ObjectiveTo compare the clinical effect and security of Reparil Gel on osteoarthritis of the knee.Methods60 patients were randomly divided into Reparil Gel group and Fenbid group, who applied Reparil Gel or take Fenbid orally respectively. Western Ontario and McMaster University Osteoarthritis Index (WOMAC) was used to assess patients' pain, joint stiffness and disability of knee on 0 week, 2 week, 6 week after treatment. The side effect was observed.ResultsBoth group showed good clinic effect on 2 weeks (P<0.05)and 6 weeks (P<0.001)after treatment. Significant difference between two group was found 2 weeks after treatment, but there was no difference 6 weeks after. There was no side effect had been observed in Reparil Gel group, while stomachache, nausea or anorexia had been found in 4 case of Fenbid group 2 weeks after, and 8 case of Fenbid group 6 weeks after.ConclusionReparil Gel are same effective as Fenbid, but less side effect happened.

ObjectiveTo investigate the etiology, exacerbating factors and outcome of geriatric patients with acute renal failure (ARF) in emergency and critical internal medicine. MethodsClinical features of elderly inpatients with ARF who were diagnosed in internal medicine of our hospital during the past 10 years were retrospectively analyzed. Patients were divided into community-acquired ARF (CA-AFR) group and hospital-acquired ARF (HA-ARF) group. Comparisons between CA-ARF group and HA-ARF group, and between elderly patients and non-elderly patients with ARF in internal medicine were performed. ResultsAmong 381 elderly ARF patients in internal medicine, there were 218 (57.2%) CA-ARF patients and 163 (42.8%) HA-ARF patients. Most of the HA-ARF patients (153 cases) were distributed in medical intensive care. Compared with CA-ARF group, patients in HA-ARF group were older, with more underlying diseases, a higher ratio of infections and/or heart failure and more severe acute renal failure. Infection and heart failure/severe myocardial isehemia were the major exacerbating factors for HA-ARF. Of the 163 patients with HA-ARF, 146 patients died and 17 patients survived. Patients in the death group had more underlying diseases, a higher ratio of severe infections and heart failure/severe myocardial ischemia, a higher ratio of cases with multiple organ dysfunction syndrome(MODS) and a higher score of APACHE Ⅱ.When compared with non-elderly patients with ARF, the elderly patients had a higher proportion ofHA-ARF, a higher ratio of MODS, a higher score of APACHEⅡ and a higher mortality of ARF.ConclusionsThe elderly critical patients are susceptible to HA-ARF with more chronic underlying diseases. Infection and heart failure/severe myocardial ischemia are the major exacerbating factors.The prognosis depends on the treatment of predisposing diseases and removal of exacerbating factors.

Objective To explore the correlation between quantitative value of joint bone scan by single photon emission computed tomography (SPECT) and serum bone metabolic markers in patients with active rheumatoid arthritis (RA).Method Clinical data of 60 newly diagnosed RA patients were retrospectively collected in Department of Rheumatology and Immunology from May 2013 to December 2014,including 28 cases with medical history less than 6 months and 32 from 6 months to 2 years.Serum Cterminal telopeptide of type Ⅰ collgen(CTX-Ⅰ)and N-terminal propeptide of type Ⅰ collagen(PINP) were tested by chemiluminesence.SPECT whole body bone and target joint scan before treatment was done.Thirty-nine healthy subjects as control group received ultrasound,electrocardiogram,X-ray,and whole body bone imaging examination.Quantitative values of joint imaging were calculated for the statistical analysis.Result Demographic data between RA group and control group were comparable (P ＞ 0.05),including sample,sex,age and BMI.The joint SPECT value,CTX-Ⅰ and PINP levels were all significantly higher than those of control group (P ＜ 0.01),which were 6.48 ± 1.98 versus 3.73 ± 1.t6;(0.66 ± 0.37) mg/L versus (0.58 ±0.21) mg/L;(46.35 ±28.15) mg/L versus (30.47 ± 13.75) mg/L respectively.Joint SPECT values had positive correlations with serum CTX-Ⅰ levels in all RA patients,as well as PINP in patients with disease duration 6mon-2years.And the according correlation coefficients were 0.513,0.495,0.402 (P ＜ 0.05).But SPECT value had no correlation with CTX-Ⅰ (P =0.081) in patients with disease duration less than 6 mon.The correlation coefficient was 0.336.Conclusion SPECT imaging quantitative values were positively correlated with serum bone metabolic parameters.Thus SPECT imaging alone or combined with bone markers are helpful in diagnosing active RA.

Objective To evaluate the value of CT perfusion imaging (CTPI) in the diagnosis of hepatocellular carcinoma (HCC). Method CTPI was carried out on 21 patients with 26 lesions to obtain the following perfusion parameters: hepatic blood flow (HBF), hepatic blood volume (HBV),mean transit time (MTT), permeability surface area product (PS), and hepatic arterial fraction (HAF). The parameters from the lesion and non-lesion areas were compared. In addition, serum AFP was measured in the HCC patients and a linear correlation analysis between the alpha-fetoprotein (AFP) level and the CTPI parameters was performed. Result CTPI failed in 3 patients with 3 lesions and was successful in 18 patients with 23 lesions which included 18 HCC, 4 hemangioma of the liver,and 1 hepatic focal nodular hyperplasia (FNH). On comparison of the HCC parameters in the lesion and non-lesion areas, significant differences were found in the HAF which was 4.11 times higher in the lesion than the non-lesion areas, while the MTT and PS were significantly lower. There was no significant difference in the HBF and HBV. Correlation between the serum AFP level and the CTPI parameters of the HCC lesion was insignificant. The differences of all the parameters between the lesion and the non-lesion in hemangioma were similar to those in HCC, except for a higher HBF in the lesion than in HCC. There was no significant difference between the parameters of FNH and the non-nodular part of the liver. Conclusion CTPI played an important role in the diagnosis and differential diagnosis of HCC, especially when the AFP was negative and/or the imaging manifestation was atypical on contrast CT.

Objective To investigate the clinical value of 99Tcm-MIBI SPECT-CT image fusion technology for diagnosing breast tumor and detecting axiiiary lymph node metastasis. Methods 99Tcm-MiBI breast and axillary lymph node planar and SPECT-CT imaging in 80 female breast tumor patients were done. All patients had pathological examination results after surgery as control. Results SPECT-CT fusion images sensitivity for breast cancer diagnosis, specificity and accuracy rates were 88.2 % (45/51), 93.1% (26/29) and 90 % (71/80). Planar imaging sensitivity, specificity and accuracy rate were 82.4 % (42/51), 79.3 %(23/29) and 81.3 %(65/80). SPECT-CT fusion images were higher than planar imaging (P <0.05). SPECT-CT fusion images sensitivity, specificity and accuracy for detecting axillary lymph node metastasis were 81.8 %(18/22), 89.7 % (26/29) and 86.3 % (44/51). Planar imaging sensitivity, specificity and accuracy were 77.2 % (17/22), 86.2 % (25/29) and 82.4 %(42/51). There was no significant difference between them (P0.05). Conclusion SPECT-CT image fusion technology in the diagnosis of breast cancer is better than planar imaging. SPECT-CT image fusion in detecting axillary lymph node metastasis of breast cancer is similar to planar imaging.

AIM: To observe the activity and distribution of astrocytes and glial fibrillary acid protein(GFAP) after middle cerebral artery occlusion (MCAO). METHODS: The rat MCAO model was made by two-kidney, tow clip renovascular hypertensive rat stroke prone(RHRSP). Rats were killed and brain samples were collected at the end of 1,3,6 and 9 weeks after MCAO, respectively. The ultrastructure of astrocytes was determined at broder of infarct (A area); distant of infarct (B area) and opposite of hemisphere (C area) by electron microscope. The number and optical density of GFAP-positive cells were also observed. RESULTS: The astrocyte proliferation distributed in the whole brain after MCAO. The highest numbers of GFAP-positive cells were observed at A area, then B area. The lowest numbers of GFAP positive cells were found in C area. The time course of GFAP-positive cell change was that the highest number was observed at 1 week after MCAO, then decreased by time from 3, 6 weeks to 9 weeks. The optical density of GFAP-positive cells showed the same patterns. CONCLUSION: The correlation between astrocyte proliferation and tissue damage after MCAO can be estimated by GFAP expression. The astrocyte proliferation plays an important role in healing process after MCAO.

Purpose To study the malignant transformation after treating rat oval cell line ( WB-F344 ) with chemical carcinogen N-methyl-N′-nitro-N-nitrosoguanidine ( MNNG) . Methods WB-F344 cells were cultured with MNNG for severe times. The biological characteristics of induced cells were detected through the following methods:to check proliferation activity by flow cytometry analysis, to examine malignant transformation degree of induced cells by soft agar assay and tumor formation in NOD/SCID mice, and to investi-gate the transcriptional and protein levels of hepatocellular carcinoma marker GGT, GST-P by real time-PCR. Results Oval cells in-duced by MNNG showed changes in biological characteristics and malignant molecular markers. Conclusion Hepatic oval cells model is successfully established, which can be confirmed by tumor formation in NOD/SCID mice.

Objective To assess the value of shear-wave elastic modulus for differential diagnosis of benign and malignant breast lesions using Meta-analysis.Methods Relevant Chinese and foreign articles about shear-wave elastography for differentiating benign and malignant breast lesions were collected from the literatures published before Apr.2016.Meta-analysis was conducted to assess the overall ability of the shear wave elastic modulus including Emax,Emea,Eratio and Esd.Results Totally 31 studies were brought into the Meta-analysis.The summarized sensitivity (SSEN) and summarized specificity (SSPE) of Emax were 0.87(95％CI [0.83,0.91]) and 0.91 (95％CI [0.87,0.93]).The SSEN and SSPE of Emea were 0.84 (95％CI [0.77,0.89]) and 0.88 (95％CI [0.84,0.91]),The SSEN and SSPE of Eratio were 0.88(95％CI [0.83,0.91]) and 0.87 (95％CI [0.80,0.91],the SSEN and SSPE of gsd were 0.85 (95％CI [0.80,0.89]) and 0.90 (95％CI [0.85,0.94]).The summarized receiver operator characteristic analysis showed that the area under the curve of E E Eratio and Esd were 0.95,0.93,0.93 and 0.93.Conclusion The shear wave elastic modulus contribute to differentiate benign and malignant breast lesions.Among these indices,Emax is the best one.

Objective To systematically analyze and assess the overall value of transrectal shear wave elastograpy in diagnosis of prostate cancer (PCa) using Meta-analysis.Methods Relevant Chinese and foreign papers diagnosing PCa with transrectal shear wave elastograpy published before December 2016 were searched.The references were evaluated and screened according to the criteria of diagnostic research.The selected references were analyzed by Meta-Disc 1.4 and Stata 12.0 statistical software.Results Eight articles were included in the present Meta-analysis.Five of these literatures were about transrectal shear wave elastograpy in diagnosis of PCa,the summarized sensitivity (SEN) and summarized specificity (SPE) in diagnosis of PCa were 0.80 (95％CI [0.75,0.84]) and 0.75 (95％CI [0.71,0.79]),respectively;the positive likelihood ratios (PLR) and negative likelihood ratios (NLR) were 3.60 (95 ％ CI [2.57,5.05]) and 0.17 (95 ％ CI[0.08,0.37]),respectively;the area under SROC curves was 0.895.Five of these literatures were about transrectal shear wave elastograpy supplemental prostatic biopsy in diagnosis of PCa,the summarized SEN and SPE were 0.86 (95％ CI [0.83,0.88]) and 0.84 (95％CI [0.82,0.85]) respectively;the PLR and NLR were 5.81 (95％CI [3.07,10.99]) and 0.14 (95％CI [0.04,0.49]) respectively;the area under SROC curves were 0.924.Conclusion Transrectal shear wave elastograpy has better clinical value in detection of PCa and can be used to supplemental prostatic biopsy.

AIM:Atherosclerotic calcification is highly linked with plaque instability and cardiovascular events .Adenosine monophosphate-activated protein kinase ( AMPK) has been involved in the pathogenesis of various cardiovascular disease .The contributions of AMPKαsubunits to the development of atherosclerotic calcification in vivo remained unknown .We hypothesized that AMPKαsubunits may play a role in the development of atherosclerotic calcification .METHODS: Atherosclerotic calcification was generated by 24-week fed of western diet in ApoE-/-background mice .Calcification was evaluated in aortic roots and innominate arteries of ApoE-/-mice or in mice with dual deficiencies of ApoE and AMPKαsubunits globally ( AMPKα1 and AMPKα2 ) , or vascular smooth muscle cell ( VSMC)-specific or macrophage-specific knockout of AMPKα1 with atherosclerotic calcification pone diet . The mechanism of AMPKα1 in regulating Runx2 was further explored in human aortic VSMC .RESULTS: Ablation of AMPKα1 but not AMPKα2 in ApoE-/-background promoted atherosclerotic calcification with increased Runt -related transcription factor ( Runx2 ) expression in VSMC compared with ApoE-/-mice.Conversely, chronic administration of metformin, which activated AMPK, markedly reduced ath-erosclerotic calcification and Runx2 expression in ApoE-/-mice but had less effects in ApoE-/-/AMPKα1 -/-mice.Furthermore, VSMC-but not macrophage-specific deficiency of AMPKα1 in ApoE-/-background promoted atherosclerotic calcification in vivo com-pared with the controls .AMPKα1 silencing in human aortic VSMC prevented Runx 2 from proteasome degradation to trigger osteoblastic differentiation of VSMC .Conversely , activation of AMPK led to Runx 2 instability by inducing its small ubiquitin-like modifier modifi-cation (SUMOylation).Protein inhibitor of activated STAT-1 (PIAS1), the SUMO E3-ligase of Runx2, was directly phosphorylated by
AMPKα1 at serine 510, to enhance its SUMO E3-ligase activity.Ablation of PIAS1 serine 510 phosphorylation inhibited metformin-in-duced Runx2 SUMOylation, and subsequently prevented the effect of metformin on reducing oxLDL-triggered Runx2 expression in hu-man aortic VSMC.CONCLUSION:Deficiency of AMPKα1 in VSMC increases Runx2 expression and promotes atherosclerotic calcifi-cation in vivo.AMPKα1 phosphorylates PIAS1 to enhance Runx2 SUMOyalation and subsequent degradation .