Objective To observe the effect of carvedilol and metoprolol in patients with chronic heart failure (CHF) and its effect on TNF-α and IL-6.Methods 94 cases of CHF were randomly classified into carvedilol group with 47 cases and metoprolol group with 47 cases, which were treated with metoprolol and metoprolol,respeetively.The clinical effects and the lovels of TNF-α and IL-6 were compared.Results The clinical effeetive rate in carvedilol group was significantly higher than that in metoprolol group( P < 0.05 ).After treatment, the levels of TNF-α and IL-6 were significantly decreased in both groups (P < 0.05 ).Moreover, the levels of TNF-α and IL-6 in carvedilol group were significantly lower than those in metoprolol group after treatment (P < 0.05).Conclusion Carvedilol in improving clinical effective rate and decreasing the levels of TNF-α and IL-6 was better than metoprolol,whieh played an important role in treatment of CHF.

Objective To study the ketone luo acid tromethamine analgesia in patients with knee osteoarthritis joint replacement in advance of inflammatory factor and the influence of stress state. Methods Choice for knee osteoarthritis knee joint replacement patients 61 cases, were randomly divided into control group (30 caese) and the observation group (31caese), the control group only received intravenous anesthesia compound epidural block, on the basis of the observation group receied ketone luo acid tromethamine analgesia in advance, the contrast analysis of two groups of patients with preoperative and postoperative VAS score, cytokines and cortisol levels. Results The observation group of patients with postoperative pain VAS score (24 h, 48 h, 72 h) were significantly lower than control group (P<0.05);Observation group with 24h after IL - 8, TNF alpha level significantly lower than the control group (P<0.05), the observation group after 48h of IL-6, IL-8, TNF-a levels were significantly lower than control group (P<0.05).0bservation group 24h after surgery in patients with Cor significantly lower than the control level (P<0.05), after 48 h Cor and ACTH level observation group were significantly lower than the control group (P<0.05).Conclusion Ketone luo acid tromethamine analgesia in advance can obviously relieve knee osteoarthritis pain after joint replacement, and can significantly reduce inflammatory factor levels, reduce the postoperative patients with stress state.

ObjectiveTo investigate the association between serum level of osteopotin(OPN) and disease activity of rheumatoid arthritis (RA) patients, and explore the importance of OPN in the pathogenesis of interstitial lung disease (ILD) in RA. MethodsSixty-five RA patients and 20 healthy controls were pros-pectively enrolled. RA patients were divided into active group(n=43) and inactive group(n=22), and ILD groups (n=24) and non-ILD group (n=41). Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of OPN in patients with RA and healthy controls, and the relationship between OPN and other clinical and laboratory findings were analyzed.Results① Serum OPN tended to be significantly higher in RA patients (median, 18.0 ng/ml) than in the healthy controls (median, 14.3 ng/ml), P<0.01; ②The serum level of OPN in RA patients showed a significant positive correlation with the course of disease, numbers of tender joints , ESR and CRP, but no positive relationship was found in number of swollen joints; ③ The serum level of OPN was significantly higher in RA-ILD patients(median, 20.0 ng/ml) than that in non-lLD (median, 17.0 ng/ml, P<0.05). And there was remarkable negative correlation between the concentration of serum OPN and the value of PaO2, but no association was found with pulmonary function %VC and %DLCO. ④ Compared with the non-ILD group, the ILD group had more active disease in terms of tender joint counts and swollen joint counts, ESR, CRP(P<0.01) and the serum titer of RF-IgM,(P<0.05). ConclusionOPN plays a role in the pathogenesis of RA and is related to the disease activity. It may serve as an active disease inflammatory marker of RA . OPN may be involved in the pathogenesis of RA related ILD and is associated with the severity of pulmonary damage.

Intracranial atherosclerotic stenosis (ICAS) is an important cause for the occurrence,development,and recurrence of ischemic stroke.Age,hypertension,diabetes,and smoking etc.are its traditional risk factors.Among them,symptomatic ICAS is the key of clinical intervention.Its treatments include intensive medical therapy,endovascular treatment,extracranial intracranial arterial bypass grafting,encephaloduroarteriosynangiosis,and external counterpulsation,etc.

Objective To observe the effects and toxicity of nimotuzumab combined paclitaxel and carboplatin in the treatment of advanced non small cell lung cancer .Methods 168 cases of patients with advanced non-small cell lung cancer were randomly divided into study group and control group ,with 84 cases in each group .Study group was treated with nimotuzumab 200 mg ,1 times per week ,for 6 weeks ,two weeks later the patients were treated with 200 mg and stopped when the disease progressed ,paclitaxel lipo-some(135 mg/m2 ,iv drip 3 h ,1 days) ,carboplatin(300 mg/m2 ,iv drip ,1 days);the control group was given paclitaxel liposome(135 mg/m2 ,iv drip 3 h ,1 days) ,carboplatin(300 mg/m2 ,iv drip ,1 days) ,21 days for 1 cycle .Results Study group RR 38 .1% (32/84);control group RR 23 .8% (20/84)(P<0 .05) .The main side effects of two groups of were gastrointestinal reaction and bone marrow suppression ,there were 64 cases of above Ⅱ digestive tract reaction in the study group ,accounting for 76 .2% ,52 cases ofⅡ degrees of bone marrow suppression ,accounting for 61 .9% ,52 cases of Ⅱ degrees of alopecia ,accounting for 61 .9% ;54 cases of control group Ⅱ digestive tract reaction ,accounting for 66 .7% ,54 cases of Ⅱ degrees of bone marrow suppression ,accounting for 66 .7% ,and 58 cases of Ⅱ degrees of alopecia ,accounted for 57 .1% (P>0 .05) .In the study group ,progression-free survival period was 7 .8 months ,the median survival period was 14 .2 months;in the control group ,progression-free survival period was 5 .1 months ,the median survival period was 9 .8 months(P<0 .05) .Conclusion nimotuzumab combined paclitaxel and carboplatin in the treatment of advanced non small cell lung cancer has good clinical curative effect ,and would not increase adverse reactions .It is worthy of clinical application .

Objective To investigate the proportion and the clinical significance of status of different hepatitis B virus(HBV) serological markers in HBV related chronic liver disease(CLD),including chronic hepatitis B(CHB),liver cirrhosis(LC) and hepatocellular carcinoma(HCC).Methods The related clinical data of 2 482 inpatients during the period of January 2006 to December 2007 were collected and analyzed statistically.Results In 1 226 patients with CHB,64.4% of them were hepatitis B e antigen(HBeAg)-positive,and 35.6% of them were HBeAg-negative.In 362 patients with LC,27.1% of them HBeAg-positive,66.0% HBeAg-negative,6.9% HBsAg-negative,and in 894 patients with HCC,16.4% were HBeAg-positive,75.1% HBeAg-negative and 8.5% HBsAg-negative.In every disease entity of CLD,the sex ratio for serological markers was similar,though the ratio of male-to-female in the patients with HCC(8.8∶1) was significantly higher than that of LC(4.5∶1) and CHB(4.4∶1),respectively.The age of HBeAg-negative patients with CHB was significantly older than that of HBeAg-positive patients with CHB.The average age of patients with different status of serological markers in LC or HCC was similar.No statistical difference was found in ALT levels between the HBeAg-positive and HBeAg-negative patients with CHB.However,the proportion of low ALT levels became higher in the patients with LC or with HCC when HBeAg positive turned to be HBeAg-negative then to HBsAg-negative.Conclusions The proportion and the clinical significance of changes in serological markers are different in three different entities of CLD.

Objective To study the incidence of and identity risk factors for hemorrhage and thromboembolism during long-term warfarin therapy.Methods All patients were studied in the People's Hospital of Peking University Anticoagulant Clinic from 2001-04 to 2003-11,in whom a course of warfarin therapy intended to last for more than 4 weeks.All bleeding and thromboembolism events were classified as minor or serious or fatal and life-threatening.Incidences of adverse events were analyzed statistically.Results A total of 128 patients were enrolled in the investigation,the median age of the study group was 67 years(ranged 25 to 83).There were 41 bleeding events occurring in 34 patients,and 5 events of thromboembolism.Age and hepatocirrhosis were significantly associated with bleeding complications(P=0.040 and P=0.014).Conclusion Hemorrhage is the major side effect of warfarin;age and hepatocirrhosis are significantly associated with bleeding complications.

Objective To evaluate the frequently used electrocardiographic criteria and propose a modified algorithm for differentiating typical atrioventricular node reentrant tachycardia(AVNRT)from atrioventricular reciprocating tachycardia(AVRT).Methods Twelve-lead electrocardiograms(ECGs)during sinus rhythm and atrioventricular node reentrant tachycardia(AVNRT)or atrioventricular reciprocating tachycardia(AVRT)with a narrow QRS complex were obtained from 154 patients who had received successful radiofrequency catheter ablation from Jan.2003 to Nov.2005.The ECGs of initial 104 patients were analyzed by 3 observers without knowledge of the electrophysiological diagnosis.According to these initial results,we proposed a modified stepwise ECG algorithm which used pseudo r′/S/Q waves,RP interval,and ST-segment elevation in lead aVR during tachycardia.Two observers assessed the algorithm in additional 50 patients.Results The algorithm was able to increase the overall accuracy from 77% and 79% with original algorithm to 84% and 87% with the modified algorithm,respectively.The inter-observer concordance was 85%.The intra-observer concordance was 89% in both investigators.Conclusion The modified algorithm can improve the accuracy of differential diagnosis between typical AVNRT and AVRT via concealed accessory pathway.

[Objective]To evaluate the indications,efficacy and safety of posterior total laminectomy decompression and reduction with pedicle screws for lower cervical fracture and dislocation.[Method]From June 2005 to February 2008,41 patients with lower cervical fracture and dislocation received posterior total laminectomy decompression and reduction with pedicle screws.The patients(M=32,F=9)were 22-47 years old,with an average of 33.5 years old.There were 38 fresh and 3 old injuries.[Result]All the patients were operated on successfully without severe complications during perioperative period.Totally 252 (89%) screws were exactly implanted in the cervical pedicle.The everage surgery time was 3.1 h (2.5-4 h).The average blood loss during the operation was 460 ml (250-950 ml). The average time of follow-up was 27.5 months(24-36 months). All patients had satisfiactory reduction and no internal fixator failure.Thirty-two patients who were followed up for more than 24 months had complete fusion. The motor and sensory score (ASIA92) were improved significantly at 2 years follow-up(P