With the continuous development of musculoskeletal ultrasound,ultrasound diagnosis of inflammatory arthri tis,especially early diagnosis had an increasing important role.Psoriatic arthritis (PsA) was a kind of inflammatory arthritis,which was closely related with psoriasis.It could involve the whole body's large and small joints,especially peripheral joints (often asymmetric),sacroiliac joint and spine.The course of PsA was protracted and easy to recur.Clinical and ima ging manifestations of PsA are similar to rheumatoid arthritis (RA),and need to identify diagnosis.The diagnosis and antidiastole in musculoskeletal ultrasound of PsA were reviewed in this article.

Objective To compare the rates of regimen modification between patients with different initial antiretroviral therapy, and to investigate risk factors associated with drug toxicity-related regimen modification.Methods A two-years retrospective cohort study was conducted in 14 060 patients who initiated antiretroviral treatment with Zidovudine (AZT)/Tenofovir disoproxil (TDF)+Lamivudine (3TC)+Efavirenz (EFV) since 2012.There were 5 126 patients initiated TDF+3TC+EFV therapy (TDF group) and 8 934 patients initiated AZT+3TC+EFV therapy (AZT group).Chi-square test was used to compare the rate of first-line regimen modification and the rate of toxicity-related regimen modification between two groups.Cox proportional hazard model was used to investigate the risk factors associated with regimen modification.Results A total of 14 060 acquired immunodeficiency syndrome patients were observed for a median period of 1.85 person-years.There were 2 795 patients who changed their initial antiretroviral regimen and the rate of initial regimen modification was 19.9%.Two hundred patients who changed their initial regimen due to pregnancy were excluded.There were 2 070 patients in AZT group who changed their initial regimen with a rate of 23.5%.Among them, 1 652 patients changed their regimen due to drug toxicity and the rate was 18.8%.There were 525 patients in TDF group who changed their initial regimen with a rate of 10.4% and the rate of toxicity-related regimen modification was 6.2%.The differences between two groups were statistical significance (χ2=366.68 and 416.89, respectively, both P<0.01).The risk of regimen modification in AZT group were significantly higher than that in TDF group (aHR=2.89, 95%CI: 2.57-3.24).The risk of toxicity-related regimen modification in AZT group was also significantly higher than that in TDF group (aHR=3.85, 95%CI: 3.34-4.45).Conclusions Patients initiated antiretroviral treatment with AZT+3TC+EFV are more likely to change their initial regimen than those who initiated treatment with TDF+3TC+EFV.Female, age >45 years old, BMI<18.5 kg/cm2 and baseline CD4+ T cell count<200/mL were risk factors associated with regimen modification.

OBJECTIVETo investigate the therapeutic effects of closed reduction and external fixation (plaster or splint) for the treatment of displaced humeral supracondylar fractures in children.

METHODSFrom March 2007 to September 2009,33 children (15 female and 18 male) with humeral supracondylar fractures treated in our hospital, ranging from 3 to 12 years old with an average of 6.4 years old. All the fractures were extension-type injuries, the flexion injures were excluded in our study. The humeral supracondylar fractures were classified according to Gartland classification. There were 21 Type H and 12 type III. In the initial treatment, all the patients were treated with closed reduction and external immobilization. The blood supply of the damaged upper extremity was evaluated before and after treatment. Clinical assessment was obtained at final follow-up using Flynn criteria, and radiologic assessment was obtained using Baumann and lateral humerocapitellar angles.

RESULTSAll the children were treated successfully with closed reduction in the initial time; 24 children maintained limb alignment by external immobilization. Nine patients lost position due to the swelling around the elbow which affected unstable external fixation during the follow-up, 5 of which were treated with a repeated closed reduction and internal fixation with Kirschner wires, 4 of which were treated with traction. Thirty-one patients had a satisfactory outcome and 2 patients had an unsatisfactory outcome according to the Flynn criteria at the latest follows-up.

CONCLUSIONClosed reduction and external stabilization is an important method for the treatment of displaced humeral supracondylar fractures in children. Making regular follow-up visits after closed reduction and casting is important for patients to maintain acceptable alignment, avoid complications and diagnose any loss of reduction.

Casts, Surgical ; Child ; Child, Preschool ; External Fixators ; Female ; Fracture Fixation, Internal ; Humans ; Humeral Fractures ; surgery ; Male ; Splints

Objective To study the spatiotemporal trend of Japanese encephalitis in Guangxi Zhuang Autonomous Region between 1989 and 2006.Methods Retrospective space-time permutation scan statistic and inverse distance weighted (IDW) interpolation were employed to detect the spatiotemporal trend of Japanese encephalitis in Guangxi,from the year 1989 to 2006.Results The spatiotemporal pattern of Japanese encephalitis was divided into four phases by IDW interpolation maps,from 1989 to 2006.The first phase was spatiotemporal cluster located in southeast region,from 1989 to 1996.The second phase showed discrete distribution from 1997 to 1998.The third phase of spatiotemporal cluster located in Lingshan county,Pubei county and Bobai county,in 1999.And the last phase was spatiotemporal cluster located in northwest region from 2000 to 2006.Three statistically significant spatiotemporal clusters were detected by retrospective space-time permutation scan statistic.The primary cluster appeared in 1999 (LLR=253.25,P=0.001,RR=4.62),with 109°54′ E,22°28′ N (located in Pubei county) as its center and radiated 45.24 km.From 2000 to 2006,the secondary cluster showed in northwest (LLR=75.91,P=0.001,RR = 1.88),with center located at 105°23′ E,24°68′ N (Longlin county),and radiated 199.85 kn.From 1989 to 1996,the other secondary cluster appeared in the southeast area(LLR=46.29,P=0.001,RR= 1.16),with center located at 110°94′ E,24°03′N(Zhaoping county) and radiated 229.12 km.Conclusion Space-time permutation scan statistic and geographical information system could be applied to quantitatively detect the potentially spatiotemporal trend of the disease.The spatiotemporal cluster shifted from southeast to northwest,from 1989 to 2006.

Objective Overexpression of SERCA2a could improve cardiac function in human and experimental heart failure(HF)models.We observed the proteomics changes post SERCA2a overexpression in a pacing induced HF model in dogs.Methods Beagles were divided into four groups:control group,HF group(230 beats/min for 4 weeks),HF+EGFP group(myocardial injection of 1 × 1012 v.g recombinant adeno-associated virus carrying enhanced green fluorescent protein gene,rAAV2/1-EGFP)and HF+ SERCA2a group ( myocardial injection of 1 × 1012 v.g recombinant adeno-associated virus carrying SERCA2a gene,rAAV2/1-SERCA2a).Thirty days after gene transduction,left ventficular systolic and diastolic functions were measured by echoeardiography and invasive hemodynamics in all animals.By use of 2-dimensional gel electrophoresis(2-DE),-500 distinct protein spots were detected in myocardium of all animals.Protein spots observed to be altered between failing and SERCA2a overexpressed hearts were subjected to tryptic peptide mass fingerprinting for identification by MALDI-TOF mass spectrometry in combination with LC/MS/MS analysis.Results At 30 day after gene transfer,HF signs were significantly reduced,cardiac function[LVSP:(214.72±31.74)mm Hg(1 mm Hg=0.133 kPa)vs.(139.32±36.79)mm Hg,+dp/dtmax:(6779.43±217.58)mm Hg/s vs.(2746.85±931.23)mm Hg/s and -dp/dtmax:(-4341.42±322.02)mm Hg/s vs.(r-2531.14 ±616.15)mm Hg/s,LVEDP:(21.86±6.95)mm Hg vs.(59.78±6.92)mm Hg]significantly improved in HF+SERCA2a dogs than those in HF+ EGFP group(all P＜0.05)and parameters were comparable between HF+SERCA2a and control groups.We identified alterations in the expression level of more than 10 proteins in myocardium.These protein changes were observed mainly in two subcellular compartments:the cardiac contractile apparatus and metabolism/energetics.Conclusion These results showed that overexpression of SERCA2a could improve cardiac function accompanied with numerous alterations in protein expressions involved in calcium handling,myofibrils,and energy production in this dog model of chronic heart failure.

Objective To evaluate the effect and safety of low-dose aspirin for primary prevention of cardiovascular events.Methods We searched for randomized controlled trials (RCT) in the following electronic databases:MEDLINE,EMbase,the Cochrane Library (Issue 3,2008),CBM,CNKI.Quality assessment and data extraction were conducted by two reviewers independently.All data were analyzed using Review Manager 4.2.Results Six studies (TPT,HOT,PPP,WHS,POPADAD,J-PAD) involving a total of 72 466 participants met the inclusion criteria.Meta-analysis results showed that:(1) Compared with placebo,the incidences of total cardiovascular events (RR = 0.85,95 % CI:0.80-0.92),stroke (RR = 0.87,95% CI:0.77-0.98),nonfatal stroke (RR = 0.81,95% CI:0.70-0.95) and transient ischemic attack (RR =0.76,95% CI:0.64-0.90) were significantly lower in low-dose aspirin group than those in placebo control group (all P＜0.05).(2) Nonfatal myocardial infarction (RR = 0.89,95 % CI:0.77 -1.02),death from cardiovascular causes (RR =0.98,95%CI:0.86-1.13) and death from any cause (RR =0.95,95%CI:0.88-1.02) were similar between the 2 groups (all P＞0.05).(3) The risk of coronary heart disease was reduced in low-dose aspirin group in the elderly (RR = 0.81,95% CI:0.70-0.94,P＜0.05).(4) The risk of bleeding was higher in low aspirin group compared to placebo group (RR = 1.15,95% CI:1.12-1.18,P＜0.O1).Conclusions low-dose aspirin use could reduce the incidences of total cardiovascular events,stroke,nonfatal stroke and transient ischemic attack but increase the risk of bleeding,the incidence of nonfatal myocardial infarction,death from cardiovascular causes and death from any cause was not affected by low-dose aspirin use.Low-dose aspirin use was also significantly reduced the risk of coronary heart disease in the elderly.

Objective To summarize the preliminary experience of extraperitoneal laparoscopic radical prostatectomy (C.R.P.C.four-step) for localized prostate cancer and the outcomes based on early follow-up.Methods A total of 102 prostate cancer patients were screened by prostate specific antigen (PSA) and diagnosed by prostate magnetic resonance imaging and prostatic puncture biopsy with cT1c-cT3b,with average age of (67 ±5) years old,average preoperative total PSA value of (45.32 ± 18.33) ng/ml,and average prostate volume was (42 ± 12)cm3.All these patients underwent extraperitoneal laparoscopic radical prostatectomy by the four-step technique,abbreviating as C.R.P.C.[C:control DVC (dorsal deep venous complex).R:recognize three anatomical layers (prostate and bladder junction,seminal vesicle,and Denonvilliers' fascia surface).P:preserve urethral sphincter and bladder neck.C:continuous anastomosis between urethra and bladder neck (4 key needles at 3,5,7 and 9 o'clock)].The operative time,estimated blood loss,length of hospital stay and postoperative complications were recorded,and the postoperative PSA was followed up.Results All the 102 cases were successfully treated by iaparoscopic radical prostatectomy.The operative time was from 55 to 156 min (mean 92 min),and the estimated blood loss was from 55 to 185 ml (mean 105 ml).There was no case converted of open surgery,only one case received blood transfusion for postoperative hemorrhage (0.98％),and positive surgical margin was found in 15 case (14.70％) by pathological examination.Postoperative urinary extravasation within one week occurred in 2 (1.96％) cases,and resolved after tensioning the catheter and prolonging the indwelling time.During the follow-up period of 12 to 45 months,2 cases were incontinent (grade I-II),and the other cases(98.04％) had no incontinence or dysuria.However,11 cases (10.78％) developed to biochemical recurrence within 6 months after the operation.Conclusions The C.R.P.C.four-step technique of lparoscopic radical prostatectomy is easily to be grasped and performed by the greenhand urologists,and was efficient and safe.

OBJECTIVETo evaluate the efficacy and safety of gonadotropin-releasing hormone analogue (GnRHa) triptorelin 11.25 mg 3-month sustained release formulations in the treatment of metastatic prostate cancer.

METHODSFrom January 2004 to March 2006, a randomized, parallel-controlled, multicenter clinical trial was conducted. One hundred and twenty-seven patients with documented metastatic prostate cancer were randomized to receive one injection of the 11.25 mg formulation triptorelin (n = 65) or three injections at 28-day intervals of the 3.75 mg formulation (n = 62). Changes from baseline of TPSA, prostate volume, testosterone, LH, FSH, PRL and estradiol were assessed over 3 months. Changes of the metastatic lesions were also observed and evaluated. The occurrences of adverse events were evaluated as well.

RESULTSAfter 3 months treatment, total PSA level decreased significantly from baseline both in 11.25 mg group and 3.75 mg group. At 30, 60 and 90 days, TPSA (median level) declined from 164.55 microg/L into 11.34, 4.12, 3.89 microg/L in 11.25 mg group, and from 101.38 microg/L into 6.88, 2.41, 2.57 microg/L in control group respectively. The patients ratio with over 90% decreasing from TPSA baseline were 78.6% and 75.5% respectively in two groups (P = 0.700). Prostate volume were also decreased significantly in both groups, median volume declined from 48.0 mm(3) into 21.5 mm(3) in 11.25 mg group and from 45.0 mm(3) into 21.0 mm(3) in 3.75 mg group. No significant differences were found between the two groups in changes of TPSA (P = 0.601) and prostate volume (P > 0.05). Both formulations were able to induce castration levels, 0.31 microg/L in 11.25 mg group and 0.26 microg/L in 3.75 mg group (P > 0.05). 13.8% and 17.7% of adverse events were recorded respectively in two groups, and no differences were found (P = 0.547).

CONCLUSIONAs a new long-acting sustained release formulation, triptorelin 11.25 mg is comparable to triptorelin 3.75 mg formulation in the aspect of efficacy and safety for the treatments of metastatic prostate cancer.

Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents, Hormonal ; administration & dosage ; therapeutic use ; Gonadotropin-Releasing Hormone ; analogs & derivatives ; therapeutic use ; Humans ; Male ; Middle Aged ; Prostatic Neoplasms ; drug therapy ; pathology ; Safety ; Treatment Outcome ; Triptorelin Pamoate ; administration & dosage ; therapeutic use

Temporomandibular joint (TMJ) diseases are common clinical conditions. The number of patients with TMJ diseases is large, and the etiology, epidemiology, disease spectrum, and treatment of the disease remain controversial and unknown. To understand and master the current situation of the occurrence, development and prevention of TMJ diseases, as well as to identify the patterns in etiology, incidence, drug sensitivity, and prognosis is crucial for alleviating patients′suffering.This will facilitate in-depth medical research, effective disease prevention measures, and the formulation of corresponding health policies. Cohort construction and research has an irreplaceable role in precise disease prevention and significant improvement in diagnosis and treatment levels. Large-scale cohort studies are needed to explore the relationship between potential risk factors and outcomes of TMJ diseases, and to observe disease prognoses through long-term follw-ups. The consensus aims to establish a standard conceptual frame work for a cohort study on patients with TMJ disease while providing ideas for cohort data standards to this condition. TMJ disease cohort data consists of both common data standards applicable to all specific disease cohorts as well as disease-specific data standards. Common data were available for each specific disease cohort. By integrating different cohort research resources, standard problems or study variables can be unified. Long-term follow-up can be performed using consistent definitions and criteria across different projects for better core data collection. It is hoped that this consensus will be facilitate the development cohort studies of TMJ diseases.

Beijing has been one of the epicenters attacked most severely by the SARS-CoV (severe acute respiratory syndrome-associated coronavirus) since the first patient was diagnosed in one of the city's hospitals. We now report complete genome sequences of the BJ Group, including four isolates (Isolates BJ01, BJ02, BJ03, and BJ04) of the SARS-CoV. It is remarkable that all members of the BJ Group share a common haplotype, consisting of seven loci that differentiate the group from other isolates published to date. Among 42 substitutions uniquely identified from the BJ group, 32 are non-synonymous changes at the amino acid level. Rooted phylogenetic trees, proposed on the basis of haplotypes and other sequence variations of SARS-CoV isolates from Canada, USA, Singapore, and China, gave rise to different paradigms but positioned the BJ Group, together with the newly discovered GD01 (GD-Ins29) in the same clade, followed by the H-U Group (from Hong Kong to USA) and the H-T Group (from Hong Kong to Toronto), leaving the SP Group (Singapore) more distant. This result appears to suggest a possible transmission path from Guangdong to Beijing/Hong Kong, then to other countries and regions.
Genome, Viral ; Haplotypes ; Humans ; Mutation ; Open Reading Frames ; Phylogeny ; SARS Virus ; genetics