BACKGROUND:Studies have found that after stimulation, chemerin can further amplify the inflammatory signal, resulting in the release of inflammatory factors and matrix metaloproteinases. It indicates that chemerin may serve as an important regulator of cartilage metabolism, and plays an important role in the pathogenesis of osteoarthritis. OBJECTIVE: To explore the correlation between level of chemerin in synovia and serum and severity of knee osteoarthritis. METHODS: Eighty patients with knee osteoarthritis were enroled in the study. Knee osteoarthritis grading was evaluated according to the Kelgren-Lawrence classification. Chemerin levels in synovia and serum were examined with enzyme-linked immunosorbent assay. RESULTS AND CONCLUSION:The level of chemerin in synovia and serum in patients with knee osteoarthritis were positively correlated with the Kelgren-Lawrence classification (r=0.981,P< 0.001;r=0.901,P < 0.001). And there was a positive correlation between the level of chemerin in synovia and in serum (r=0.596,P < 0.01). Experimental findings suggest that the levels of chemerin in synovial fluid and serum that are positively correlated with the Kelgren-Lawrence classification can be used as a reference biomarker of severity of knee osteoarthritis.

Objective To explore the application of integrating 64-slice CT image with three-dimensional electroanatomic mapping(Carto-Merge) in guiding catheter ablation of atrial fibrillation(AF).Methods Fifteen patients with drug-refractory AF received catheter ablation of AF.64-slice CT scan was performee 1-3 days prior to the ablation procedures.Using a novel software package,the left atrium(LA)with PVs was segmented and extracted for image registration with a combination of landmark registration and surface registration.Results The integration of the CT image into the electroanatomic mapping system was performed successfully in all patients with an error of 2.11?0.82 mm.Thirty pairs of PVs were electrically isolated after circumferential rediogrequency pulmorary rein ablation.The mean procedure time was 170.51?38.47 minutes.Cardiac tamponade occurred in one patient.All the fifteen patients were free of AF recurrence after 3 months of follow up including the 2 cases of persistent AF who required antiarrhythmic drugs.No thromboembolic events or stenosis were observed.Conclusion Integration of 64-slice CT image into the CARTO system successfully performed in patients undergoing catheter ablation of AF and enhance the ablation success rate.

[Objective]To evaluate outcome of the treatment of unstable distal radius fractures in the elderly patient using a volar T-shape plate.[Method]From January 2001 to April 2003,42 cases with unstable distal radius fractures older than 60 years(range 60～75 years;mean age 65.1 years) were treated with a T-shape plate fixation.The fractures were classified according to the AO classification of distal radius fracture: 4 A2,7 A3,5 B1,3 B3,9 C l,11 C2,3 C3.Artificial bone graft substitutes were used in 28 cases with severe cortex destruction and insufficient buttress.[Result]All patients were followed up(mean 18.2months,range 12～24months).Final volar tilt was averaged 3.66? and radial tilt 20.1?,and radial shortening averaged 1.59 mm in 6 cases.Step-off or gap of the articular surface was found in 6 cases(mean

[Objective]To study the accuracy of Helfet test in the diagnosis of the knee meniscus tear.[Method]From Apr.2007 to Oct.2007,52 cases of the lateral meniscus tear and 23 cases of the medial meniscus tear were checked-up with Helfet test,McMurray test ,KS test,and arthroscope comparatively.[Result]The Helfet Test was positive in most of the lateral meniscus tear cases.The consistency with McMurray test and arthroscope was lateral meniscus tear,especially to bucket-handle and Horizontal tear high respectively.The rate of accuracy to lateral menicus was 81.4%.The rate of accuracy to bucket-handle and Horizontal tear were 89.6% and 87.2% respectively.[Conclusion]The "Helfet" test is sensitive to the knee lateral meniscus tear.It is fast,simple,reliable,reproducible,positive for diagnose of lateral meniscus tear,and is worth of being used widely.

Objective: To explore influence of p38 mitogen-activated protein kinase (p38MAPK) inhibitor on myocardial cell apoptosis and expression of tumor necrosis factor (TNF)-α in rats with ischemia/reperfusion (I/R) injury. Methods: According to number table method, a total of 30 SD rats were randomly and equally divided into blank control group, I/R group and inhibitor group. p38MAPK mRNA expression, TNF-α level and myocardial cell apoptotic rate were measured, compared and analyzed among three groups. Results: Compared with blank control group, there were significant increase in TNF-α level [(3.68±0.16) μg/L vs. (5.02±0.09) μg/L], p38MAPK mRNA expression [(1.76±0.46) vs. (2.35±0.02)] and myocardial cell apoptotic rate [-(3.51±0.40) % vs. - (1.8±0.23) %] in I/R group, P=0.001 all. Compared with I/R group, there were significant decrease in p38MAPK mRNA expression (2.09±0.16), TNF-α level [(4.15±0.11) μg/L] and myocardial cell apoptotic rate [-(2.9±0.50) %] in inhibitor group, P=0.001 all. Conclusion: Inhibition of p38 mitogen-activated protein kinase expression in myocardium of rats can decrease production of tumor necrosis factor-α and myocardial cell apoptosis, then relieve ischemia/ reperfusion injury of myocardial cells.

ObjectiveTo evaluate regional and global systolic function of left ventricle (LV) after mitral valve replacement(MVR) of different methods by 2-dimensional strain (2DS).MethodsAccording to the operational method whether preserve the posterior leaflet and its subvalvular apparatus,48 patients who underwent MVR were divided into two groups,the preservation group (group A) and the resection group (group B).Echocardiography was examinated before and after MVR and the apical four-chamber view,two-chamber view and long-axis view of LV were acquired.Regional peak strain (Sp) and global strain (GS) of LV longitudinal movement were analysed by 2DS software.Results①Compared to preoperation,the Sp in basal segment of posterior septum and inferior wall and middle segment of lateral wall in group A increased significantly ( P ＜0.01 or P ＜0.05).The Sp of group B were improved in both basal and middle segments of posterior septum ( P ＜0.05),while declined in middle segment of lateral wall and anterior wall,basal segment of lateral wall and apical segment of anterior wall significantly (P ＜0.01 or P ＜0.05).②Compared with group A,subtractions between preoperative and postoperative Sp of group B decreased in middle segment and apical segment of anterior wall,middle segment of lateral wall and middle segment of inferior wall significantly ( P ＜0.01 or P ＜0.05).③The GS of group A increased significantly ( P ＜0.05),while that in group B tended to reduce with no statistical significance ( P ＞0.05).Compared with group A,subtractions between preoperative and postoperative GS of group B droped significantly (P ＜ 0.05).ConclusionsAppropriate preservation of the posterior leaflet and its subvalvular apparatus has morebeneficial effect in improving the early regional and global function of LV after surgery,which would be recommended in MVR.Early regional and global systolic function of LV after MVR could be accurately evaluated by 2DS relatively,which has the application value of guiding clinical treatment and estimating prognosis.

Objective To explore the differential diagnostic value of speckle-tracking imaging (STI) between dilated cardiomyopathy(DCM) and ischemic cardiomyopathy(ICM).Methods 40 DCM patients,32 ICM patients and 30 normal controls were enrolled for this study.Different views of high frame images of left ventricle were recorded.The time to peak radial strain,circumferential strain and longitudinal strain of 18 myocardial segments were measured by STI,and the maximum differential (Ts-dif) and the standard deviation(Ts-SD) of time to the peak strain were calculated.The left ventricular parameters measured by STI were compared between DCM and ICM,and the diagnostic sensitivity and specificity were investigated by the areas under the receiver operating characteristic (ROC) curves.Results Parameters of different segments of ICM were obviously higher than those of DCM (P ＜ 0.05),and there were significant differences between ICM and DCM.The areas under the ROC curves of Ts-dif and Ts-SD to radial strain were 0.920 and 0.946 respectively.At the cut off of 170 ms and 53 ms for diagnosing DCM and ICM,the sensitivity,specificity and accuracy were 87.5％,87.5％,87.5％ and 90.6％,90％,90.2％ respectively.Conclusions These strain parameters by STI,especially Ts-SD to peak strain can offer a new quantitative diagnostic method in distinguishing DCM from ICM.

Objective To investigate the value of contrast-enhanced ultrasound (CEUS) in evaluation of the protective effect of edaravone injection in rabbit skeletal muscle ischemia-reperfusion injury.Methods Thirty healthy New Zealand white rabbits were established a model of skeletal muscle ischemia-reperfusion injury in left hind limb and randomly divided into the experimental group and control group.Edaravone was injected with the dose of 1.5 mg/kg at the time of 30 minutes before reperfusion in the experimental group,the control group were given an equal volume of physiological saline.Blood samples were collected respectively at the times of pre-ischemia,post-ischemia and 24 hours after reperfusion for detecting creatine kinase(CK),lactic dehydrogenase(LDH),and CEUS parameters such as peak intensity(PI),time to peak (TTP) and area under the curve(AUC) were measured at the same time.Pathological examination was carried out after the rabbits were sacrificed.Results ①Serological tests:compared to before the blocking of blood supply,the content of CK and LDH after the blocking were significantly increased (P ＜ 0.01);compared to before or after the blocking,the content of CK and LDH at the time of 24 hours after reperfusion in the two groups were increased,and was lower in the experimental group than the control group.(②CEUS:compared to before the blocking,PI,TTP and AUC in each group were significantly increased after the blocking and at the time of 24 hours after reperfusion(P ＜0.01);compared to those in the control group,PI and AUC in the experimental group were decreased at the time of 24 hours after reperfusion,but there was no significant difference in TTP(P ＞0.05).③Correlation analysis:there was a good correlation between PI,AUC and CK,LDH (r =0.87,0.81,0.86,and 0.80,respectively).④Pathological analysis:muscle fibers were swelling with no stripes,partial fractures and interstitial edema and a large amount of inflammatory cells were infiltrated in the control group,while muscle fibers were almost normal with a small amount of inflammatory cells infiltrated in the experimental group.Conclusions Edaravone injection before reperfusion can obviously improve rabbit skeletal muscle ischemia-reperfusion injury,and CEUS can be used to observe these changes directly and effectively.

Aim To investigate the drug-containing serum of Rhizoma drynariae on osteogenesis differentiation of bone marrow mesenchymal stem, and discuss the possible mechanism.Methods BMSCs were cultured in media with different concentrations of medicine containing serum.BMSCs proliferation ability was detected in 3,5,7,9 days by CCK-8.ALP activity was detected after 7,10,14 days′ induction.After 3 weeks culturing, alizarin red staining was performed to observe the formation of calcium nodules.The expression of β-catenin,LRP5,RUNX-2 and Osteriex mRNA were detected using RT-PCR.The protein expression of β-catenin,LRP5 was detected using Elisa method.Results Rhizoma drynariae drug-containing serum could obviously promote the proliferation of BMSCs and calci-fied nodule formation.Besides, the ALP activity was improved in a certain period of time.The expression of β-catenin,LRP5,GSK-3β,RUNX-2 and Osteriex mRNA were significantly up-regulated,and the protein expression of β-catenin,LRP5 was up-regulated too.The expression of GSK-3β was down-trgulated.Conclusions Rhizoma drynariae drug-containing serum promotes mineralization and osteogenic differentiationof BMSCs, and the mechanism is closely related with activating WNT/beta-catenin signaling pathway, raising the beta-catenin, LRP5, RUNX-2, and Osteriex mRNA expression, beta-catenin, LRP5 protein expression,and down-regulation of GSK-3β mRNA expression.

Seminar is an exploratory learning model with problem-based and project-or-ganized characteristics.The application practice of Seminar learning model in the process of teaching and training postgraduates of health management shows that the model has an important influence on improving the quality of postgraduates in our country.