Objective To study the prediction value of C-reactive protein (CRP) level to ankylosing spondylitis disease activity score (ASDAS),the most widely used activity score in ankylosing spondylitis (AS).Methods A total of 386 patients with AS were enrolled and divided into 2 groups by CRP≥3.5 mg/L (n =266) and CRP ＜ 3.5 mg/L(n =120).ASDAS-CRP was evaluated in patients with CRP below the normal range (3.5 mg/L) in different subgroups.Three methods were used to test the consistency between ASDAS-CRP and ASDAS-erythrocyte sedimentation rate (ESR).Results The ASDAS-CRP showed a good correlation with the ASDAS-ESR when CRP level was ≥ 3.5 mg/L (r =0.899,P =0.000).In the group of CRP ＜ 3.5 mg/L,ASDAS-ESR showed better consistency with ASDAS-CRP when CRP level was below 1.5 mg/L(intra-class correlation coefficient 0.902;kappa coefficient 0.70).By the evaluation of variant gradient matrix,CRP 1.5 mg/L coincided with disease activity states.Conclusion There is good consistency between ASDAS-CRP and ASDAS-ESR.When CRP level is below the normal range,1.5 mg/L could be a cut-off value to calculate the optimal ASDAS-CRP score.

Objective To analyze antimalarial assosiated retinopathy detected by different methods with of modern ocular fundus examination, and explore screening strategy and the diagnosis of hydroxych-loroquine assosiatedretinopathy according to clinical experience and international guidelines. Methods Full fundus examination was performed in two patients with antimalarial retinopathy. The related literature were reviewed. Results Two patients had bull's eyes maculopathy and abnormal visual fields. Conclusion Clin-icians' alertness to hydroxychloroquine related retinopathy may improve early diagnosis of hydroxychloroquine toxicity. New objective tests are more sensitive than visual fields examination. Visible bull's-eye maculopathy is a late change, and the goal of screening is to recognize toxicity at early stage.

Objective To assess the surgical treatment of iatrogenic biliary strictures. Methods The clinical data of 235 patients with iatrogenic biliary injuries and strictures who had been admitted to our hospital from January 1989 to December 2006 were reviewed retrospectively. Cholangio-jejunal Roux-en-Y anastomosis (n=182), surgical repair with pediele flap of autogenous tissues (n=34), end-to-end choledocho-choledo-chostomy (n= 12), common bile duct incision and figuration +T-tube drainage ( n =6) and liver transplanta-tion ( n = 1 ) were applied to the patients. Results A total of 189 patients were followed up for 1 to 10 years. The total excellent and good rate was 94.7% (179/189). The recurrence rate of the biliary stricture was 5.3% (10/189), and the main cause of which were biliary cirrhosis, selerosing cholangitis and calculus. One patient with severe biliary cirrhosis and portal hypertension died of liver failure postoperatively. Conclusions The cholangio-jejunal Roux-en-Y anastomosis is a reliable and effective method. Surgical repair of the bile duet with pedicle flap of autogenous tissues could preserve the function of the sphincter of Oddi, but the long-term effect needs further investigation. Biliary stent is not usually necessary to install. Liver transplantation is efficient for the patients with end stage of biliary diseases caused by biliary stricture.

Objective To explore the the role of fraction exhaled nitric oxide(FeNO) in airway inflammation of Mycoplasma pneumoniae pneumonia(MPP).Methods Inpatients with low respiratory tract infection were enrolled from August to November in 2012,69 patients had MPP and 33 had no MPP(non-MPP).Patients with MPP were further grouped into a bronchopneumonia group and the lobar pneumonia group.Fifty-four inguinal hernia patients without respiratory tract infection during the last 2 weeks were enrolled as a control group.FeNO was measured by nitric oxide analyzer.Eosinophile level was detected by blood cells analysator.Results The level of FeNO in patients with MPP [(6.28 ±3.00) ppb] was lower than that of patients of non-MPP [(10.85 ± 2.86) ppb] and the control group [(9.74 ± 3.10) ppb] (t =7.30,6.26,respectively,all P ＜ 0.000 1) ; the level of FeNO between the bronchopneumonia group [(5.78 ± 3.06) ppb] and the lobar pneumonia group [(6.48 ± 2.98) ppb] with infection of Mycoplasma pneumoniae (MP) had no statistical significance(t =0.88,P ＞0.05).The proportion of blood eosinophile in patients with MPP [(0.60 ±0.51) ％] was lower than that of non-MPP group [(1.15 ± 0.76) ％] (t =4.14,P ＜ 0.000 1) ; the proportion of blood eosinophile between bronchopneumonia group [(0.61 ± 0.57) ％] and lobar pneumonia group [(0.60 ± 0.55) ％] with infection of MP had no discrepance (t =-0.05,P ＞0.05).Conclusions MP infection decreases production of FeNO.The possible mechanism for this phenomenon is that the cilia loss and hyperimmune response to MP may affect the production of FeNO.The airway inflammation of mycoplasma pneumonia is associated with cilia loss and hyperimmune response.

Objective:To study the influence of protein transduction domain (PTD)-oligomerization domain (OD)-HA fusion proteins on apoptosis of bcr/abl-positive cell lines. Methods:bcr/abl-positive cells were treated with PTD-OD-HA protein. The apoptoses of the cells were detected by flow cytometry (FCM), DNA ladder and transmission electron microscopy (TEM), and the levels of apoptosis-related genes bax and bcl-2 were detected by RT-PCR and Western blotting. Results:FCM examination demonstrated that PTD-OD-HA protein induced the apoptosis of bcr/abl-positive cells; DNA ladder showed that the classic DNA ladders appeared in BaF3-P210 and K562 cells after 48 h treatment with PTD-OD-HA proteins; the apoptoses of BaF3-P210 cells were observed by TEM; the levels of bax in mRNA and protein increased in BaF3-P210 and K562 cells, and bcl-2 decreased. Conclusion:PTD-OD-HA proteins specifically induced the apoptosis of bcr/abl positive cells.

Objectives To investigate the clinical features of pneumonia in children with elevated alanine aminotransferase(ALT). Methods Clinical and laboratory data of 3 979 children with pneumonia admitted to the hospital were collected and retrospectively analysed, and ALT was detected in all cases. Results In 3 979 children with pneumo-nia, elevated ALT (13.78%) was found in 548 cases, most of which had mildly elevated ALT and were infants less than 6 months. The average age in elevated ALT group was less than that in normal ALT group (P=0.000). Apart from the symp-toms of pneumonia, most of them had non-specific clinical symptoms, 169 cases (30.84%) with anorexia or feeding dif-ficulties. 22 cases (4.01%) with poor spirit or weak, 10 cases (1.82%) with crying or abdominal pain;6 cases (1.09%) with dark urine; 4 cases (0.73%) with skin and/or sclera jaundice, 2 cases (0.36%) with bleeding tendency. Children in mildly elevated ALT group recovered faster than in moderate-to-severe elevated ALT group. Conclusions Mildly elevated ALT was most common in pneumonia with elevated ALT which was more likely to occur in younger age group. Clinical mani-festations were often non-specific with good outcomes.

OBJECTIVE:To compare the inhibition effect of Compound danshen tablets on platelet activation and that of Danshen tablets in patients with coronary atherosclerosis.METHODS:90 patients with coronary atherosclerosis were randomized into compound danshen tablet group,danshen tablet group and control group with treatment course of 2 months.30 cases were included into normal group.Radioimmunoassay and realtime RT-PCR were applied to detect mRNA expression of PTGIS,cAMP,TXA2 and PGI2 in plasma respectively and compared with control group.RESULTS:As compared with normal group,the mRNA expression of cAMP,PGI2,PTGIS were decreased markedly while expression of TXA2 was increased remarkably.In compound danshen tablets group and danshen tablets group the mRNA expression of cAMP,PGI2 and PTGIS were increased while the expression of TXA2 was decreased.The increase and decrease of mRNA expression in compound danshen tablets group was higher than that in danshen tablet group.CONCLUSION:Both of Compound danshen tablets and Danshen tablets could inhibit platelet activation and prevent acute coronary syndrome.The effect of Compound danshen tablets on inhibiting platelet activation is better than that of Danshen tablets.

Objective To determine risk factors for the miss rate of colorectal adenomas during colonoscopy.Methods A total of 981 patients,diagnosed as having at least one polyp in colonoscopy,received a second colonoscopy in 6 months from November 2012 to March 2016.All polyps were removed in the second colonoscopy.Bio-information of patients such as sex,age,surveillance interval and features of polyps such as number,size,shape,location,pathology,withdrawal time,bowel preparation was retrospectively analyzed.Factors associated with the miss rates in these patients were analyzed with Chisquare and was also analyzed with Logistic regression model for multiple factors.Results A total of 981 patients were selected according to the inclusion and exclusion criteria,including 604 males and 377 females.Miss rates of males and females were 38.9％ (235/604) and 27.9％ (105/377) (P＜0.01)respectively.Age ranged from 25 to 87 years with mean age being 61.0±9.7 years.Miss rates of senior patients ＜65 and ≥65 years were 31.5％(195/619) and 40.1％(145/362) respectively (P＜0.01).A total of 1 728 adenomas were found in first colonoscopy.A total of 2 267 adenomas were found in the second colonoscopy.The adenoma miss rate was 23.8％ (539/2 267).The miss rate of adenoma whose size ≤ 5 mm was 42.5％ (311/732);and that of larger size of 6 to 9 mm was 17.8％ (194/1 090);that of even larger size,i.e.,≥10 mm,was 7.6％(34/445)(P＜0.01).Miss rates of Is,Isp,Ip,LST and Ⅱ adenomas in shape were 28.4％(489/1 720),9.3％(24/235),6.6％ (12/182),9.0％(6/67) 20.5％ (8/39) respectively (P＞0.05).Location with highest adenoma miss rate were descending colon,ascending colon and transverse colon,27.8％(64/230),25.5％(120/470),25.5％ (161/632) respectively.Miss rates of high and low risk adenoma were 44.8％ (277/618) and 17.4％ (63/363) (P＜0.01).The highest adenoma miss rate of all the pathology type was tubular adenoma.The adenoma miss rate was 26.9％ (449/1 671) (P＜0.01).Miss rates of good and poor bowel preparation were 30.2％ (271/897) and 82.1％ (69/84) (P＜0.01).Miss rates of adequate and inadequate withdrawal time were 24.3％ (174/717) and 62.9％ (166/264) (P＜0.01).Conclusion Male,old-age,diameter ≤ 5 mm,poor bowel preparation and inadequate withdrawal time,high risk adenoma are the risk factors for missed adenoma.But the shape and location of adenoma are not the risk factors.

Purpose The diagnosis of adult onset Still's disease (AOSD) is usually difficult due to the lack of specific clinical manifestation.This paper summarizes the manifestations of 18F-FDG PET/CT in adult onset Still's disease and investigates the value of PET/CT in diagnosis and differential diagnosis of AOSD.Materials and Methods Fiftyfour patients who was diagnosed as AOSD were selected and underwent 1 8F-fluorodeoxyglueosepositron emission tomography/computed tomography (18F-FDG PET/CT).The clinical features,laboratory examination and the maximum standard uptake value (SUVmax) of liver,spleen,bone marrow,lymph node were collected.Then the main PET/CT manifestations of patients with AOSD,the influence factor of SUVmax and correlation between SUVmax and laboratory indexes were analyzed.Results FDG accumulation occurred mainly in bone marrow (88.89％;SUVmax:3.91 ± 1.16),spleen (79.63％,SUVmax:3.24±0.89) and lymph node (77.78％;SUVmax:3.83± 1.97).FDG accumulation can also occurred in joints,parotid gland,submandibular gland,pleural and other organs.Compared with the nonglucocorticoid group,SUVmax of the spleen,bone marrow and lymph node were significantly decreased in the glucocorticoid group with or without fever (P＜0.05),whereas the SUVmax of liver,spleen,bone marrow and lymph node between the two glucocorticoid groups were not statistically different (P＞0.05).The SUVmax of liver,spleen,bone marrow and lymph node between two groups with or without disease-modifying anti-rheumatic drugs were not statistically different (P＞0.05).Correlation analysis showed that spleen SUVmax and lactate dehydrogenase,bone marrow SUVmax and C reactive protein were weakly correlated (r=0.33 and 0.30,P＜0.05).Conclusion The main manifestations of 18F-FDG PET/CT of AOSD are FDG accumulation in spleen,bone marrow and lymph nodes.Glucocorticoid can reduce the SUVmax.18F-FDG PET/CT can help to rule out malignancy,guide biopsy and assist in definite diagnosis of AOSD.

OBJECTIVE To explore the protective effect of polysaccharides from Salvia Chinensis Benth. (PSSC) on lipopolysaccharide (LPS) and D- galactosamine (GalN)- provoked mouse acute liver failure (ALF) and the possible molecular mechanism. METHODS Kunming mice were randomly divided into four groups: normal control, model, model+PSSC 30 and 100 mg·kg- 1 groups. PSCC was given once a day and for a week. To establish an ALF model, mice of model and PSSC groups were ip injected with LPS 10 μg·kg-1 and GalN 700 mg·kg-1 at the end of PSSC treatment. The microscopic structure of the liver was detected by HE staining. Serum and hepatic biochemical parameters of glutamic-oxalacetic transaminase (GOT), glutamic- pyruvic transaminase (GPT), catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), malondialdehyde (MDA), and glutathione (GSH) were detected by colorimetric methods. The relative content of hepatic reactive oxygen species (ROS) was measured by DCFH-DA fluorescent probes. Levels of cytokines tumor necrosis factor-α (TNF-α), interleukin 1β(IL-1β) and IL- 6 in the serum and liver were detected by ELISA. Activity of caspase 3 in liver homogenates was detected by aspase 3 activity assay kit. RESULTS Compared with normal control group, in the liver of model group, hepatocytes were arrayed in disorder, cytoplasm of hepatocytes shrank, and boundaries between cells were fuzzy, the infiltration of a large number of inflammatory cells and tissue hemorrhage could be detected, pathological scores were elevated significantly (P<0.01), levels of MDA and ROS in the liver of ALF model mice were elevated to 2.2 and 4.3 times that of the normal control, respectively (P<0.01), the level of GSH decreased to 51% (P<0.01), and the activities of SOD, CAT and GSH- Px declined to 74%, 36% and 42%, respectively (P<0.01). Levels of TNF- α, IL- 1β and IL- 6 in the serum and liver of model group were increased (P<0.01), and caspase 3 activity was increased to 5.3 times that of the normal control (P<0.01). Compared with the model group, the number of surviving mice in PSSC groups increased, liver pathological scores declined (P<0.01), levels of MDA and ROS increased (P<0.01), levels of GSH, TNF-α, IL-1β and IL-6 in the liver and serum declined (P<0.01), and caspase 3 activity decreased (P<0.01). CONCLUSION PSSC is able to alleviate LPS and GalN-induced ALF in mice. Inhibition of hepatic oxidative stress, inflammatory response, and cell apoptosis is possibly implicated in the protective effect of PSSC.