BACKGROUND:There are many reports on the clinical effect of total knee arthroplasty in the treatment of advanced rheumatoid arthritis, but the reports on the effect of total knee arthroplasty on the disease activity in patients with rheumatoid arthritis are rare. Therefore, the more clinical evidences are needed for supporting.
OBJECTIVE:To explore the effect of total knee arthroplasty on disease activity in patients with rheumatoid arthritis.
METHODS:109 patients with rheumatoid arthritis were included;48 cases in the replacement group, and received total knee arthroplasty combined with internal medicine medications;the 61 cases in the drug treatment group were treated with simple internal medicine medications. The rheumatoid factor, blood sedimentation rate and C-reactive protein levels of the patients in two groups were measured before treatment, 1 and 2 years after treatment, and the Ishikawa joint function scoring criteria was used to assess the functions.
RESULTS AND CONCLUSION:There were no significant differences in the rheumatoid factor, blood sedimentation rate and C-reactive protein levels between two groups before treatment (P>0.05). At 1 and 2 years after treatment, the indicators in the drug treatment group were higher than those in the replacement group (P<0.05);the indicators in the two groups at 2 years after treatment were significantly lower than those before treatment (P<0.05). The rheumatoid arthritis symptom scores of the affected joints of the patients in two groups were significantly improved, especial y the pain, swel and subjective attitudes, and the replacement group was better than the drug treatment group (P<0.05). The total knee arthroplasty can affect the disease activity of rheumatoid arthritis in short-term, and the effect of total knee arthroplasty is better than simple drug treatment.

Objective:To study B cells proliferation and activation induced by tumor derived-autophagosomes ( TDA). Methods:Splenocytes of mice were incubated with 10μg/ml TDAs in vitro ( with the 10μg/ml whole cell lysate as the control).At the 3rd day,the expression of MHCⅠ,Ⅱand co-stimulate molecules including CD86,CD40 were detected by flow cytometry,and B cells proliferation was detected at the 5th day.B cells were selected from spleen of mice using anti-CD43 dynabeads,and incubated with 10μg/ml TDA in vitro ( with the same concentrated whole tumor cell lysate as the control).At the 7th day,IgM in the supernatant were tested by ELISA.Results:When compared with whole cell lysate stimulated B cells,TDA efficently stimulated B cells division in vitro ( TDA group:28.6%, Whole cell lysate group:4.4%) , and significantly up-regulated the expression of MHC class Ⅰ,Ⅱ and co-stimulatory molecules (CD86 and CD40) on B cells,and enhanced the levels of total IgM secretion in vitro.Conclusion:Tumor-derived autophagosomes ( TDA) ,as a vacuole antigen vector, could stimulate B cells proliferation, activation, and increased IgM secretion in vitro.

OBJECTIVE To investigate the nosocomial infection knowledge nurses in graduating class. METHODS 286 nurses of graduating class were investigated by questionnaires. RESULTS The students were lacked of knowledge about nosocomial infection and 61.70% nurses of graduating class had never participated in the training of nosocomial infection knowledge (the average score only 58.67). They were interested in the disinfection and sterilization of infection diseases. And they wanted to get it through clinical infection control group (81.56% students selected this educational methods). CONCLUSIONS It is necessary to strengthen the training and education of nosocomial infection. And adjust the training mode and content according object.

OBJECTIVE:To evaluate the bioavailability of two nimesulide preparations.METHODS:A total of 20 healthy male volunteers were enrolled in a randomized crossover study in which the subjects were randomly assigned to receive single dose of 200 mg nimesulide orally disintegrating tablets(test)or nimesulide tablets(reference).The plasma concentrations of nimesulide were determined by RP-HPLC,and the pharmacokinetic parameters and bioavailability were calculated with DAS program.RESULTS:The main pharmacokinetic parameters of nimesulide test and reference preparations were as follow:AUC0～24:(54.67?18.25)vs.(56.15?15.54)?g?h?mL-1;AUC0～∞:(56.38?18.03)vs.(57.63?15.26)?g?h?mL-1;Cmax:(7.61?2.72)vs.(7.50?2.19)?g?mL-1;tmax:(3.83?1.39)and(3.80?1.28)h.The relative bioavailability of nimesulide or-ally disintegrating tablets as against nimesulide tablet was(98.7?22.9)%.CONCLUSION:Nimesulide test and reference preparations were bioequivalent.

Objective To investigate the expression of peripheral blood (PB) CD4+ CD25+ Foxp3+ regulatory T cells (Tregs) in patients with benign end-stage liver disease after liver transplantation and the relationship between levels of PB Tregs and acute rejection. Methods A prospective analysis was performed on 55 consecutive patients who underwent liver transplantation.Fourteen out of 55 cases suffered from acute rejection after liver transplantation were defined as rejection group,while the rest patients were classified into no acute rejection group. PB was obtained from liver transplant patients at different time points longitudinally: pre-transplant, post-transplant within one year and acute rejection. The circulating CD4+ CD25+ Foxp3+ Tregs in PB were measured by flow cytometry. Blood samples were drawn during acute rejection, at the same time, liver biopsies were performed. The circulating CD4+ CD25+ Foxp3+ Tregs were compared between two groups.Results There was no difference between two groups in levels of circulating CD4+ CD25+ Foxp3 + Tregs cells pre-transplant. However, the levels of circulating CD4+ CD25+ Foxp3+ Tregs in rejection group were decreased significantly as compared with no-rejection group (2. 23 % ± 0. 54 % vs. 2. 99 % ±0. 86 %,P＜0.01). The frequency of CD4+ CD25+ Foxp3+ T cells was negatively correlated with rejection activity index (RAI) (r = - 0. 80, P＜0. 01 ). Conclusion Monitoring PB CD4+ CD25+ Foxp3+ Tregs levels may be helpful in evaluating the immune state and act as a more sensitive marker for acute rejection diagnosis in the patients following liver transplantation.

Objective To investigate the value of biliary tumor markers for differential diagnosis of the benign and malignant biliary tract diseases.Methods Tumor markers (CA19-9,CEA and CA242) examination and bacterial culture were performed in a total of 160 patients,who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for biliary diseases.Resuts There were significant differences between malignant group and benign group in bile and serum in the level of CA19-9,CEA and CA242 (P ＜0.05) ; Cut-off value,according to ROC curve,was 239 ku/l in CA19-9,40 ng/ml in CEA and 60 ku/ml in CA242,respectively.There were significant differences between the bile marker and the serum marker in sensitivity,accuracy,negative predicative value of CEA (P ＜ 0.05).No significant differences was found in specificity between the serum group and the bile group.There were significant differences in bile CA19-9 level between cholangiocarcinoma,pancreatic cancer,duodenal papilla carcinoma with carcinoma metastasizing to bile duct,and hepatocellular carcinoma (P ＜ 0.05).Both in benign group and malignant group,there were significant differences in CA19-9 level between infectious bile and noninfectious bile (P ＜ 0.05).Conclusion The level of CA19-9,CEA and CA242 in bile can be applied to differentiate benign and malignant biliary diseases.The bile tumor markers do not have advantage over serum tumor markers in specificity for diagnosis.Bile bacterial infection can result in the elevation of bile CA19-9 while it does not have impact on differential diagnosis.

OBJECTIVETo observe the therapeutic effects of continuous plasma filtration absorption (CPFA) treatment on burn sepsis.

METHODSThirty burn patients with sepsis hospitalized in Beijing Fengtai You'anmen Hospital from July 2009 to October 2012 were treated by CPFA for twice besides routine treatment. The blood samples were collected at five sites (A, B, C, D, and E, respectively) of blood purification equipment before and after CPFA, before and after hemoabsorption, and before hemofiltration. The plasma levels of TNF-α, IL-1β, IL-6, IL-10, interleukin-1 receptor antagonist (IL-1RA), soluble tumor necrosis factor receptor (sTNFR) I , and sTNFR-II from sites A, C, and E were determined with ELISA before CPFA was performed for the first time, and those from sites B and D were determined with ELISA after CPFA was performed for the first time. Plasma levels of the above-mentioned cytokines from sites A and B were determined with ELISA before CPFA and after CPFA was performed for the second time. The data of plasma levels of IL-1βP3, IL-1RA, sTNFR-I, sTNFR-II, and TNF-α before CPFA and after CPFA was performed for the second time were collected for calculation of the ratios of IL-1RA to IL-1β and sTNFR-I plus sTNFR-II to TNF-α. The expression rate of human leukocyte antigen DR (HLA-DR) on the CD14 positive monocytes, acute physiology and chronic health evaluation (APACHE) II score, body temperature, pulse, respiratory rate, and leukocyte count of patients were evaluated or recorded before CPFA and after CPFA was performed for the second time. Patients'condition was observed. Data were processed with paired t test.

RESULTSThe plasma levels of TNF-α, IL-1β, IL-6 and IL-10 from site B after CPFA was performed for the second time were significantly lower than those from site A before CPFA was performed for the first time (with t values respectively 7.05, 5.23, 4.73, 2.37, P values below 0.01). After CPFA was performed for the first time, the plasma levels of TNF-α, IL-1β, and IL-6 from site D were significantly lower than those from site C before CPFA was performed for the first time (with t values respectively 5.48, 2. 17, 1.78, P < 0.05 or P <0.01). The plasma levels of all cytokines were close between site B after CPFA was performed for the first time and site E before CPFA was performed for the first time (with t values from 0.04 to 1.05, P values above 0.05). The plasma levels of TNF-α, IL-1β, and IL-6 from site B after CPFA was performed for the second time were significantly lower than those from site A before CPFA was performed for the second time (with t values from 1.87 to 5.93, P <0.05 or P <0.01). The ratios of IL-1RA to IL-1β and sTNFR-I plus sTNFR-II to TNF-α, and expression rate of HLA-DR were increased significantly after CPFA was performed for the second time as compared with those before CPFA (with t values from 3.99 to 7. 80, P values below 0.01). APACHE II score after CPFA was performed for the second time was 11 ± 6, which was lower than that before CPFA (22 ± 7, t =4.63, P <0.01). After CPFA was performed for the second time, body temperature, pulse, and respiratory rate of patients were improved (with t values from 1.95 to 3.55, P values below 0.05) , and the leukocyte count was significantly decreased (t =4.36, P <0.01) as compared with those before CPFA. All patients survived and were discharged with length of stay of (27 ± 31) d, and no adverse effects occurred during CPFA treatment.

CONCLUSIONSCPFA, which combines hemoabsorption and hemofiltration, can facilitate the treatment of burn sepsis by decreasing the level of pro-inflammatory cytokines efficiently, alleviating systemic inflammatory response, and improving the immune status.

Adsorption ; Aged ; Biomarkers ; blood ; Burns ; blood ; complications ; immunology ; Cytokines ; blood ; Fluid Therapy ; Hemofiltration ; methods ; Hospitalization ; Humans ; Inflammation Mediators ; blood ; Interleukin 1 Receptor Antagonist Protein ; blood ; Interleukin-10 ; blood ; Interleukin-6 ; blood ; Sepsis ; blood ; immunology ; therapy ; Treatment Outcome ; Tumor Necrosis Factor-alpha

Objective To improve the detecting sensitivity of serum specific IgE (sIgE) by improving the quality of coated antigen in shrimp. Methods The extracts from shrimp protein was prepared. Western blot assay was used to identify the major allergenic protein components. The protein components>55 ku were separated by Sephadex gel chromatography. SDS-PAGE technology was used to analyze proteins. Samples of shrimp protein and proteins>55 ku were used as the coat-ing antigen to coat 96 microplate respectively. Western blot assay and ELISA were used to evaluate preliminary sensitivity of the purified antigen for detecting sIgE. Results Immunoblot experiments showed that the protein>55 ku was the main aller-genic protein component of shrimp. Those >55 ku proteins were separated successfully by Sephadex gel chromatography, showing 10 identifiable bands in SDS-PAGE. Dot-pot immunoassay showed that proteins>55 ku used as coated antigens could improve the spots density of the weak serum. Meanwhile, the result of ELISA showed that sIgE detection value in-creased 92.9%in patients with shrimp allergy after coating effective antigens. Conclusion The detecting sensitivity of sIgE can be improved by using effective protein components of shrimp as coated antigens.

Objective To analyze retrospectively the death pattern, risk factors, and death time of 253 patients at the Respiratory Care Unit of General Hospital of PLA in order to improve care quality and reduce mortality.Methods The information of patients was extracted from the hospital information system ( HIS) , and then classified and calculated accord-ing to different time points.Results Between November and next March,the mortality rate was higher than in other months (P<0.05), accounting for 19.5%.Mortality of those admitted between 8∶01 and 9∶00 or between 23∶01 and 24∶00 was higher than at other times(P<0.05), accounting for 41.7%and 50.0%, respectively.There was statistically significant difference(P<0.01) in mortality between days of the week,with the highest on Saturday, accounting for 43.1%.Mortality on non-work days was higher than on workday(P<0.01), accounting for 38.3% and 13.2%, respectively.Mortality at off-hour was higher than at office time(8∶00-11∶30 and 14∶30-18∶00 on workday) (P<0.01), accounting for 31.3%and 5.2%, respectively.Logistic regression analysis showed that age, month of admission, and the hour of discharge were associated with the outcome.Conclusion The high mortality between November and next March may be related to the higher incidence of respiratory diseases in winter, air pollution and cold weather.High mortality is also significantly associ-ated with the care quality of the medical staff.

Objective To evaluate the impact of aderent perirenal fat (APF) on retroperitoneal laparoscopic partial nephrectomy (RLPN). Methods Clinical data of 52 patients who underwent RLPN for a small renal tumor from October 2013 to December 2015 was analyzed retrospectively. All the patients were divided into two groups according to the presence of APF by preoperative computed tomography imaging. Clinical data was collected including patients' age, gender, BMI, history of hypertension, history of diabetes, American Society of Anesthesiologists score (ASA), intra-abdominal fat (IAF), tumor size, RENAL Nephrometry score (RNS), operative time, warm ischaemia time (WIT), estimated blood loss (EBL), and length of hospital stay. Results Between the two groups, the BMI, tumor size, WIT, length of hospital stay were similar [(26.70 ± 3.33) kg/m2 vs (25.65 ± 4.01) kg/m2, (3.53 ± 1.21) cm vs (3.64 ± 1.05) cm, (27.17 ± 7.55) min vs (25.21 ± 5.64) min, (12.54 ± 4.06) d vs (10.61 ± 3.70) d, P > 0.05)], as well as the ASA and RNS. APF patients were older [(59.25 ± 11.03) y vs (49.71 ± 11.86) y, P = 0.004]. There were a high proportion of men (75.0% vs 46.4%, P = 0.036), patients with hypertension (62.5% vs 28.6%, P = 0.014), and patients with diabetes (41.7% vs 14.3%, P = 0.026). In the APF group, IAF was more [(2.02 ± 0.47) cm vs (1.35 ± 0.66) cm, P = 0.000], operative time was longer [(146.08 ± 45.45) min vs (119.32 ± 28.83) min, P = 0.017], and EBL was higher [(82.92 ± 45.73) ml vs (51.79 ± 25.10) ml, P = 0.005]. Conclusion The adherent preirenal fat sticking renal results in a longer operative time and a higher EBL, but has no influences on the WIT and length of hospital stay. APF makes it difficult to expose the tumor, not to remove it.