Objective To analyze the clinical efficacy of diacerein plus methotrexate and leflunomide in the treatment of rheumatoid arthritis in elderly patients.Methods Eighty elderly patients with rheumatoid arthritis seeking treatment at our hospital from September 2010 to December 2012 were divided into the treatment group (n =40) and the control group (n =40).Patients with osteoarthritis were excluded from enrollment.The treatment group was given diacerein,in addition to methotrexate and leflunomide,whereas the control group received methotrexate and leflunomide.Results Compared with the control group,the treatment group showed a lower swollen joint count [(0.93±0.21) vs.(3.43±0.69),t=10.728,P=0.013],a lower tender joint count [(1.15±0.46)vs.(3.6110.83),t=11.443,P=0.008],shorter morning stiffness (1.6±2.2 min vs.13.5±4.2min,t=11.164,P=0.011),and greater hand grip strength [7.97±1.53) kPa vs.(5.68±2.07)kPa,t=10.562,P=0.014].When measured by health assessment questionnaire (HAQ),visual analogue scale (VAS) and DAS28 scores,the treatment group also performed better than the control group.Additionally,the treatment group displayed a more favorable laboratory profile,which included the erythrocyte sedimentation rate (ESR) (9.51±4.32 mm/h vs.26.47±6.32 mm/h,t=9.892,P=0.028),C-reactive protein (CRP) [(2.34±0.57) mg/L vs.(8.13±2.14) mg/L,t=9.427,P=0.031],and rheumatoid factors (RF) [(231.3±45.5) kU/L vs.(283.3±68.4) kU/L,t=10.023,P=0.018].Furthermore,the adverse reaction rate was significantly lower in the treatment group than in the control group (15.0％ vs.37.5％,x2 =5.230,P=0.020).Conclusions Diacerein in combination with methotrexate and leflunomide has shown clearly positive outcomes in the treatment of rheumatoid arthritis in elderly patients and should be recommended in clinical treatment.

A supportive appraisal system is needed in medical ethics construction to guarantee its persistent effect.This paper carries forward the realization of a harmonious physician-patient relationship as the final goal of medical ethics construction,and repelling medical corruption as its sub-target,so as to enhance the quality of medical service.By analyzing medical corruption with real case demonstration and ethical theories,the internal correlation of medical ethics and medical corruption is clarified,and the idea that " construction of medical ethics appraisal system calls for to carry forward medical professionalism,repel medical corruption,and construct a harmonious physician-patient relationship".

The expxprience of 8 thousand cases using contrast medium in abdomen CT scanning were reported.The results showed that it was more suitable for selecting 76% Urografin.The best oral concentration was 1.5%.In abdomen scanning intramuscular injection 654-2 conventionally could improve the image quality.The rectum and sigmoid region scanning should use tee contraast medium through the anus.Vein injection rapidly(bolus)was a best vein contrast method.When visualing badly after bolus or needing observe vessels of contin- uous several sections,continuous bolus method was used.while delay scanning was often used in defining nature of angioma.

No abstract available.
Delivery of Health Care* ; Korea*

About 30％ ～ 40％ of small cell lung cancer (SCLC) patients belong to limited disease (LD).In the setting of limited-disease small cell lung cancer (LD-SCLC),the combination of thoracic radiotherapy (TRT) with chemotherapy is the standard treatment for LD-SCLC with improved survival and local control.It is proven that prophylactic cranial irradiation can improve the prognosis of patients with SCLC.Radiotherapy should join in the early chemotherapy and individualized formulate appropriate target volume.Radiation schemes of conventional fractionation or hyperfractionation way are recommended.

BACKGROUND:To evaluate the psychological characteristics of the patients waiting for renal transplantation in order to analyze coping style, thus perform the corresponding personalized clinical psychological intervention which is conductive for patients to face reality and disease. OBJECTIVE:To investigate the psychological characteristics of the patients waiting for renal transplantation and to analyze the effect of different social factors on the coping style of patients and to explore the corresponding clinical mental intervention method METHODS:Fifty-eight patients waiting for renal transplantation and 60 patients without renal transplantation were randomly selected from Second Department of Urology, Organ transplantation Center, the 309th Hospital of PLA between February 2009 and August 2010, the patients were required to fil in a psychological questionnaire form using the currently general used medical response. The effect of social factors on the coping style and psychological stress status was analyzed with multi-factor Logistic regression analysis. RESULTS AND CONCLUSION:From the questionnaire survey, the evasive and yielding value scores of the patients waiting for renal transplantation were significantly higher than those of the patients without renal transplantation (P<0.05), but there was no significant difference of confrontation score between the patients (P>0.05). It indicated that the psychological pressure of the patients waiting for renal transplantation was bigger that of the patients with out renal transplantation, which may related with course of the disease, cost and the rejection after transplantation for the patients has to endured. Multi-factor Logistic regression analysis showed that sex, education, income, payment methods and age of the patients were al related with the confrontation, evasive and yielding scores, as those with technical secondary school education or better got the best confrontation score while those with annual income less than 60 000 yuan got the highest score in evasive and yielding styles. The results show that income and education level of patients are the main factors that affect the coping style and psychological stress status of the patients waiting for renal transplantation, treating the patients with reasonable renal clinical care interventions can help the patients face to the disease positively and can reduce the damage of transplantation to the psychology of the patients.

Objective To study the effect of restraint and watered stress of different durations on the gastric empting in rats. Methods 48 male SD rats (weight ±150 g) were divided randomly into 6 groups with 8 in each. The experimental rats were restrained and watered in 23℃ water box for 1 h/d, while the controls were free. The body weight, general conditions and behavioral indexes of the rats were observed and recorded. The gastric empting rate was measured in rats with semi-solid diet after 3 d,7 d and 28 d during the statistically significant differences among different groups of different stress groups,and between the 3 d test group and 3 d control group. The gastric empting rate was higer in the 7-day test than in 7 d controlled group, lower in the 28 d test group than 28 d control group. Conclusion Different chronic stress can cause changes of gastric empting rate. With the prolonging of stress time, the empting rate is rising and then decending.

Objective To study the effect of electrical stimulation of the fastigial nucleus of the cerebellum (FNS) on learning,memory and the expression of growth-association protein-43 (GAP-43) after cerebral ischemia and reperfusion.Methods Sixty healthy,adult,male Sprague-Dawley rats were randomly divided into a normal group,a sham-operation group (sham group),a model group and an FNS group,with 15 rats in each.Left middle cerebral artery occlusion and reperfusion (MCAO/R) was administered to the rats in the FNS and model groups using the thread embolism method.The rats of the FNS group were given FNS treatment using a pair of needle electrodes inserted into the cerebellar fastigial nucleus 3hrs after the MCAO/R.Needle electrodes were similarly inserted in the model group rats,but no electrical stimulus was applied.Then the rats' learning and memory abilities were tested using a Morris water maze on days 1,3 and 7 after the MCAO/R modeling.The expression of GAP-43 mRNA on the side of the cerebral infarction was detected using a quantitative,real-time polymerase chain reaction.Results The average escape]atencies of the rats in the model and FNS groups were significantly longer than those of the normal and sham groups at all time points,but the FNS group rats demonstrated a significantly shorter average escape latency than the rats of the model group at each time point.The normal and sham groups showed a significantly lower expression of GAP-43 mRNA than the model and FNS group rats at all time points.The FNS group rats had a significantly higher level of GAP-43 mRNA than the rats of the model group.Conclusion FNS improved the rats' learning and memory abilities.This might be associated with the up-regulation of GAP-43 mRNA in neurons on the side of the cerebral infarction which could promote the regeneration and repair of peripheral nerve axons in the area of the infarction.

To evaluate CT in the diagnosis of tuber culosis of the brain． CT findings in 95 cases with tuberculosis of t he bran confirmed clinically were analyzed retrospectively． Results: The CT detectability fate was 80%． The direct CT si ngs included exudation in basal system, meningitis, enhancement and intracranial tuberculosi s． The indirect signs had hydrocephalus infarction, atrophy calcification, periventricular hypo densith and subdural fluid accumulation etc． The most usual appearance was hydrocephalus． Conclusions: (1) It was helpful to diagnose when very two kinds of direct sings or a kind of dir ect sings and more than two kinds of indirect sings appeared． (2)The plain and contrast canning s hould be routinely used in tuberculosis of the brain．

Objective To analyse CT appearances of fibroma and fibrosarcoma and to provide evidences for clinical diagnosis and treatment.Methods 8 cases with surgically-and pathologically-proved hard fibroma(nasal cavity,maxillary sinus and soft palate each and all 2 cases)and fibrosarcoma(nasal cavity and maxillary sinus each and all 1 case)were studied with retrospectively analysis.The scanning parameters were 5 mm thickness and interval for axial scanning.Results CT appearances of fibroma were single circular,semicircular or elliptical soft tissue masses which usually had homogeneous density,clear margin,thin and full envelope,wide base or a pedicel and slight or middle enhancement after contrast.The tumors grew distensibly,bones near the mass were constricted and thinned or absorbed but never destroried and the structures nearby were deviated but not involved.Fibrosarcoma showed such common CT manifestations as other malignant tumors in the same locations.Conclusion CT appearances of fibroma has some features,they are different from more common benign lesions.Fibrosarcoma can not be differeciated from other maglinant tumors,thier diagnosis must depend on pathology.