Objective To observe the efficacy of intra-articular (IA) blockade of TNF-α by 3 etanercept injections in patients with rheumatoid arthritis (RA).Methods Eighteen moderate activity RA patients with resistant knee synovitis underwent three monthly IA injection of etanercept (25mg).The primary outcomes were visual analogue scale of target knee general health (VAS-TKGH) and VAS target knee Pain Score,and we also collected diameter of target knee joint,VAS fatigue Score,Health Assessment Questionnaire (HAQ),the 28-joint based disease activity score (DAS28) and joint fluid volume,which were all assessed at baseline and every four weeks after IA injection.Results All those 18 patients completed the treatment with the average disease duration of was (8 4.7 ± 54.1) months.After each IA injection,VAS-TKGH was significantly improved than baseline (P =0.03,0.02,0.02).and VAS target knee pain score was also significantly improved than baseline (P =0.03,0.00,0.00).After 3rd IA injection,VAS-TKGH was further reduced compared with those after 1 st and 2nd IA injection (P =0.02,0.03) ; while,VAS target knee pain score was further reduced after 3rd IA injection (P =0.00).Knee joint diameter,VAS fatigue score,HAQ and DAS 28 were significantly lower after 1st IA injection than baseline (P =0.03,0.02,0.03).After 2nd IA injection,VAS fatigue score,HAQ,and DAS28 were significantly further improved compared to treatment once (P =0.00,0.02,0.02) ;after 3rd IA injection,HAQ and DAS28 were further improved compared to those after 2nd IA injection (P =0.01,0.02).Joint fluid volume was significantly decreased after 2nd IA injection (P =0.01).Conclusion The tailor approach of intra-articular injections of anti-TNF agent might benefit RA patients who had resistant synovitis,and the side effect was rare.However,the sample was small and further observation is needed.

China ; Foundations ; Integrative Medicine ; Natural Science Disciplines

Humans ; Integrative Medicine ; Medicine ; Medicine, Chinese Traditional

The article reviewed the progress of traditional Chinese medicine in treating fibromyalgia syndrome and summarized the status and feature of different therapies in recent years in order to provide idea for the further researches. In addition, the article also discussed the problems and solutions of the researches.

Tis study discusses the applicable relationship between Buyang-huanwu decoction and hemodynamic cerebral infarction from pathogenesis of Qi asthenia causing blood stasis.pathological features of hemodynamic cerebral infarction and the function and mechanism of Buyang-huanwu decoction and so on.It also investigates the methods of applying Buyang-huanwu decoction to treat hemodynamic cerebral infarction from such aspects as dose,occasion,contraindication and attentions.

The importance and necessity of undergraduates participating in the training plan of the medical research was clarified.Based on the actual ability of students and the characteristic of experimental teaching plan,we think that combination of experimental teaching of small group with research training is a strategy for enhancing the ability of the medical undergraduates to do research.This proposal will speed up the medical educational goal by the activation of novel idea,the cultivation of innovatory thought and the enhancement of creative ability.

Objective To build the relationship model of childhood aubuse, personality, insecurity and dissociative trait in medical students. Methods Through stratified sampling,262 medical students were investiga?ted by the Personal Report of Childhood Abuse( PRCA) ,Dissociative Trait Scale( DTS) ,Self?Rating Feeling of In?security Scale( SRFIS) ,Revised NEO Five?Factor Inventory( NEO?FFI?R) . A path analysis was applied by AMOS (Analysis of Moment Structures) version 7.0. Results ①Childhood abuse was positively related to insecurity, dissociative trait and neuroticism( r=0.248~0.361, P<0.01) ,but was passively related to extraversion,agreeable?ness and conscientiousness( r=-0.168~-0.250, P<0.01). Insecurity was positively related to dissociative trait and neuroticism( r=0.479~0.522, P<0.01) ,but was passively related to extraversion,agreeableness and conscien?tiousness( r=-0.234~-0.324, P<0.01). Dissociative trait was positively related to neuroticism( r=0.597, P<0.01) ,but was passively related to openness, extraversion, agreeableness and conscientiousness ( r=-0. 133~-0.453, P<0.05). ②The path analysis showed that childhood abuse was directly related to insecurity(B=0.339, P<0.01)and personality(B=-0.226, P<0.01)of medical students. Personality was directly related to insecurity and dissociative( B=-0.609~-0.363, P<0.01) . Insecurity was directly related to dissociative trait( B=0.448, P<0.01) . Personality and insecurity mediated entirely the relationship between childhood abuse and dissociative trait of medical students. The model fit indexes were χ2/ df =1.151<3.000, P=O.080>0.05,RMSEA=0.024<0.050, GFI=0.935,AGFI=0.909,NFI=0.923,RFI=0.902,IFI=0.989,TLI=0.986 and CFI=0.989. Conclusion Per?sonality and insecurity as mediated variable mediate the relationship between childhood abuse and dissociative trait of medical students. Childhood abuse has no direct effect on dissociative trait of medical students.

Objective By reviewing the relevant literature, we explored the current status and problems of the evaluation of the training effectiveness, and put forward the corresponding countermeasures, in order to provide a theoretical basis for the effect evaluation of nurse training in China. Methods By searching Citation online search and integration system (CITE), the Chinese biomedical literature service system (CBM), we included the literatures on the effect evaluation of the nurses training in the core journals from January 2006 to November 2015. Retrieval literatures were imported the bibliographic management software Note express by database. The corresponding field were analyzed in the literature′s age distribution, evaluation object, evaluation model, evaluation method, evaluation index and evaluation tool, et al. Results There were 343 literatures had retrieved, the total number of literatures presented a increasing tendency. The evaluation methods, evaluation tools and evaluation indicators presented a tendency of diversity, and the evaluation model was relatively single. Only 16 (4.7%) literatures tried to construct the training effect evaluation system of nurses, which was not based on some theory or hypothesis, which had not been effectively put into practice. Conclusion The effect evaluation system of nurse training needed to be done in depth, such as reconstruction of the new training evaluation model, the establishment of training evaluation system of different professional, different levels, different positions, to research evaluation methods, evaluation criteria and clinical practice testing, to design, training evaluation management software etc.

OBJECTIVE:To observe clinical efficacy and safety of levofloxacin and azithromycin in the treatment of community acquired mycoplasma pneumonia (CAMP).METHODS:A total of 108 patients with CAMP were randomly divided into group A and group B (n=54).Group A received intravenous administration of levofloxacin (0.6 g,qd) and group B intravenous administration of azithromycinin (0.5 g,qd) for 7 days.The clinical efficacy and ADR of 2 groups were observed.RESULTS:The total effective rates of group A and group B were 83% and 56%,there was significant difference between 2 groups (P0.05).CONCLUSION:The clinical efficacy of levofloxacin in the treatment for CAMP is better than that of azithromycin.Levofloxacin and azithromycin have good safety.

Objective To Evaluate the efficacy and safety of Qingre-Huoxue Recipe ( QHR ),Qingre -Huoxue Recipe and Methotrexate(QHR+MTX) in improving clinical symptoms of dampness-heat and blood-stasis syndrome of rheumatoid arthritis.Methods According to multi-center,randomized,and control intervention design,142 RA patients were randomly divided into QHR group (71 cases) and QHR+MTX group (71 cases).With clinical symptoms as evaluation indexes,FAS set and PP set were adapted for analysis.Results FAS set analysis:Both groups can significantly reduce pain VAS score [ (4.82 ± 1.98) vs (4.31 ± 1.85) ],reduce tenderness and swollen joint number[(4.87±4.05)vs(4.20±3.36)、(8.72±6.24)vs(7.14±5.03)respectively],shorten morning stiffness [ (39.56 ± 46.68) min vs (36.65 + 42.58) min] and significantly reduce the symptoms of fatigue[ (4.13 ±2.34) vs (3.74 ±2.20) ],also with good security.But there was no statistically significant difference between the two groups.Conclusion Qingre-Huoxue Recipe with MTX had no significant advantage in improving clinical symptoms in patients with the dampness-heat and blood-stasis syndrom of RA than without MTX.