Objective To investigate the clinical characteristics of patients with polyarteritis nodosa (PAN),and to improve the understanding of the disease.Methods The data of 65 consecutive PAN patients admitted to Peking Union Medical College Hospital from October 2001 to March 2013 were analyzed.Patients were divided into two groups based on hapatitis B surface antigen (HBsAg) status.Chi-square test,Fisher exact probability,t test and Mann-Whitney test were used for statistical analysis.Results The male/female ratio of patients with PAN was 1.3/1,and the average age was (37.6±1.6) years old.Fever (in 40 cases,62％) was the most frequent manifestation.Skin was involved in 51 cases (79％),urologic involvement in 44 cases (68％),peripheral nervous system involvement in 22 cases (34％) and gastrointestinal involvement in 21 cases (32％).Forty-six (71％) patients had high-sensitivity C reactive protein (hs-CRP) elevation and 11 (17％) patients had eosinophil count elevation.The most common vascular involvements were limb arteries in 22 cases (34％),renal artery in 19 cases (29％),and gastrointestinal artery in 17 cases (26％).Patients with negative HBsAg had more frequent arthralgia or arthritis(41％ vs 9％,x2=4.00,P＜0.05),more indicators of poor prognosis (30％ vs 0,P＜0.05) and more glucocorticoid pulse therapy (30％ vs 0,P＜0.05) when compared with patients with positive HBsAg.Conclusion Clinical manifestations of PAN are complex.Young patients with fever of unknown origin,rash,weight loss,myalgias,accompanied by symptoms of multi-organ damage including urologic,peripheral nervous system,gastrointestinal involvement and negative autoantibodies should be highly suspected for the diagnosis of PAN.For the treatment of patients with positive HBsAg,special attention should be paid to maintain the delicate balance between controlling the organ damage caused by PAN and prevention of hepatitis B virus (HBV) infection reactivation.

Objective:To analyze the high risk behaviors of HIV/AIDS and its influencing factors in men who have sex with man(MSM)in a city,so as to provide evidence for the targeted intervention.Methods:Between July 2006 and October 2006,1000 MSM were sampled by snowball sampling and had a face to face interview by well trained investigators with informed consent.Questions on age,education background,and sex orientation were designated and 3 ml blood samples were obtained for examination of HIV and syphilis.?2 test and logistic regression analysis were used for statistical analysis.Results:The average age of the 1 000 MSM was 27.8?9.1 years old.In the past 6 months,43.6% of them had 3 or more male sex partners,53.6% had unprotected anal intercourse with men,8.0% had commercial sex with men,and 24.3% had sex with women.Elder subjects had a higher ratio of unprotected anal intercourse and male-female sex;subjects with lower educational background had more sex partners and male-female sex.Subjects working in the bathhouse had a higher ratio of commercial sex and male-female sex.Subjects with a male-female sex orientation or undetermined sex orientation had a higher ratio of commercial sex.Syphilis was detected in 93(9.3%)subjects and HIV was detected in 104(10.4%)subjects;among them 18 subjects had both syphilis and HIV.Multivariate logistic regression analysis showed that the aged(OR=3.5,95%CI 1.7-7.1),the number of male sex partners(OR=3.8,95%CI 1.9-7.6),the behavior of unprotected anal intercourse(OR=1.9,95%CI 1.0-3.5)and the infection of syphilis(OR=2.1,95%CI 1.4-3.4)were independently associated with the risk of HIV/AIDS prevalence;the knowledge of AIDS was the protective factor of HIV/AIDS prevalence(OR=0.5,95%CI 0.3-0.7).Conclusion:High risk behaviors of HIV exist in MSM population in the researched city;there is local epidemic of HIV.Interventions should be given according to age,educational background,sex orientation,etc.

Objective To survey the high risk behavior and infection of HIV/AIDS among men who have sex with men(MSM)and provide scientific evidence for HIV/AIDS prevention and control.Methods MSM were sampled by snowball sampling method and were interviewed by well trained investigators face to face under the informed consent.Their venous blood samples were collected for HIV seropositivity rate.Results A total of 1000 MSM,averagely aged(27.8?9.1)years,were interviewed,among whom 43.9% perceive AIDS knowledge.78.6% had anal intercourse with male partners,31.8% of whom always used condom in the past 6 months.8.0% participants had commercial sex with men in the past 6 months.The prevalence of HIV in the surveyed subjects was 10.4%.Conclusion Potential risk of HIV epidemic threatens local MSM who spread the risk to general population.High risk behavior is ubiquitous among MSM.It is imperative to carry out targeted interventions among MSM.

Objective To explore the correlation of epicardial adipose tissue (EAT) volume with atrial fibrillation (AF) and its recurrence after radiofrequency ablation (RA).Methods Eighty-five AF patients (AF group) and 90 non-AF patients (control group) were chosen between January 2014 and May 2016.Their EAT volumes were measured by CT scanning.Patients in AF group after RA were followed up 6-18 months,and the recurrence of AF was recorded.The recurrence of AF within 3 months of RA was defined as blanking recurrence group (n =27) and non-blanking recurrence group (n =58),and that after 3 months of RA was defined as the 1 ong-term recurrence.Results The total EAT volume and left atrial EAT volume were significantly larger in blanking recurrence group than in non-blanking recurrence group [(118.71 ±28.94) cn3 vs (97.73 ±24.86)cm3,(29.98 ±8.09)cm3 vs (23.11 ±8.30)cm3,t =6.219,4.451,P ＜ 0.01].Multivariate logistic resgression analysis showed that total EAT volume and left atrial EAT volume were the independent risk factors for AF.All showed that total EAT volume and left atrial EAT volume were the independent risk factors for blanking recurrence.The incidence of long-term recurrence was significantly higher in blanking recurrence group [40.7％ (11/27)] than in non-blanking recurrence group [15.5 ％ (9/58)] (x2 =7.142,P ＜ 0.05).Conclusions The incidence of AF is higher in patients with a Iarger total EAT volume and a larger left atrial EAT volume and AF is easier to recur even though after RA.

Objective To study the relation of epicardial adipose tissue (EAT) thickness with 1eftventricular remodeling and dysfunction in dilated cardiomyopathy (DCM) patients.Methods One hundred and twenty DCM patients who received treatment from Febuary 2012 to February 2016 were served as DCM group,and 76 healthy subjects undergoing physical examination were served as control group.Their left ventricular end-diastolic diameter (LVEDD),left ventricular end systolic diameter (LVESD),left ventricular end diastolic volume (LVESV),left ventricular end systolic volume (LVEDV),left ventricular end diastolic volume index (LVEDVI),left ventricular end systolic volume index (LVESVI),sphericity index (SI),leftventricular ejection fraction (LVEF),and EAT thickness were measured by routine cardiac ultrasonography and compared between two groups.Results The levels of LVESD,LVEDD,LVESV,LVEDV,LVESVI,LVEDVI and EAT thickness in DCM group were significantly higher,and the levels of LVEF,SIS and SID in DCM group were significantly lower (P＜0.05).The EAT thickness in DCM group with NYHA class Ⅱ,Ⅲ,Ⅳ was (8.1 ± 1.8),(7.8 ± 2.0),(7.9 ± 1.7) mm,and there was significant difference (F=1.973,P＞ 0.05) Linear correlation analysis showed that the EAT thickness was positively related with the LVESD,LVEDD,LVESV,LVEDV,LVEDVI,LVESVI,SISand SID (r =0.247,0.231,0.256,0.267,0.293,0.281,0.261,0.237,P＜0.05).There was no relationship between EAT thickness and LVEF (r =0.132,P＞ 0.05).Logistic multifactor regression analysis showed that EAT thickness was an independent risk factor for left ventricular remodeling in DCM patients (OR =0.793,95％CI:0.431-1.734,P =0.039).Conclusions The EAT thickness is significantly related with the left ventricular remodeling and can be used as an independent risk factor for predicting left ventricular remodeling in DCM patients.

From July 2006 to November 2008,16 patients with unstable intertrochanteric fractures were treated with cemented bipolar hemiprosthesis arthroplasty, including 5 males and 11 females, at a mean age of 84 years (range, 78-92 years) in the First Affiliated Hospital of Soochow University. Of them, 15 patients were followed with mean time of 14 months. The cemented bipolar hemiprosthesis was purchased from Beijing Montagne. The patients received 5-7 days of antibiotics following arthroplasty in addition to medicine of anticoagulation and analgesia. 1 case died of pulmonary heart disease 10 months after the operation and 3 cases had heterotopic ossification. There was no prosthesis loosening or dislocation. According to Harris hip scores, 3 cases were rated as excellent, 9 good, 3 fair, and 0 poor; the excellent and good rate was 80%. Results show that cemented bipolar hemiprosthesis arthroplasty is effective in treating elderly unstable intertrochanteric fractures, but operation indications require more attention.

BACKGROUND: Many clinical cases have proved that the satisfactory reposition, fusion and internal fixation in the internal fixation for inferior lumbar spondylolisthesis are not consistent with the postoperative symptoms and physical signs, and functional restoration.OBJECTIVE: To investigate the application of somatosensory evoked potential(SEP) in the monitoring during internal fixation for inferior lumbar spondylolisthesis, and the effects of SEP monitoring on the improvement of postoperative symptoms and the spinal functions as well.DESIGN: A randomized controlled trial.SETTING: Inpatient department of spinal surgery, an affiliated hospital of a university. PARTICIPANTS: Fifty-two patients with inferior lumbar spomlylolisthesis including 23 male and 29 female cases aged between 18 and 68 years old were admitted by the Department of Spinal Surgery, Second Affiliated Hospital(Shenzhen People's Hospital) of Jinan University, from June 2000 to December 2003. All cases were randomly divided into control group(n = 20) and monitor group ( n = 32).METHODS: SEP induced by segmental stimulation in cutaneous nerve was used in the control group for preoperative and intraoperative monitoring, and postoperative follow up. The intraoperative potential changes in patients with excellent and good improvement in postoperative functions had been retrospectively investigated to confirm the effective indices for intraoperative monitoring, which thereby provided references for intraoperative monitoring in patients of monitor group.MAIN OUTCOME MEASURES: ① Evaluation of postoperative spinal function; ② SEP latency and amplitude.RESULTS: SEP values after postoperative anesthesia were set as basis.The manifestations of intraoperative potential alterations: ① If the latency reduced 10% -15% or the amplitude increases more than 40% after fixation, it suggested favorable prognosis; ② The potential indices were stable during monitoring, or the reduction of latency was less than 10%,or the increase of amplitude was less than 30%, the fixation could be continued, and partial functions of nerve root and symptoms could be improved after surgery; ③ During the surgery, if potential indices had transient lluctuation, which could be recovered to basic potential within 15 to 20 minutes, fixation should be stopped during the fluctuation. Still partial functions of nerve root and symptoms could be improved after surgery; ④If the intraoperative latency prolonged more than 5%, or amplitude reduced more than 10%, or part of the components disappeared, or the wave shape dispersed, it might suggest postoperative aggravation of pain and dyskinesia. So intraoperative adjustment was necessary. The coincident rate of the improvement of the indices of intraoperative monitoring and the improvement of postoperative spinal function reached 93.75%.CONCLUSION: SEP induced by segrmental stimulation in cutaneous nerve is an objective and effective method in the monitoring and instruction of decompression, reposition, fixation of internal fixation for inferior lumbar spondylolisthesis, which has important merits in the improvement of the function of nerve root and the restoration of spinal function.

Objective To explore the distribution and antimicrobial resistance of pathogens causing healthcare-associated infection(HAI) in a hospital,and provide theoretical basis for rational use of antimicrobial agents and control of HAL Methods HAI occurred in patients in this hospital between 2011 and 2015 were chosen,distribution of major pathogens causing HAI and antimicrobial resistance were analyzed.Results A total of 852 pathogenic strains were isolated,including 458 (53.75 ％) strains of gram-negative bacteria,259 (30.40 ％) fungi,and 135 (15.85 ％) gram-positive bacteria,the top 4 pathogens were Klebsiella pneumoniae (n =159,18.66 ％),Candida albicans (n =119,13.97％),Acinetobacter baumannii (n =81,9.51％),and Escherichia coli (n =74,8.69 ％).Isolation rate of gram-negative bacteria increased from 47.41 ％ in 2012 to 61.57％ in 2015,fungi increased from 24.78％ in 2011 to 34.45％ in 2014 (2015 was 27.95％),gram-positive bacteria decreased from 26.55％ in 2011 to 10.48％ in 2015.Resistance rates of Escherichia coli and Klebsiella pneumoniae to imipenem and meropenem were 8.11％-12.58％;Acinetobacter baumannii had the lowest resistance rate to cefoperazone/sulbactam(23.46％),resistance rate of Candida albicans to fluconazole was up to 59.66％,vancomycin-resistant gram-positive bacteria was not found.Conclusion The major pathogens causing HAI are opportunistic pathogens,antimicrobial resistance is serious,the species and distribution varies with different years,it is necessary to enhance specimen detection rate,strengthen the monitoring on pathogen resistance,and use antimicrobial agents rationally.

Objective To investigate the frequence and clinical characteristics of peripheral neuropathy (PN) of patients with systemic lupus erythematosus (SLE) in China.Methods The data of 67 consecutive PN related with SLE (SLE-PN) patients admitted to Peking Union Medical College Hospital (PUMCH) during January 1995 to August 2011 were retrospectively analyzed.At the same time,a total of 201 cases were randomly selected as controls from 4447 SLE patients without SLE-PN in PUMCH during the same period.Chi-square test,t test and Mann-Whitney test were used for statistical analysis.Results The prevalence of SLE-PN in SLE patients was 1.5％(67/4514).Seventy-two cases of PN were discovered in 67 patients.Polyneuropathy was the most frequent presentation and was diagnosed in 45 cases(62.5％),mononeuropathy in 9 cases (12.5％),myasthenia gravis in 8 cases (11.1％),cranial neuropathy in 7 cases (9.7％),autonomic disorder in 2 cases (2.8％) and acute inflammatory demyelinating polyradiculoneuropathy in 1 case (1.4％).No plexopathy was diagnosed.No symptoms were observed in 5 cases (6.9％) PN.There were differences between SLE patients with and without SLE-PN in age[(37±14) years vs (32±14) years,P＜0.05],fever(65.7％ vs 47.8％,P＜0.05),myositis (17.9％ vs 5.0％,P＜0.01),skin and mucous involvement of skin and mucous (80.6％ vs 59.7％,P＜0.01),central nervous system involvement (38.8％ vs 19.9％,P＜0.01),gastrointestinal involvement (6.0％ vs 18.4％,P＜0.05),anti-Sm antibody positivity (34.4％ vs 18.6％,P＜0.05),anti-RNP antibody positivity (46.9％ vs 29.9％,P＜0.05),elevation of IgG (52.4％ vs 30.1％,P＜0.01),and SLEDAI score [12.0(9.0) vs 9.5(10.8),P＜0.05].Conclusion SLE-PN is not rare in patients with SLE.SLE patients with peripheral neuropathy tend to have more active disease.Multidisciplinary collaboration and comprehensive treatment can help to relieve pain and improve the quality of life.

Objective To compare the outcome of proximal femoral nail antirotation (PFNA)and third generation of Gamma nail (TGN) in the treatment of femoral intertrochanteric fracture in the elderly. Methods From January 2007 to June 2008, the patients with intertrochanteric fractures were divided into PFNA group ( n = 55 ) and TGN group ( n = 52 ) randomly. The two treatment groups were comparable in aspect of general data. The clinical data of surgical trauma, complications and postoperative function of the two groups were compared in our study. Results The mean operation time was (66.6 ± 15.4) min in PFNA group and (73. 1 ± 20.8 ) min in TGN group (P ＞ 0. 05 ). The mean intraoperative blood loss differed significantly, (219.5 ± 107.5 ) ml in PFNA group compared with (269.0 ±123.9) ml in TGN group ( P ＜ 0. 05 ). The mean fluoroscopy time was ( 2.97 ± 1.14 ) min in PFNA group and (3.43 ± 1.18) min in TGN group (P＜0.05). Unilateral femoral shaft splits at the distal end of the nail was observed intra-operatively in four patients of the PFNA group and in one of the TGN group,with no statistical difference between two groups. Of all, 91 patients ( n =46 in the PFNA group and n =45 in the TGN group) were followed up for a duration of ( 17.5 ±3.69) months. There was one re-fracture and one implant failure during the follow up period in PFNA group, which was not found in TGN group. Fiftyone patients recovered to normal activity status, including 27 in the PFNA group and 24 in the TGN group,with no statistical differences. Conclusions Intertrochanteric fracture can be treated successfully with PFNA and TGN. There is no significant difference in complications and functional outcome between the two groups. However, PFNA takes advantages of less blood loss, less operative time and less fluoroscopy time over TGN.