identification of childhood leukemia from juvenile idio-pathic arthritis in order to decrease the rate of misdiagnosis.

Objective To discuss the expression of cyclooxygenase-2 (COX-2) and vascular endothelial growth factor (VEGF) in adenomyosis and its clinical significance. Methods The expression of COX-2 and VEGF was examined by immunohistochemistry SP method, in ectopic endometrium and eutopic endometrium, compared with normal endometrium. Results (1) COX-2 expression in ectopic, eutopic endometrium with adenomyosis was significantly higher than that in control group (P<0.05). No statistically significant difference was found between ectopic endometrium and eutopic endometrium group with adenomyosis (P0.05).(2) VEGF expressions in ectopic, eutopic endometrium with adenomyosis were both significantly higher than that of control group (P<0.05); no statistically significant difference was found between ectopic endometrium and eutopic endometrium group (P0.05).(3) COX-2 and VEGF had the positive relativity in the ectopic endometriumal expression of adenomyosis patient (P<0.05). Conclusion COX-2 and VEGF may play a key role in adenomyosis. Both may have close relation in angiogenesis and may provide new targets for therapy of adenomyosis.

Objective To estimate the biological effects of leptin on human HaCaT keratinocytes and explore their molecular mechanisms.Methods Cell counting kit-8 (CCK-8) was used to evaluate the proliferation of cultured HaCaT cells treated with different concentrations of leptin for 24 and 48 hours.Some HaCaT cells were classified into four groups to remain untreated,be treated with leptin (100 μg/L) and piceatannol (a specific inhibitor of STAT3 phosphorylation) alone or in combination for 24 hours,respectively,followed by the evaluation of cell proliferation using CCK-8 kit.Flow cytometry was performed to assess cell cycle of HaCaT cells treated with leptin of 100 μg/L,Western blot to determine the phosphorylation level of Erk1/2 and STAT3 in HaCaT cells treated with leptin of 100 μg/L for different durations.Statistical analysis was done by Student's t-test for unpaired data using GraphPad Prism 5 software.Results The proliferation of HaCaT cells was accelerated to different degrees after treatment with leptin of 50 and 100 μg/L for 24 and 48 hours,and the accelerating effect was in a dose-dependent manner within 24 hours (r =0.9989,P ＜ 0.05).Piceatannol apparently inhibited the promotive effect of leptin on the proliferation of HaCaT cells.There was an obvious elevation in the percentage of cells at S phase ((57.70 ± 5.88)％ vs.(42.50 ± 7.55)％,P ＞ 0.05),but a significant decrease in that at G0/G1 phase ((39.70 ± 1.57)％ vs.(45.20 ± 1.44)％,P ＜ 0.05),with a significant increase in proliferation index (0.603 ±0.0157 vs.0.564 ± 0.0144,P ＜ 0.05) in HaCaT cells treated with leptin of 100 μg/L for 24 hours compared with the untreated controls.Western blot showed that leptin of 100 μg/L markedly enhanced the phosphorylation level of STAT3 in HaCaT cells.Conclusion Leptin may upregulate the proliferation of HaCaT cells through activation of STAT3 pathway.

Objectives To explore the changes of T helper (Th) lymphocyte and its related factors in children with syste-mic-onset juvenile idiopathic arthritis (SoJIA). Methods A total of 36 SoJIA inpatients, hospitalized from January 2012 to June 2013, were divided into active phase group and remission group. In addition, 20 healthy children were selected as normal con-trols. Th1, Th2 and Th17 cell ratios in peripheral blood mononuclear cells were detected and compared between each group by flow cytometry. Serum interferon-γ(INF-γ), interleukin-4 (IL-4), interleukin-17 (IL-17) levels were measured by enzyme-linked immunosorbent assay. Results The proportions of Th17 cells over CD3+CD8-cell were (3.30±2.15)%, (1.78±1.14)%and (1.22± 1.14)%in active phase group, remission group and control group. The difference among three groups was significant (H=14.437, P=0.001), and the active phase group had higher proportion of Th17 than the other two groups (P<0.05). The ratio of Th1 and Th2 over CD3+CD8-cell between each group was not significantly different (P>0.05). The serum IL-17 levels were (125.82 ± 45.87) pg/ml, (57.79±25.84)pg/ml and(50.02±18.37)pg/ml in active phase group, remission group and control group with signifi-cant difference among three groups (F=31.82, P=0.000), and the active phase group had higher level of IL-17 than the other two groups (P<0.05). But serum INF-γ and IL-4 were not significantly different between each group (P>0.05). Conclusions Acquired cellular immunity is involved in pathogenesis of SoJIA, the increased proportion of Th1 and Th17 cell and the changes of related cytokines seem to correlate with active phage of SoJIA.

Objective To evaluate the inlluence of atopy on juvenile idiopathic arthritis (JIA).Methods The study involved 117 cases with JIA from Department of Pediatrics,Renji Hospital Affiliated to School of Medicine of Shanghai Jiaotong University from Jul.2008 to Jul.2013.These patients were enrolled for retrospective cohort study,and subdivided into JIA and atopic group or JIA and non-atopic group.There were 34 cases combined with atopy,83 cases without atopy.Based on the diagnosis of allergic rhinitis (AR),those JIA children in the atopic group were organized into AR group (19 cases) and non-AR group (15 cases).The clinical and laboratory data were recorded and analyzed to compare the differences of the remission of American College of Rheumatology Pediatric (ACR Pedi) 30/50/70 between atopic group and non-atopic group,AR group and non-AR group.In AR group,the correlation between AR scores and disease activity score (DAS28) was analyzed.Results 1.The physician's and patients'/parents' general assessment on a 100 mm visual-analogue scale (VAS),number of joints with restriction of movement and childhood health assessment questionnaire (CHAQ) were significantly elevated in atopic group compared with controls at the beginning (all P ＜ 0.05).In the follow-up 3 months after disease onset,the proportion of reaching ACR Pedi 30,50 and the proportion of reaching ACR Pedi 50,70 in 6 months later in JIA with atopy were lower than JIA children without atopy (all P ＜ 0.05) ; In the follow-up 3 and 6 months,the cumulative glucocorticoid dose was higher in atopy group compared with Non-atopy,which showed a statistical significance (all P ＜ 0.05).2.Among the AR group,at the disease onset,the physician's and patients'/parents' VAS,number of joints with restriction of movement and CHAQ were elevated in AR group compared with controls with statistical significance (all P ＜ 0.05).In the follow-up 3 months,the proportion of reaching ACR Pedi 30 and 50 was lower in AR group compared with non-AR group.In the follow-up 6 months,the cumulative glucocorticoid dose was higher in AR group compared with non-AR,which showed a statistical significance.But the ratio of ACR Pedi 30,50 and 70 were lower in AR group compared with non-AR group (all P ＜ 0.05).Among JIA combined with AR,at the beginning,follow-up 3 and 6 months after disease onset,the scores of AR positively correlated with DAS28 (r =0.671,0.518,0.496,all P ＜ 0.05).Conclusion Atopy or AR may exert an adverse influence on JIA.

Objective To design an auxiliary measurement device for anterior cruciate ligament injury in order to improve the accuracy of specialist examination and postoperative functional assessment.Methods The device consisted of a main frame and support pads,which was designed based on the principles of anatomopathology and mechanical mechanics.The frame was set above and paralleled to the tibia,and the measurement scale was put at the vertical direction of the frame.The support pads were fixed to the tibia and patella respectively to execute auxiliary measurement by providing opposite acting force.Results The success rate of preliminary diagnosis by the device was higher than that by traditional method.Conclusion The device gains advantages in convenience,practicality,low cost and etc,and is worthy promoting in the orthopedics department.