Interstitial lung disease represents a group of diffuse pulmonary diseases that mainly affects pulmonary mesenchyme and alveolar spaces,resulting in loss of alveolar-capillary functions.It is also a common complication or an important factor that influences the prognosis of rheumatoid arthritis,dermatomyositis,systemic sclerosis.Searching for the biomarkers for the early diagnosis of the disease and/or indicative of the activity of the condition has been a subject of active investigations.KL-6,expressed on type Ⅱ pneumocytes,is seen as the most promising biomarker for the diagnosis of the disease.This review summarizes the recent researches about the use of KL-6 in the diagnosis and treatment of interstitial lung disease.

Objective To evaluate the risk factors for intracranial hemorrhage in premature infants. Methods Cochrane Library, PubMed, ScienceDirect, Chinese Academic Literature Main Database, Chinese Science and Technology Periodi-cal Database, Wanfang Periodicals and Dissertation Database were searched for articles published from January 2000 to December 2012 on the risk factors of intracranial hemorrhage in premature infants, with retrospective retrieval and manual retrieval as supplement. RavMan5.2 provided by Cochrane was used for meta-analysis. Fixed-or random-effects models were selected according to the results of heterogeneity test. Results Nine studies were conifrmed to be eligible. Odds ratio (OR) and 95%conifdence interval (CI) of the risk factors were as follows:gestation age≤32 weeks (OR=3.29, 95%CI=2.76-3.91), birth weight≤1 500g (OR=2.68, 95% CI=2.24-3.20), maternal complications (OR=1.59, 95% CI=1.23-2.06), intrauterine distress or birth asphyxia (OR=2.42, 95% CI=2.06-2.84), mechanical ventilation (OR=3.23, 95% CI=2.55-4.09), metabolic acidosis (OR=2.88, 95%CI=2.04-4.05), use of high concentration of oxygen (OR=2.98, 95%CI=1.63-5.44), prenatal use of dexametha-sone (OR=0.69, 95%CI=0.55-0.86), respiratory distress syndrome (OR=1.57, 95%CI=1.04-2.39). Those differences were all statistically signiifcant. There was no difference in caesarean section (OR=0.99, 95%CI=0.84-1.17), multiparity (OR=1.05, 95%CI=0.79-1.40) and gender (OR=1.25, 95%CI=0.97-1.59). Conclusions The risk factors for intracranial hemorrhage in premature infants are gestation age≤32 weeks, birth weight≤1 500 g, maternal complications, intrauterine distress or birth asphyxia, mechanical ventilation, metabolic acidosis, use of high concentration of oxygen, respiratory distress syndrome, but prenatal use of dexamethasone can reduce the incidence of intracranial hemorrhage in premature infants.

Objective To analyze the clinical characteristics of amyopathic dermatomyositis (ADM).Methods Twenty six patients diagnosed as ADM from January 2006 to January 2010 in PLA General Hospital were retrospectively analyzed.The clinical manifestation,laboratory findings,imaging manifestations,treatment and prognosis of the 26 patients were recorded.Results There were 18 females and 8 males with age of 30-68 years.Overall disease course after diagnosis was 2-18 months.All patients had Gottron rash and interstitial pneumonia.Fifteen patients had history of pulmonary infections.Three patients had comorbidity of tumor.Creatine phosphokinase,creatine phosphokinase isoenzyme,glutamicoxaloacetic transaminase and lactate dehydrogenase were normal in all 26 patients.Four patients had positive anti-Jo-1 antibodies.Antinuclear antibodies were positive in nine patients.Electromyogram was slightly abnormal in 5 patients.Muscle biopsy was abnormal in 19 patients.Twenty patients had improved after receiving corticosteroids and immunosuppressive agents.Six patients died.Conclusions It has been estimated that ADM represents approximately 20％ of all cases of dermatomyositis.It seems that patients with ADM have greater incidence of lung involvement and combined cancer.ADM patients need to be treated positively to improve the prognosis.

Objective To study the clinical and imaging characteristics of patients with infectious sacroiliac arthritis.Method Twenty-one patients diagnosed with infectious sacroiliac arthritis were analyzed retrospectively between 2000 and 2014.The chief complaint was pain in hip and lumbosacral area.Their clinical features,laboratory tests and pathological examination results as well as CT/MRI/PET-CT images were evaluated.Results There were nine males and thirteen females eighteen (85.7％) patients had unilateral sacroiliac joint involvement.Among these patients,three were diagnosed with brucellosis sacroiliac arthritis(BSI),eight patients with tuberculosis sacroiliac arthritis (TSI),and ten patients with non-brucellosis and non-tuberculosis infectious sacroiliac arthritis (ISI).For those patients with non-brucellosis and non-tuberculosis infectious sacroiliac arthritis,white blood cell count,erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)were dramatically increased.Twelve patients were diagnosed pathologically including 6 ISI,2 BSI and 4 TSI.Twelve patients and seventeen patients were scanned by CT and MRI respectively.Two patients undertook PET-CT examination.Antibiotic therapy showed significant therapeutic effects in all patients.Conclusion Infectious sacroiliac arthritis patients with hip or lumbosacral pain as the chief complaint can be easily misdiagnosed as spondyloarthritis.Comprehensive analysis of clinical features,imaging and laboratory findings is essential for accurate diagnosis.

Objective : To investigate the epidemiological characteristics of heatstroke and its correlation with meteorological factors in Shaoxing in 2017,and to provide evidence for heatstroke prevention and control. Methods : The data of heatstroke cases and the daily meteorological indexes were collected from July 2017 to August 2017 in Shaoxing to describe the spatial,temporal and population distribution of heatstroke cases. The correlation between heatstroke and meteorological factors was analyzed by multivariate logistic regression model. Results : A total of 759 cases of heatstroke were reported,with an average age of（53.3 ±17.9）years. There were 487 males cases（64.16%）and 272 female cases（35.84%）. There were 618 cases of mild heatstroke（81.42%）and 141 cases of severe heatstroke（18.58%）. There were six cases of death from severe heatstroke,and the mortality of severe heatstroke was 4.26%. Minimum temperature（rs=0.851,P<0.001）,maximum temperature（rs=0.726,P<0.001）and wind speed（rs=0.285,P=0.025）were positively correlated with the incidence of heatstroke,and relative humidity（rs=-0.693,P<0.001）and rainfall（rs=-0.414,P=0.001）were negatively correlated with the incidence of heatstroke. The results of logistic regression analysis showed that high daily minimum temperature was a risk factor for severe heatstroke（OR=1.854,95%CI：1.606-2.140）. Conclusion The mortality of severe heatstroke patients was high in Shaoxing,the daily minimum temperature was correlated with severe heatstroke.

Objective To evaluate the specificity and limitations of sacroiliac joint magnetic resonance imaging (MRI) in the diagnosis of axial spondyloarthritis (SpA)in patients with chronic low back pain.Methods We retrospectively analyzed clinical data of 390 patients with chronic low back pain in Department of Rheumatology,the PLA General Hospital from January 2013 to December 2015,including clinical manifestations,laboratory examinations and MRI data of sacroiliac joints.Results There were 238 men and 152 women recruited.A total of 326 cases were diagnosed as axial SpA,including 216 men and 110 women with mean age (27.10 ± 8.64) years and mean duration (7.64 ± 3.50) months.Among these 326 patients,243 (74.5％) were HLA-B27 positive.The other 64 patients were considered as diagnoses rather than SpA (non-SpA),consisting of 22 men and 42 women with mean age (31.29 ± 7.76) years and mean duration (5.75 ±2.90)months.Non-SpA group had 10 (15.6％) patients with HLA-B27 positive.There were 68.1％ and 65.0％ SpA patients showing bone marrow edema and bone erosion of sacroiliac joint in MRI imaging respectively.Although there were 25.0％ non-SpA patients with bone marrow edema and 7.8 ％ with bone erosion in MRI of sacroiliac joint,the scores of bone marrow edema 0.00 (0.00,0.75) and bone erosion [0.00(0.00,0.00)] were significantly lower compared with those in axial SpA group [bone marrow edema scores 2.00 (0.00,4.00),bone erosion scores 1.00 (0.00,3.00);P ＜ 0.05].The scores of fat infiltration [1.00 (0.00,4.25),1.00 (0.00,4.00)] and bone sclerosis [0.00 (0.00,1.00),0.00(0.00,1.75)] were not statistically different between two groups.Diagnostic sensitivity of bone marrow edema and bone erosion for axial SpA were 56.4％ and 64.1％ respectively,specificity were 93.8％ and 92.2％ respectively.The positive predictive value of bone marrow edema and bone erosion for axial SpA were 9.09 and 8.21,negative predictive value were 0.46 and 0.38.Diagnositic sensitivity of fatty infiltration and bone sclerosis for axial SpA group were 29.1％ and 57.7％,specificity were 64.1％ and 46.9％.The positive predictive value of fatty infiltration and bone sclerosis for axial SpA were 0.81 and 1.08,negative predictive valne were 1.10 and 0.90.Conclusion Sacroiliac joint MRI is a valuable method to diagnose axial SpA in patients with chronic low back pain.Yet it still has some limitations.Clinical presentations and spinal MRI would be helpful in some patients.

To improve the clinical teaching work, the objective structured clinical examination (OSCE) was first introduced into the periodontal clinical assessment held by Departments of Periodon-titis and Mucosal Disease. With the OSCE exam station and item pool established, standardized pa-tients tralned, the examination form reformed, the knowledge, skill, and attitude of the examinee were assessed comprehensively. Compared with traditional exam,the OSCE evaluated the examinee's skills on clinical admissions, history collection, treatment plan development better. Most examinee have got satisfactory result (pass rate: 86.4 %, 19/22; good rate: 36.4%, 8/22; excellent rate: 9.1%, 2/22). The feedback of the following questionnalre also showed that most of the candidates thought the OSCE helpful to promoting the learning of theoretical knowledge (87.5%, 14/16) and good for converting the learned knowledge and skills into occupation ability (87.5%, 14/16).

Objective To observe and analyze the medium and long term follow-up data of arrhythmias after transcatheter closure of children with ventricular septal defect (VSD). Methods Retrospectively analyzed the clinical data of 1071 children with VSD, who successfully underwent transcatheter device closure, at l, 3, 6, 12 months and ev-ery year post procedure from March 2002 to December 2010. Results Of all 1071 children, 272 cases (25.4%) were ob-served of having arrhythmias within 1 month after intervention, mainly including atrioventricular block (AVB), branch block, junctional tachycardia, atrial and ventricular tachycardia, frequent contractions, etc. Among them, 22 cases (2.1%) had above II degree AVB, complete left bundle branch block (CLBBB) and other causes of serious arrhythmias. After treatment, all cases got better and no permanent pacemaker was necessary. After 1 to 107 months (2.8±1.7 years) fol-low-up, 161 cases (18.2%) were observed of having persistent abnormal ECG mainly caused by AVB and branch block, including 10 cases (1.1%) with serious arrhythmias. In 4 cases with late-onset AVB, 3 cases had already appeared AVB in early postoperative, 1 case had recurrence CLBBB, left ventricle enlarge, and died of heart failure during follow up. Four cases were implanted permanent pacemaker. Conclusion During follow-up, serious arrhythmias after VSD closure, such as AVB or CLBBB, have high risk of recurring. Conduction block arrhythmias may reappear or worsen, while arrhythmias like tachycardia and premature heart rhythm mostly return to normal.

Objective To analyze the causes of failed transcatheter closure for ventricular septal defects (VSD)in children. Methods One thousand two hundred and eighty children aged 13 to 141 months who underwent transcatheter closure from June 2009 to September 2013 in Guangdong General Hospital were selected. There were 43 failures(3. 36% ). The clinical data including transthoracic echocardiograph( TTE),radiography,interventional ap-proach and surgical findings were analyzed. Results Forty - three patients included 25 male and 18 female. The pa-tients' ages ranged from 13 to 141(43. 0 ± 31. 9)months and their weight ranged from 10 to 35(16. 3 ± 5. 59)kg. The causes of failure including doubly committed subarterial VSD misdiagnosed as perimembranous VSD(PMVSD)or intracristal VSD were in 6 patients. The size of occluder was too small in 13 cases,and there were statistical differences between three measurements of size of VSD(F = 19. 134,P = 0. 001). The size of VSD measured by left ventricular an-giography was significantly smaller than that measured by TTE,and there was statistical difference[(4. 78 ± 1. 11) mm vs(6. 48 ± 1. 43)mm,t = 4. 50,P = 0. 001]. The dimension of VSD measured by left ventricular angiography was significantly smaller than that measured by surgical findings,and there was statistical difference[(4. 78 ± 1. 11) mm vs(7. 02 ± 1. 08)mm,t = 5. 92,P = 0. 001]. But,the size of VSD measured by TTE had no significant difference compared with that measured by surgical findings(t = 1. 42,P = 0. 168). Aortic regurgitation occurred in 14 cases;atrioventricular block or left bundle branch block in 3 patients;tricuspid stenosis in 2 cases and residual shunt in 5 pa-tients. Conclusions Doubly committed subarterial VSD may be misdiagnosed as PMVSD or intracristal VSD. In the ca-ses of VSD concomitant with aortic valve prolapse,size of the occluders should be referred to VSD dimensions measured by TTE. In the cases of VSD adjacent to aortic valve,suitable occluders should be selected and operation technique should be improved to avoid aortic regurgitation.

Objective To improve the understanding of the clinical features, differential diagnosis and prognosis of pachydermodactyly. Methods The clinical data of 20 patients with pachydermo dactyly and follow-up data of 6 patient were analyzed. Results Seventeen out of 20 patients were male. The average onset age was (15±2) years. All of them had asymptomatic, firm swellings which developed insidiously on both sides of the proximal interphalangeal (PIP) joints. All the patients indicated that they were in the compulsive habit of interlacing their fingers and squeezing them. For all patients, biochemical examinations were normal and there was no rheumatoid factor or antinuclear antibodies. X-ray and MRI showed that the thickening of soft tissue around PIP joints without changes in bones or joints structure. Histopathologic findings from the swellings reveMed marked hyperkeratosis, with slight epidermal hyperplasia, and a markedly thickened dermis with whorled, densely aggregated bundles of coarse collagen. Even though 8 patients in the group had gotten rid of the aforesaid habit for 3 to 22 years, the swellings of their PIP joints did not resolve. Conclusion Pachy-dermodactyly is a benign digital fibromatosis which usually involves the PIP joints. It can be distinguished from juvenile rheumatoid arthritis and knuckle pad.