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

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

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.

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.

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.

[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.

Objective To investigate the relationship of angiotensin converting enzyme (ACE I/D) gene I/D polymorphism with vitiligo.Methods PubMed,the Cochrane Library,China academic journal full-text database and VIP database and Wan fang database were searched according to the inclusion and exclusion criteria,and the quality of included studies was assessed.The data were quantitatively analyzed by Stata 12.0 software.Results Nine articles were included.Meta analysis results showed that the susceptibility of vitiligo difference was statistically significant in the total population of ACE I/D genotype (DD + II)vs.DI (OR=0.759,95％ CI:0.643 ～0.896,P=0.001),the (DD+DI) vs.II (OR=1.523,95％ CI:1.153 ～2.011,P =0.003).The genotype subgroup analysis showed the D vs.I (OR =1.381,95％ CI:1.054 ～1.810,P=0.019),DDvs.II (OR=1.830,95％ CI:1.110～3.017,P=0.018),(DD+ II) vs.DI (OR=0.814,95％ CI:0.667 ～0.994,P=0.043),and the (DD+ID) vs.II (OR=1.690,95％ CI:1.147 ～2.489,P =0.008) in Asian.The difference was statistically significantly related to vitiligo.Arab genotype (DD + II) vs.DI (OR =0.545,95％ CI:0.354 ～ 0.840,P =0.006) was associated with vitiligo occurrence.Begg's inspection publication bias analysis showed all genetic types did not exist any publication bias.Conclusions The ACE gene I/D polymorphism may be associated with vitiligo susceptibility.

Aim To investigate the expression of G protein-coupled receptor TGR5 and its effects on FN and TGF-β1 expression cultured under high glucose condition in rat glomerular mesangial cells , and then to explore the role of TGR5 in diabetic nephropathy. Methods INT-777 and TGR5 plasmid were used to activate TGR5 under high glucose(HG,30 mmol·L - 1 glucose ) condition, and anti-TGR5 small interfering RNA(TGR5 siRNA) was used to knock down TGR5. The protein expression of FN and TGF-β1 in rat me-sangial cells was detected by Western blot. Results TGR5 could be detected in rat glomerular mesangial cells. Both FN and TGF-β1 protein levels could be in-creased by high glucose compared with control group(P < 0. 05),and be inhibited by activiation of TGR5(P <0. 05). On the other hand,knockdown of TGR5 could increase FN and TGF-β1 protein to abnormal levels(P< 0. 01,P < 0. 05). Conclusion TGR5 suppresses HG-induced FN and TGF-β1 expression in rat glomer-ular mesangial cells,suggesting a protective role in the process of diabetic nephropathy.