BACKGROUND:At present, it is controversial to choose methotrexate therapy alone or triple therapy in the treatment of rheumatoid arthritis.
OBJECTIVE:To systemical y evaluate the efficacy and safety of methotrexate therapy and methopterin+hydroxychloroquine+sulfasalazine triple therapy in the treatment of rheumatoid arthritis.
METHODS:Computer retrieval was performed on the Cochrane library, PubMed, EMBASE NRR (http://www.updatesoftware.com/National), CCT (http://www.control ed-trails.com) and the Chinese biomedical literature database. Manual retrieval was performed on Chinese major orthopedic journals. Randomized control ed trials of methotrexate therapy alone and methopterin+hydroxychloroquine+sulfasalazine triple therapy treatment for rheumatoid arthritis were col ected. Methodological quality of the included studies was evaluated. The statistical software Revman 5.0 provided by the Cochrane col aboration was used.
RESULTS AND CONCLUSION: A total of four literatures in a randomized control ed trial, a total of 297 cases were included;the methodological quality was al class B. Meta-analysis results showed that blood sedimentation improvements were larger in methotrexate therapy alone than in the triple therapy [mean difference=7.01, 95%confidence interval (CI) (2.82, 11.19), P=0.001). Improvements of joints were better in triple therapy than that in single therapy [OR=0.62, 95%CI (0.41, 0.95), P=0.03). There was no significant difference in adverse events. Meta analysis could not be done in ACR, because literature did not provide detailed data. Compared with the triple therapy treatment, methotrexate therapy alone obviously reduced the sedimentation of rheumatoid arthritis in adults, but in terms of joint function improvement, triple therapy was superior to methotrexate therapy alone. Moreover, on the adverse event, there was no significant difference between the two groups. Because this system evaluation included a less number of cases, it stil needs strict large-sample randomized control ed studies to increase the strength of the evidence.

BACKGROUND: The commonly used research methods of lumbar biomechanics are animal model,physical model and corpse model respectively. However, each model has its own disadvantages.OBJECTIVE: To establish the finite element model of lumbarmotionsegments in order to provide theoretical basis for biomechanical research of lumbar.DESIGN: Single sample study based on healthy volunteer.SETTING: Orthopaedic department of a university hospital.PARTICIPANTS: The experiment was completed in the Orthopaedic Department of Xiangya Hospital of Central South University from December 2003to August 2004. A healthy male volunteer was chosen as a mock object.METHODS:CT scanning was conducted to the spine(T12 - S1) of a healthy volunteer by 2 mm layer and got 264 images. The 3D model of normal Chinese male L4 5 motion segments was built by combininglumbar images scanned by CT and anatomic data through 3DSMAX software. Then it was transferred into finite elementmodel by finite element analyzing software SAP2000.MAIN OUTCOME MEASURES: ① Vertebral body model andintervertebraldisc model built by 3DSMAX software; ② Finite element model of motion segment made by SAP2000 software.RESULTS:The finite element model of lumbar L4-5 segments had been built. It had totally 2 120 nodes that include 1 728 Solid units, 592 Area units and 50 Link units.CONCLUSION: The finite element model of lumbar motion segments can be established through CT scanning, digital image processing and computer aid design to further study the biomechanics of spine.

Objective To explore the stress changes of C7/T1 intervertebral space pre-and post C5/6 discectomy and artificial disc replacement.Method Eleven healthy adult fresh muhisegmental cadaveric cervical spine segments were utilized in this investigation and biomechanically evaluated under the following C5/6 conditions:intact spine,discectomy,and Bryan Disc prosthesis implantation.The load,of neutrality and pure moments of axial,flexion,extension,and lateral bending were applied on each group.The stress changes of the inferior (C7/T1)interverlebral space was detected by modified cyclo-shaped miniature transducer.Result Under axial,anteflexion,and lateral bending loading,the discectomy indicated a significant increase in the stress of the inferiorer(C7/T1)intervertebral space,compared to intact condition and CADR(P＜0.05).Under extension loading,the discectomy indicated an increase in the stress of the inferiorer(C7/T1)intervertebral space,compared to intact condition(P＞0.05).Under axial,flexion,extension and lateral bending loading,the Bryan Disc prosthesis implantation indicate minor increase of the stress in the inferior(C7/T1)intervertebral space to intact condition(P＞0.05).Conclusion There was no difference between the C5/6 ADR and intact spine group.The discectomy of the Cs/6 can increase the stress of the C7/T1 intervertebral spaoe.

BACKGROUND: There are many methods for the treatment of femoral head necrosis, such as core decompression, bone graft, arthroplasty and joint replacement, and each of which has its own shortcomings. So, percutaneous bal oon angioplasty combined with coral artificial bone provides a new attempt for the treatment of femoral head necrosis. OBJECTIVE: To observe the effect of percutaneous bal oon angioplasty combined with coral artificial bone on femoral head necrosis repair. METHODS: Twenty-four Duroc piglets were enrol ed to establish bilateral femoral head necrosis models by liquid nitrogen freezing method. Then, model piglets were randomly treated with percutaneous bal oon angioplasty combined with injectable coral artificial bone (experimental group) or bone cement (control group) on one affected side, and meanwhile, given no treatment on the contralateral side (blank control group). At 2, 4, 8 and 16 weeks after surgery, X-ray examination, biomechanical test and histological detection were conducted. RESULTS AND CONCLUSION: X-ray showed that at 16 weeks after surgery, numerous new bones could be found in the experimental group and there was a fuzzy boundary between the artificial bone and surrounding tissues; no new bone formed in the control group, and the boundary was clear; in the blank control group, the surface of the femoral head col apsed, and bone trabeculae arranged disorderly, which were seriously destroyed. And in the histological detection at 16 weeks after surgery, there were numerous bone trabecula and osteoblasts around the coral bone in the experimental group, and the coral artificial bone almost dissolved; in the control group, bone cement was in an irregular shape and no bone trabecula formed; in the blank control group, bone trabecula were damaged in the col apsed area, whose structure was in disorder. Additional y, biomechanical changes in the experimental group were significantly better than those in the other two groups at different time points after surgery (P < 0.05). In conclusion, percutaneous bal oon angioplasty combined with coral artificial bone can repair femoral head necrosis by promoting new bone formation.

Objective To assess the value of selective renal arteriography and embolization in the therapy of nephrorrhagia diseases.Methods Fifteen patients of renal hemorrhages including 10 iatrogenic renal trauma,3 renal harmatoma and 2 renal closed injury with ineffective medical treatment underwent selective renal artery embolization.Results Renal artery an-giographies confirmed renal segmental arteries and/or their branches injuries.Gelatin sponge,PVA or steel coil were used for embolization.During 1-3 months fllowing-up,renal abscess was found in 2 patients without superselective embolization,while haematuria occurred in one case after embolization with gelatin sponge but stopped after medical treatment.The renal function of all patients were normal after embolization.Conclusion Superselective renal artery embolization has reliable effect and slight complication in the treatment of nephrorrhagia,especially suitable for patients after surgery and renal inadequacy.

The standardized training is an indispensible stage for the improvement of residents' comprehensive quality and for the training of high-qualified talents.The article preliminarily explored the standardized training model for residents,which was in accordance with the characteristics of the department of cardiology mainly from four aspects:the set-up of reasonable training program,the training of practical skills,the training of humanistic quality and the training of life-long learning ability.