ObjectiveTo compare the clinical effect and security of Reparil Gel on osteoarthritis of the knee.Methods60 patients were randomly divided into Reparil Gel group and Fenbid group, who applied Reparil Gel or take Fenbid orally respectively. Western Ontario and McMaster University Osteoarthritis Index (WOMAC) was used to assess patients' pain, joint stiffness and disability of knee on 0 week, 2 week, 6 week after treatment. The side effect was observed.ResultsBoth group showed good clinic effect on 2 weeks (P<0.05)and 6 weeks (P<0.001)after treatment. Significant difference between two group was found 2 weeks after treatment, but there was no difference 6 weeks after. There was no side effect had been observed in Reparil Gel group, while stomachache, nausea or anorexia had been found in 4 case of Fenbid group 2 weeks after, and 8 case of Fenbid group 6 weeks after.ConclusionReparil Gel are same effective as Fenbid, but less side effect happened.

ObjectiveTo investigate the etiology, exacerbating factors and outcome of geriatric patients with acute renal failure (ARF) in emergency and critical internal medicine. MethodsClinical features of elderly inpatients with ARF who were diagnosed in internal medicine of our hospital during the past 10 years were retrospectively analyzed. Patients were divided into community-acquired ARF (CA-AFR) group and hospital-acquired ARF (HA-ARF) group. Comparisons between CA-ARF group and HA-ARF group, and between elderly patients and non-elderly patients with ARF in internal medicine were performed. ResultsAmong 381 elderly ARF patients in internal medicine, there were 218 (57.2%) CA-ARF patients and 163 (42.8%) HA-ARF patients. Most of the HA-ARF patients (153 cases) were distributed in medical intensive care. Compared with CA-ARF group, patients in HA-ARF group were older, with more underlying diseases, a higher ratio of infections and/or heart failure and more severe acute renal failure. Infection and heart failure/severe myocardial isehemia were the major exacerbating factors for HA-ARF. Of the 163 patients with HA-ARF, 146 patients died and 17 patients survived. Patients in the death group had more underlying diseases, a higher ratio of severe infections and heart failure/severe myocardial ischemia, a higher ratio of cases with multiple organ dysfunction syndrome(MODS) and a higher score of APACHE Ⅱ.When compared with non-elderly patients with ARF, the elderly patients had a higher proportion ofHA-ARF, a higher ratio of MODS, a higher score of APACHEⅡ and a higher mortality of ARF.ConclusionsThe elderly critical patients are susceptible to HA-ARF with more chronic underlying diseases. Infection and heart failure/severe myocardial ischemia are the major exacerbating factors.The prognosis depends on the treatment of predisposing diseases and removal of exacerbating factors.

Objective To evaluate the value of CT perfusion imaging (CTPI) in the diagnosis of hepatocellular carcinoma (HCC). Method CTPI was carried out on 21 patients with 26 lesions to obtain the following perfusion parameters: hepatic blood flow (HBF), hepatic blood volume (HBV),mean transit time (MTT), permeability surface area product (PS), and hepatic arterial fraction (HAF). The parameters from the lesion and non-lesion areas were compared. In addition, serum AFP was measured in the HCC patients and a linear correlation analysis between the alpha-fetoprotein (AFP) level and the CTPI parameters was performed. Result CTPI failed in 3 patients with 3 lesions and was successful in 18 patients with 23 lesions which included 18 HCC, 4 hemangioma of the liver,and 1 hepatic focal nodular hyperplasia (FNH). On comparison of the HCC parameters in the lesion and non-lesion areas, significant differences were found in the HAF which was 4.11 times higher in the lesion than the non-lesion areas, while the MTT and PS were significantly lower. There was no significant difference in the HBF and HBV. Correlation between the serum AFP level and the CTPI parameters of the HCC lesion was insignificant. The differences of all the parameters between the lesion and the non-lesion in hemangioma were similar to those in HCC, except for a higher HBF in the lesion than in HCC. There was no significant difference between the parameters of FNH and the non-nodular part of the liver. Conclusion CTPI played an important role in the diagnosis and differential diagnosis of HCC, especially when the AFP was negative and/or the imaging manifestation was atypical on contrast CT.

Objective To explore the correlation between quantitative value of joint bone scan by single photon emission computed tomography (SPECT) and serum bone metabolic markers in patients with active rheumatoid arthritis (RA).Method Clinical data of 60 newly diagnosed RA patients were retrospectively collected in Department of Rheumatology and Immunology from May 2013 to December 2014,including 28 cases with medical history less than 6 months and 32 from 6 months to 2 years.Serum Cterminal telopeptide of type Ⅰ collgen(CTX-Ⅰ)and N-terminal propeptide of type Ⅰ collagen(PINP) were tested by chemiluminesence.SPECT whole body bone and target joint scan before treatment was done.Thirty-nine healthy subjects as control group received ultrasound,electrocardiogram,X-ray,and whole body bone imaging examination.Quantitative values of joint imaging were calculated for the statistical analysis.Result Demographic data between RA group and control group were comparable (P ＞ 0.05),including sample,sex,age and BMI.The joint SPECT value,CTX-Ⅰ and PINP levels were all significantly higher than those of control group (P ＜ 0.01),which were 6.48 ± 1.98 versus 3.73 ± 1.t6;(0.66 ± 0.37) mg/L versus (0.58 ±0.21) mg/L;(46.35 ±28.15) mg/L versus (30.47 ± 13.75) mg/L respectively.Joint SPECT values had positive correlations with serum CTX-Ⅰ levels in all RA patients,as well as PINP in patients with disease duration 6mon-2years.And the according correlation coefficients were 0.513,0.495,0.402 (P ＜ 0.05).But SPECT value had no correlation with CTX-Ⅰ (P =0.081) in patients with disease duration less than 6 mon.The correlation coefficient was 0.336.Conclusion SPECT imaging quantitative values were positively correlated with serum bone metabolic parameters.Thus SPECT imaging alone or combined with bone markers are helpful in diagnosing active RA.

Objective To investigate the clinical value of 99Tcm-MIBI SPECT-CT image fusion technology for diagnosing breast tumor and detecting axiiiary lymph node metastasis. Methods 99Tcm-MiBI breast and axillary lymph node planar and SPECT-CT imaging in 80 female breast tumor patients were done. All patients had pathological examination results after surgery as control. Results SPECT-CT fusion images sensitivity for breast cancer diagnosis, specificity and accuracy rates were 88.2 % (45/51), 93.1% (26/29) and 90 % (71/80). Planar imaging sensitivity, specificity and accuracy rate were 82.4 % (42/51), 79.3 %(23/29) and 81.3 %(65/80). SPECT-CT fusion images were higher than planar imaging (P <0.05). SPECT-CT fusion images sensitivity, specificity and accuracy for detecting axillary lymph node metastasis were 81.8 %(18/22), 89.7 % (26/29) and 86.3 % (44/51). Planar imaging sensitivity, specificity and accuracy were 77.2 % (17/22), 86.2 % (25/29) and 82.4 %(42/51). There was no significant difference between them (P0.05). Conclusion SPECT-CT image fusion technology in the diagnosis of breast cancer is better than planar imaging. SPECT-CT image fusion in detecting axillary lymph node metastasis of breast cancer is similar to planar imaging.

Based on the investigation of a hospital's grants during 2004-2005 and the authorized during 2002-2005 (385 in total), we tried to find the trends and bias of clinical sciences at present. We analysed on the types of grants (clinical or basic), research objects, experimental methods, discipline involved, modes of cooperation, and background of applicants. A close connection between research and clinical trial, interdisciplinary study, patient-centered practice and international competitions are becoming more and more important. To meet the needs of clinical research, policies and devotions such as technical platforms are needed.

Objective To investigate the effects of virtual reality prism adaptation on visuospatial neglect in stroke patients.Methods Thirty stroke patients with visuospatial neglect were studied.The subjects were divided into atreatment group and a control group.The subjects in the treatment group were treated with virtual reality prism adaptation and routine rehabilitation interventions for 2 weeks,while those in the control group were treated with routine rehabilitation interventions only.All the patients performed a battery of spatial attention tests including line bisection,letter cancellation,clock drawing and the Attention Network Test at the beginning and after 2 weeks of treatment.Results The virtual reality prism adaptation training had significant positive effects on all the measures of visuospatial neglect.Pair-wise comparisons confirmed significant differences between the treatment and control groups after 2 weeks of treatment with regard to all of the measures.Conclusions Virtual reality prism adaptation treatzment combined with routine rehabilitation can be more effective than conventional measures alone in improving the visuospatial performance of stroke survivors.

Objective To explore the outcome of body-weight-supported treadmill training on the kinetic data of lower limb in early stage of stroke.Methods Twenty-seven hemiplegic stroke patients at early stage were recruited and randomized to an experimental group(n =15) and a control group (n =12).Both groups were administered with routine neurological interventions.In addition,the control group was treated with conventional physiotherapy and over-ground walking training,while the experimental group was treated with body-weight-supported treadmill training.The speed of the treadmill walking was started at 0.22 m/s and increased to 0.60 ～ 0.80 m/s gradually.The percentage of the body-weight being supported was not more than 30％,the training time was 5 min per session at the beginning and was increased gradually to 20 ～ 40 min.Kinetic parameters were measured by using two force plates (AMT) and six cameras capture svstem (Vicon Nexus),and motor function was evaluated using Fugl-Meyer Assessment (FMA) at baseline and after three-week's therapy.Peak moment of lower limb joints,ground reaction force and motor function were analyzed.Results FMA scores were significantly improved (P ＜ 0.05) in both groups after treatment,but there was no significant differences (P ＜ 0.05) between the two group.Ground reaction force was significantly increased (P ＜ 0.05) after treatment in the experiment group,but not in control group (P ＞ 0.05).It showed that the hip extension moment at the affected side was significantly lower (P ＜ 0.05) in experiment group than in the control group,the ankle joint flexion and extension moment peak were improved to a significantly larger extend in the experimental group (P ＜ 0.05) than in the control group.In addition,the peak flexion and extension moment of the hip-knee joint and peak flexion and extension moment of the knee-ankle joint were also significantly different from those of the control group (P ＜ 0.05).Conclusion Body-weight-supported treadmill training can facilitate motor recovery of paretic extremity by increasing ground reaction force and load support of the affected lower limb,and help normalize the abnormal gait pattern of lower extremity of stroke patients.

AIM:Atherosclerotic calcification is highly linked with plaque instability and cardiovascular events .Adenosine monophosphate-activated protein kinase ( AMPK) has been involved in the pathogenesis of various cardiovascular disease .The contributions of AMPKαsubunits to the development of atherosclerotic calcification in vivo remained unknown .We hypothesized that AMPKαsubunits may play a role in the development of atherosclerotic calcification .METHODS: Atherosclerotic calcification was generated by 24-week fed of western diet in ApoE-/-background mice .Calcification was evaluated in aortic roots and innominate arteries of ApoE-/-mice or in mice with dual deficiencies of ApoE and AMPKαsubunits globally ( AMPKα1 and AMPKα2 ) , or vascular smooth muscle cell ( VSMC)-specific or macrophage-specific knockout of AMPKα1 with atherosclerotic calcification pone diet . The mechanism of AMPKα1 in regulating Runx2 was further explored in human aortic VSMC .RESULTS: Ablation of AMPKα1 but not AMPKα2 in ApoE-/-background promoted atherosclerotic calcification with increased Runt -related transcription factor ( Runx2 ) expression in VSMC compared with ApoE-/-mice.Conversely, chronic administration of metformin, which activated AMPK, markedly reduced ath-erosclerotic calcification and Runx2 expression in ApoE-/-mice but had less effects in ApoE-/-/AMPKα1 -/-mice.Furthermore, VSMC-but not macrophage-specific deficiency of AMPKα1 in ApoE-/-background promoted atherosclerotic calcification in vivo com-pared with the controls .AMPKα1 silencing in human aortic VSMC prevented Runx 2 from proteasome degradation to trigger osteoblastic differentiation of VSMC .Conversely , activation of AMPK led to Runx 2 instability by inducing its small ubiquitin-like modifier modifi-cation (SUMOylation).Protein inhibitor of activated STAT-1 (PIAS1), the SUMO E3-ligase of Runx2, was directly phosphorylated by
AMPKα1 at serine 510, to enhance its SUMO E3-ligase activity.Ablation of PIAS1 serine 510 phosphorylation inhibited metformin-in-duced Runx2 SUMOylation, and subsequently prevented the effect of metformin on reducing oxLDL-triggered Runx2 expression in hu-man aortic VSMC.CONCLUSION:Deficiency of AMPKα1 in VSMC increases Runx2 expression and promotes atherosclerotic calcifi-cation in vivo.AMPKα1 phosphorylates PIAS1 to enhance Runx2 SUMOyalation and subsequent degradation .

AIM: To observe the activity and distribution of astrocytes and glial fibrillary acid protein(GFAP) after middle cerebral artery occlusion (MCAO). METHODS: The rat MCAO model was made by two-kidney, tow clip renovascular hypertensive rat stroke prone(RHRSP). Rats were killed and brain samples were collected at the end of 1,3,6 and 9 weeks after MCAO, respectively. The ultrastructure of astrocytes was determined at broder of infarct (A area); distant of infarct (B area) and opposite of hemisphere (C area) by electron microscope. The number and optical density of GFAP-positive cells were also observed. RESULTS: The astrocyte proliferation distributed in the whole brain after MCAO. The highest numbers of GFAP-positive cells were observed at A area, then B area. The lowest numbers of GFAP positive cells were found in C area. The time course of GFAP-positive cell change was that the highest number was observed at 1 week after MCAO, then decreased by time from 3, 6 weeks to 9 weeks. The optical density of GFAP-positive cells showed the same patterns. CONCLUSION: The correlation between astrocyte proliferation and tissue damage after MCAO can be estimated by GFAP expression. The astrocyte proliferation plays an important role in healing process after MCAO.