The treat-to-target (T2T) strategies has greatly improved the prognosis of rheumatoid arthritis (RA).However,the emergence of musculoskeletal ultrasound has further brought new challenges and opportunities for RA T2T treatment.It has been revealed the subclinical synovitis generally presented in RA patients who achieved clinical remission.The subclinical synovitis has been confirmed to be associated with subsequent progression of bone erosion and flare.Therefore,clinical remission or low disease activity may be inappropriate or insufficient target.The ultrasound evaluation in addition to clinical assessment can help to control the disease activity better,which may eventually improve the long-term outcomes of RA patients.

Objective To study the changes of endothelin-1(ET-1) and tumor necrosis factor alpha(TNF?) in lung homogenate and plasm when acute respiratory failure(ARF) animal models are treated by bilateral femoral arteriovenous extracorporeal membrane oxygenation(bAV-ECMO).Methods Ten ARF dog models were treated by the bAV-ECMO.Right atrium blood and lung tissues were collected at different time points,and ET-1 and TNF? were assayed by radioimmunological method.Results ET-1 content in plasm decreased at first,and at 1h it was elevated and at 2h reached the peak.ET-1 content in lung homogenate reached the peak at 2h and then started to decrease.The analysis of variance showed notable differences(P

Accidents, Occupational ; Humans ; Hydrogen Sulfide ; poisoning

Objective: This study aims to investigate the protein expressions of cyclooxygenase-2 (Cox-2) and hypoxia-inducible factor 1 alpha (HIF-1α) and their correlations with the clinicopathological features of osteosarcoma and tries to reveal the potential mechanisms for the formation and progression of osteosarcoma. Methods: We screened 59 typical samples of osteosarcoma tissues without os and decalcification treatment. They were grouped according to the clinicopathologic characteristics and were followed up post surgery. Expression of Cox-2 and HIF-1 alpha were detected by immunohistochemistry. The results were evaluated by X2 analysis and Spearman rank correlation analysis. The postoperative survival rates were calculated by Kaplan-Meier survival curve and the differences between groups were analyzed by Log-Rank method. Results: The positive expression rates of COX-2 and HIF-1α in osteosarcoma were 69.49% and 38.98%, respectively, which were significantly different compared with negative expression in control group (P<0.01 and 0.05). The expression of Cox-2 in osteosarcoma positively correlated with the clinical stage (P<0.05) and the expression of HIF-1α correlated with the age of patients (P<0.01). The expressions of Cox-2 and HIF-1α were closely associated with the histological classifications. In COX-2- and HIF-1α-positive groups, the total positive rates (16.67% and 0%) of intraosseous well-differentiated and parosteaosteosarcoma were significantly lower than that of any others (73.33%, and 43.18%), respectively. The difference was significant (and P<0.01 and P<0.05). The expression of Cox-2 had positive correlation with HIF-1alpha. The positive co-expression of both HIF-1α and Cox-2 was 38.98%. There was 30.50% osteosarcoma tissues had no expression of both Cox-2 and HIF-1 alpha. The positive expression rates of HIF-1α in Cox-2 - positive and Cox-2 - negative groups were 56.10% and 0%, respectively. The difference was significant (P<0.01). The postoperative survival period was negatively associated with the expression of Cox-2 and HIF-1α. The postoperative accumulative survival rates were significantly lower in Cox-2 - and HIF-1 alpha - positive patients compared with those in Cox-2 - and HIF-1 alpha-negative patients (P<0.05 and P<0.01, respectively). Conclusion: Cox-2 and HIF-1α were over-expressed in osteosarcoma. Their expressions are related with the formation and progression of tumor and may have synergistic effects in prompting the malignant development of osteosarcoma. The patients with positive expression of Cox-2 and HIF-1α have lower postoperative accumulative survival rates. Their expressions may be useful prognostic factors for osteosarcoma.

Objective To investigate the ultrasound features of gouty joints during acute and past attacks. Methods Clinical data and ultrasound features of joints during the acute and past attacks of gouty patients who were experiencing an acute attack were collected. The differences of ultrasound features between two episodes, as well as the relationship with clinical characteristics were analyzed. Results Sixty-four patients were enrolled with 21 (33%) patients at their first attack. The first metatarsophalangeal (MTP1) joints were most frequently involved, meanwhile, 9.4% patients had two or more joints attacked during one episode. The most prevalent feature was synovitis at the acute phase, followed by double contour (DC) sign (18 cases, 28%), bone erosion (12 cases, 19%) and tophi (10 cases, 16%), while 23 patients had two or more pathological changes. Whereas, the DC sign was found most in previously attacked joints (10 cases, 33%), followed by tophi (8 cases, 27%), bone erosion (7 cases, 23%) and synovitis (4 cases, 13.3%). No positive pathological changes were found in asymptomatic joints. Synovitis was more common in joints during their acute attacks (80% vs 13%, χ2=20.475, P<0.01), however, DC sign and tophi were more common in previous attacked joints (10% vs 33% and 0 vs 27%, χ2=3.892, 6.642, P<0.05, respectively). Both the DC sign and tophi were positively correlated with the disease duration. Conclusion Synovitis is the most prevalent feature in gouty joints during acute episodes; even bone erosion can be found at the first attack. The DC sign, tophi and bone erosion are common in past attacked joints. The prevalence of both DC sign and tophi are increased along with disease durations. Subclinical synovitis can be detected in a small past of joints which are not at acute attack.

Objective The double-cavity balloon oppressor surgery for rhegmatogenous retinal detachment (RRD) has been utilized in past decades. But we have not yet a domestic device available. Present study was to investigate the effectiveness of double-cavity balloon oppressor using a domestic device in primary RRD surgery. Methods This clinical trial was a prospective study. Total 74 cases of patients with rhegmatogenous retinal detachment(RRD) (74 eyes) were enrolled. Double-cavity balloon oppressor surgery was performed in 40 eyes of 40 patients, and conventional segmental scleral buckling surgery was used in 34 eyes of 34 patients. The mean operative time, retinal attachment rate, vision and astigmatism change after operation between two different operative fashions were compared. The intra- and post-operative complication was discussed. The mean follow-up period was 4. 5 months. Written informed consent was obtained from all the patients before clinical trial. Results The retinal anatomic attachment rate was 92. 5% (37/40) in balloon oppressor surgery group and 91. 1% (31/34) in conventional surgery group, and there were no significant difference in retinal attachment rate among PVR grade A, B and C1 (P ＞0. 05) . The postoperative best corrected visual acuity (operative 3 months) was improved in 29 eyes(72. 5%) after balloon oppressor surgery and 25 eyes(73. 5%) after conventional surgery, showing insignificant difference between them (P ＞ 0. 05) . The mean surgical time was about (27. 00 ±8. 60) minutes in balloon oppressor surgery group and (47. 00 ± 14. 30) minutes in conventional surgery group(t =7. 41, P ＜0. 01) . Cylinder diopter change after surgery was insignificantly different between before and after operation in balloon oppressor surgery group (0. 52 ± 0. 30 D vs 0. 81 ± 0. 41 D, P ＞ 0. 05), however, there was a significant difference in cylinder diopter change between preoperation and postoperation (0. 65 ± 0. 32 D vs 1. 83 ± 0. 69 D, P ＜ 0. 05) . Conclusion Double-cavity balloon oppressor surgery for RRD is accurate and reliable. This operation procedure offer an economic, efficient and convenient choice for treatment of RRD.

Objective To compare the clinical value of nerve stimulator-versus ultrasound-guided continuous femoral nerve block for analgesia after laparoscopic surgery.Methods Forty patients,aged 18-60 yr,with body mass index of 18-30 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic surgery,were randomly assigned into 2 groups (n =20 each) using a random number table:nerve stimulator group (group S) and ultrasound group (group U).Epidural anesthesia was performed with 1.73 ％ carbonated lidocaine in both groups.0.2％ ropivacaine 5 ml/h was infused continuously after surgery to perform femoral nerve block for analgesia.VAS score at rest was assessed at 2,6,24 and 48 h after surgery.At 24 and 48 h after surgery,VAS scores during active and passive movement were assessed.The time for catheter placement near the femoral nerve and development of subcutaneous hematoma at the puncture site,local anesthetic intoxication and nausea and vomiting were recorded.The postoperative requirement for analgesics was also recorded.Results There was no significant difference in the VAS scores and puncture for femoral nerve block-and local anesthetics-related adverse events between the two groups.The time for catheter placement near the femoral nerve was 8.0 ± 1.4 and (6.7 ± 0.9) min in S and U groups,respectively,and the time was significantly longer in group S than in group U.No patients required rescue analgesic after surgery in both groups.Conclusion Nerve stimulator-guided continuous femoral nerve block provides higher clinical value than ultrasound-guided continuous femoral nerve block for analgesia after laparoscopic surgery and it is more suitable for clinical application.

Objective To study the change of angiotensin Ⅱ in the applications of pumpless ECMO, and its effect on prognosis of the acute respiratory failure. Methods The study was performed in ten dogs [ weight 18 - 35 kg, mean weight ( 23.4 ± 4.7 ) kg].A respiratory failure animal model was established end then was treated by bilateral femoral artery-venous ECMO. Collection right atriurn blood end constitution of lung at different time (before ECMO, during ECMO 1h, 2h, 3h, 4h). Angiotensin Ⅱ content in blood and lung homogenate was detected by radio-immunity mothod. Angiotensin Ⅱ expression loci in lung were detected by immunohistochemistry mothod. Results Angiotensin Ⅱ content in plasma was decreased at completion of the model, it was back up at 1 hour and reached the peak at 3 hours, then it slowly declined. Angiotensin Ⅱ content in lung homogenate increased at the beginning, peaked by 2 hours, end then it decreased. Loci angiotensin Ⅱ in lung by immunohistochemistry were expressed in most of epithelial cells cytoplast of bronchiole dissepimont, smooth muscle cell cytoplast of small blood vessel around it end a few macrophage cytoplasts during the model time..Conclusion It is valuable to measure engiotensin Ⅱ in blood through the bilateral femoral artery-venous ECMO, because it can reflect angiotensin Ⅱ in lung and the resume of lung in certain degree.

Humans ; Otorhinolaryngologic Surgical Procedures ; methods ; Quinolones ; therapeutic use ; Respiratory System Agents ; therapeutic use

Objective To explore the regulatory effect of apigenin on the blood pressure of the spontaneous hypertension rat(SHR) rats and the possible mechanism.Methods The case groups of rats were fed with different dosage of apigenin(0.03,0.05,0.11 g/kg) by gavage for 4 consecutive weeks,while the control groups were treated with equal cubage of oil.The body weight,heart rate,blood pressure were measured every week.Results After 4 weeks of treatment with apigenin,the blood pressure of SHR in all doses groups decreased significantly;besides,apigenin could reduce the content of ET-1 and AngII,however,it didn't change NOS activity.Conclusion Apigenin has a regulatory effect on blood pressure,its lowest effective dose is 0.03 g/kg bw and it may decrease the blood pressure through reducing the content of ET-1 and AngII,not through the NO/NOS pathway.