AIM: To investigate the efficacy and safety of low-dose leflunomide (Lef) combined with methotrexate (MTX) in the treatment of rheumatoid arthritis (RA). METHODS: Sixty-four RA patients were randomly divided into two groups, with 32 patients in each group. All the patients were required to stop the treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) for 1 wk before entering the trial. Patients in the Lef+MTX group received Lef 20 mg, po, qd in the first 4 wk, followed by 10 mg,po, qd for next 20 wk. Patients also received MTX 7.5 mg,po, qw during the trial. Patients in the MTX group received MTX 15 mg,po, qw for 24 wk. Physical and laboratory examinations were performed at the beginning of the trial, after 12 wk treatment and 24 wk treatment. Entopic X-ray examination of both hands was performed before and after the treatment. RESULTS: The rate of remarkable improvement was 88% (28/32) in Lef+MTX group and 38% in MTX group (12/32). Adverse reactions were reported in 12% (4/32) patients in Lef+MTX group and 43% (14/32) patients in MTX group. The reported adverse reactions were rash and nausea in Lef+MTX group and nausea, vomiting, oral ulcer, alopecia, ALT elevation, palpitation and menoxenia in MTX group. CONCLUSION: Combination of Lef with MTX is safe and effective in treatment of RA with less adverse reactions.

Objective To compare the effect of midazolam and propofol on cytokine balance in patients undergoing cardiac valve replacement under CPB. Methods Twenty NYHA class Ⅱ - Ⅲ patients with rheumatic heart disease scheduled for elective cardiac valve replacement under CPB were randomly divided into 2 groups: midazolam group (M, n = 10) and propofol group (P, n = 10) . Patients with preoperative hepatic and renal dysfunction, coagulation defect and diabetes, primary hypertension and coronary artery disease were excluded. The patients were premedicated intramuscular morphine 0.1 mg?kg-1 and oral diazepam 0.1 mg?kg-1. Anesthesia was induced with midazolam 0.06-0.1 mg?kg-1 (group M) or propofol 1.0-1.5 mg?kg-1 (group P) and scopolamine 0.6 mg, fentanyl 4-10 ug?kg-1, vecuronium 0.1 mg?kg-1 and lidocaine 1.5 mg?kg-1, and maintained with intermittent iv boluses of midazolam 0.04-0.1 mg? kg-1 (group M) or propofol intravenous infusion at a rate of 3-5 mg?kg-1?h-1 supplemented with intermittent boluses of fentanyl and vecuronium. PETCO2 was maintained at 30-40 mm Hg during mechanical ventilation. BP, HR, ECG, CVP, PETCO2, SpO2 , nasal and rectal temperature were continuously monitored during operation. Blood samples were taken from artery before anesthesia (T1), at vena cava catheterization (T2), 30min after aortic cross-clamping (T3) and 10 min (T4), 1 h (T5), 2 h(T6), 4 h(T7) and 24 h(T8) after declamping of aorta for determination of Hct, IL-1, IL-8 and IL-10 by using ELISA. Results Plasma concentrations of IL-6, IL-8 and IL-10 were significantly increased at T4-7 as compared with the baseline value before anesthesia (T1) in both group. Plasma concentration of IL-8 in group P was significantly lower than that in group M at T7 ( P

Aim To explore the effect of N-acetyl-L-cysteine ( NAC ) on β amyloid peptide 25 - 35 ( Aβ25-35 )-induced the increase of calpain activity and its possible mechanism. Methods The activity of cal-pain was induced by 20μmol·L-1 Aβ 25-35 in primary cortical neuron. Neurons were incubated in the absent or present Aβ25-35 , or pre-incubated NAC ( 10 mmol ·L-1 ) , then co-incubated with Aβ25-35 . The meas-urement of calpain activity, H2 O2 level and mitochon-drial membrane potential was performed on a micro-plate fluorometer. The ATP level was detected using a luciferin/luciferase based ATP assay kit. Results In Aβ25-35 treated group, the activity of calpain and H2 O2 was obviously higher than that in control group. How-ever, in neurons pre-incubated in NAC and then co-in-cubated in Aβ25-35 , the calpain activity and H2 O2 level were significantly decreased compared with that in Aβ25-35 group. Upon Aβ25-35 exposure for 12 h, corti-cal neurons showed a significant decrease in mitochon-drial membrane potential and ATP level when com-pared to the control group. Pre-treatment with NAC showed an increase in mitochondrial membrane poten-tial and ATP level as compared to neurons treated with Aβ25-35 alone for 12h. Conclusion This result sug-gests that NAC can attenuate calpain activity induced by Aβ25-35 through protecting mitochondria.

Keap1 -Nrf2/ARE pathway plays a wide role of cell protection function in anti-tumor,antistress,anti-apoptosis,anti-inflammatory response.It has become a focus of the neuroprotective effects in nervous system.We will review on the latest research of Keap1-Nrf2/ARE pathways in cerebral ischemia.It will provide a basis for the prevention and treatment of central nervous system.

[Objective] To explore the relationship between TCM syndrome patterns and physicochemical parameters of chronic obstructive pulmonary disease (COPD). [Methods] Five hundred hospitalized cases of COPD were investigated. The correlation of TCM syndrome patterns with pulmonary function, blood analysis and biochemical indexes were assayed by logistic forward regression analysis and linear multiple regression analysis, and then the above indexes were analyzed by independent- samples t test. [Results] Five equations were obtained by logistic regression. Positive correlation was found between the number of white blood cells (WBC) and the pattern of phlegm-heat blocking lung, hemoglobin (HGB) level and the pattern of yang deficiency with fluid retention, as well as red cell distribution width (RDW) and the pattern of kidney deficiency. Maximal expiratory flow rate in residual 75 % vital capacity ( MEF75), peak of expiratory flow (PEF) and mean corpuscular hemoglobin (MCH) were negatively correlated with the pattern of yang deficiency with fluid retention. Maximal expiratory flow rate in residual 25% vital capacity (MEF25) and granulocyte percentage (GP) were also negatively correlated with the pattern of spleen deficiency. So did potassium ions (K+ ) level and the pattern of kidney deficiency, t test showed the same results. [Conclusion] The above indexes have great value for TCM syndrome differentiation of COPD.

Professional post means the personal capability certified by nation. Professional post has the function of choosing approriate person and helping to reform salary distribution system,and has beome an important lever to arouse the working enthusiasm of staffs.This article introduces the experience of using professional post to improve clinlical teaching work in the first affiliated hospital of Chongqing Medical University.

Based on the practical situations of higher medical education in china,the author discussesd the bottleneck problems in the development of medical bilingual teaching and proposed some measures to overcome these difficulties on the teaching objective,teaching staffs,textbooks,students' quality and evaluation mechanism of teaching quality.

Objective To study the expressions of CD24 and SLeX in lung cancer tissues,and evaluate the relation ship with development and progression of lung cancer.Methods Immunohistochemistry was used to detect the expressions of CD24 and SLeX in 70 specimens of lung cancer.Results The positive expression rates of CD24,SLeX in non-small cell lung cancer tissues were 41.3% and 63.5% respectively,There were no expression and weak expression respectively in small cell lung cancer (SCLC) tissues. The positive rates of CD24,SLeX in adenocarcinoma were 55.9% and 76.5%,respectively,which were higher than those in squamous cell carcinoma (24.1%,48.3%)(P0.05).In lung adenocarcinoma and squamous cell carcinoma,the positive expression rate of SLeX in stage Ⅲ (83.3%) was higher than that in stage Ⅰ-Ⅱ (55.6%),the positive rate in poor differentiated lung cancer(80.8%) was higher than those in moderate and well differentiate cancer(51.4%),the positive rate in female patients (76.7%) was higher than that in male patients (51.5%)(all P

Objective To study the influence of sole massage on children’s analepsia from general anesthesia.Methods One hundred children in analepsia period were divided into the test group(50 cases)and the control group(50 cases).The routine nursing and monitoring during recovery stage were done in the control group.Based on the routine monitoring and nursing care as in the control group,the test group received sole massage for 10 minutes.The two groups were compared in terms of declining percentage of SpO2, rate of nausea,blood pressure,heart-rate variability,and post-analepsia dysphoria scores.Result The test group was significantly lower than the control one in all the indexes of the declining percentage of SpO2,rate of nausea,blood pressure,heart-rate variability,and post-analepsia dysphoria scores(all P<0.05).Conclusions Sole massage during children’s analepsia from general anesthesia is effective not only in lessening their declining percentage of SpO2,rate of nausea,blood pressure,heart-rate variability, and recovery dysphoria mark,but also easing their dysphoria,anxiety and fear.It may create a good condition for children to live through analepsia period successfully and safely.

Objective To realize antimicrobial resistance and carrying status of OXA carbapenemase among imi-penem-resistant Acinetobacter baumannii (IRAB)isolated from patients of Hohhot,so as to provide guidance for the prevention and control of healthcare-associated infection(HAI)caused by multidrug-resistant Acinetobacter bauman-nii .Methods 49 IRAB isolates from 3 tertiary first-class hospitals in Hohhot between January and December 2012 were collected,antimicrobial susceptibility testing was performed by Kirby-Bauer disk diffusion method,four geno-types(blaOXA-51-like ,blaOXA-23-like ,blaOXA-24-like ,blaOXA-58-like )of OXA carbapenemase were detected by polymerase chain reaction (PCR).Results All 49 isolated IRAB strains were found to be highly resistant to antimicrobial agents (81 .63%-100.00%)except to minocycline (8.16%);blaOXA-51-like was identified in 49 strains (100.00%),42 (85.71 %)of which also carried blaOXA-23-like gene ,blaOXA-23-lik and blaOXA-51-like were both found in three hospital, blaOXA-24-like and blaOXA-58-like weren’t found.Conclusion IRAB strains present multidrug resistance,resistant to mi-nocycline is the lowest;blaOXA-23-like is the main drug-resistance mechanism of IRAB in Hohhot.