Objective We investigated interleukin (IL)-23 that might play a role in the pathogenesis of rheumatoid arthritis (RA) and whether it was correlated with disease activity and clinical manifestations in axial spondyloarthritis (SPA).In addition, the Spondyloarthritis Research Consortium of Canada (SPARCC) scores was used to examine whether recombinant human tumor necrosis factor-α receptor Ⅱ IgG Fc fusion protein for injection (rhTNFR:Fc) was effective for the reduction of magnetic resonance imaging (MRI)-proven sacroiliac joint (SIJ) inflammation.Methods The serum IL-23 levels of etanercept and conven-tional treatment groups were measured using enzyme-linked immunosorbent assay kits.At the same time, SIJ MRI SPARCC score levels were assessed by MRI, the change of clinical indicators of patients was observed.ANOVA, repeated measure data of ANOVA and Spearman's correlation analysis were used for statisical analysis.Results ① The basal serum IL-23 levels of the Etanercept group were (34.2±1.8) pg/ml and those of the conventional treatment group were (34.1 ±1.8) pg/ml (F=1 073.790, P=0.991), both were significantly higher than the healthy control group (18.1±0.8) pg/ml (P=0.005).After treatment, serum IL-23 levels of the rhTNFR: Fc treatment and conventional treatment group were (24.5 ±1.7) pg/ml and (25.2±1.7) pg/ml (F=232.488, P=0.242), (19.2±0.8) pg/ml and (21.6±1.3) pg/ml (F=114.135, P=0.025), (19.0±0.8) pg/ml and(19.4± 0.8) pg/ml (F=23.374, P=0.085) respectively.A significant decrease was observed in the two groups and the serum level of IL-23 of the rhTNFR:Fc group was lower than that of the conventional group at week 12.② SIJ MRI SPARCC scores of the rhTNFR:Fc group and the conventional drugs group were (20.1± 1.2) scores and(20.7±1.5) scores (F=2003.660, P=0.191), (12.5± 0.8) scores and (15.4±0.9) scores (F=1 680.430, P=0.004), (8.8±0.9) scores and (12.8± 0.9) scores (F=972.877, P=0.002), the scores of two group were significantly decreased after treatment.At week 12, 24 of the treatment, the rhTNFR:Fc group scores were lower than the conventional drugs group.③ The serum IL-23 levels, SLJ MRI SPARCC scores and clinical index (ESR, CRP, PGA, BASDAI, BASFI, BASMI and number of painful joints) were not correlated (P＞0.05), the SIJ MRI SPARCC scores and clinical indicators were not correlated (P＞0.05).Conclusion ① The serum IL-23 levels of the rhTNFR:Fc are higher than healthy controls.② rhTNFR:Fc treatment could significantly decrease IL-23 levels and improve the sacroiliac joint inflammation compared to conventional treatment.③ SIJ MRI is a good assessment method for the detection of SpA sacroiliac joint inflammation.

Objective The aim of the study was to investigate the application effect of de-escalation thinking in first aid nursing of craniocerebral injury complicated with cervical spine injury.Methods 23 cases of craniocerebral injury and cervical spine injury patients received first aid rescue in emergency department of our hospital during the period from September 2012 to August 2014 were set as the observation group,and the de-escalation thinking way was used during rescue process.19 cases of craniocerebral injury and cervical spine injury patients during the period from September 2010 to August 2012 were set as the control group,traditional way of clinical experience thinking way was used.The early warning time,emergency treatment time and missed diagnosis cases were compared between the two groups.Results The early warning time of diagnosed as traumatic brain injury complicated with cervical spine injury (t=18.035) and emergency treatment time (t=7.650) in the observation group were shorter than those of the control group,the difference was significant.The missed diagnosis rate of the observation group [4.35％(1/23)] was significantly lower than that of the control group (9/19),the difference was significant (x2=8.38).Conclusions Application of de-escalation thinking mode in rescue by emergency nurses can shorten the early warning and emergency treatment time,decrease the missed diagnosis rate and improve the timeliness of the rescue for craniocerebral injury complicated with cervical spine injury.

Objective To investigate the correlation between food intolerance and Henoch-Sch(o)nlein purpura (HSP) in children and the efficacy of food forbidden or alternative therapy. Methods The levels of IgG against several common food in serum obtained from 40 children with HSP were measured by ELISA. The efficacy of food forbidden or alternative food therapy was assessed after 3 months. Results Total positive rate of serum food-intolerant IgG antibodies in HSP children was 92.5%. Among these 14 intolerant foods, the positive percentage of egg was the highest (33.8%), followed by tomato (14.9%), milk (13.5%) and morrhua (12.2%). Significant differences of the sort and degree of food intolerance existed among different age groups (t=2.257, P=0.045), but not between boys and girls (t=1.053, P=0.315), city and countryside (t= 1.388, P=0.193). There was no linear correlation between total food intolerance and serum IgG level (t=0.793, P=0.445). Food intolerance had no direct relation to immune complex deposition in kidneys of HSP nephritis (r =-0.262, P =0.387). The efficacy of adjusting diet was 95% . Conclusions HSP is closely related to food intolerance. Egg is the most common intolerant food. Food forbidden or alternative therapy shows acceptable efficacy in the treatment of most Henoch-Sch(o)nlein purpura children.

Background and purpose: Renal cell carcinoma is the most common form of kidney cancer, characterized by lack of early symptoms and high malignancy. This study aimed to establish orthotopic nude mice models of human renal cell carcinoma with high success rate and good repeatability. Methods: The four types of methods which were adopted to establish the orthotopic models of renal cell carcinoma were orthotopic injection of 786-0 and ACHN cell suspensions, orthotopic injection of primary cell suspensions obtained from the subcutaneous tumor tissues, renal subcutis orthotopic implantation into renal capsule and surgical subcutis orthotopic implantation into renal fascia. To gain insights into the tumorigenicity and the growth of transplantation tumors, the imageological examination (PET/CT), histological examination (H-E staining, immunohistochemistry staining) and biochemical analysis of blood were carried out. Results: In terms of the subcutaneous transplantation of human renal cell carcinoma models in nude mice, tumorigenic rate of ACHN cells (90%) was higher than that of 786-0 cells (30%). The tumorigenic incidences of 786-0 cell suspensions orthotopic injection, ACHN cell suspensions orthotopic injection, ACHN subcutis cellular suspensions orthotopic injection, ACHN subcutis orthotopic implantation into renal capsule and renal fascia were 33%, 80%, 90%, 100% and 20%, respectively. ACHN subcutis orthotopic implantation into renal capsule was the most effective approach. Imageological and histological results accorded with poorly differentiated renal cell carcinoma. Conclusion: Four orthotopic nude mice models of human renal cell carcinoma were successfully established. Among these methods, ACHN subcutis orthotopic implantation into renal capsule is the most effective approach, which provides an ideal model for the research on biological behavior of human renal cell carcinoma and its treatment.

Objective To study the change of erythrocyte indices and serum iron in hyperthyroidism rats .Methods SD female rats were randomly divided into hyperthyroidism group and control group .Hyperthyroidism rats were induced by intragastric ad‐ministration of Euthyrox (Levothyroxine) and their blood and serum were obtained after administration of 1-8 weeks ,respective‐ly .And the control rats were given normal saline .Levels of T3 ,T4 and TSH were determined by a radioimmunoassay .Erythrocyte index were measured by automatic blood cell analyzer .Serum iron concentration and total iron binding capacity were determined by chromatometry .Results The concentration of serum T3 and T4 increased in hyperthyroidism rats ,whereas the TSH decreased . RBC was higher in hyperthyroidism rats at 2-8 weeks compared with the control rats (P<0 .05) .HCT was higher in hyperthy‐roidism rats at 1-8 weeks compared with the control rats (P<0 .01) .MCV was lower in hyperthyroidism rats at 2-8 weeks com‐pared with the control rats (P<0 .05) .MCHC was lower in hyperthyroidism rats at 1 -8 weeks compared with the control rats (P<0 .01) .RDW SD and RDW CV was higher hyperthyroidism rats at 1-2 weeks compared with the control rats(P<0 .01) .Ser‐um iron concentration and total iron binding capacity increased in hyperthyroidism rats at 4 -8 weeks compared with the control rats(P<0 .01) .Conclusion The hyperthyroidism rats in the present study is absent significant manifestation of anemia ,whereas the hypochromic changes of erythrocyte is significant .Serum iron concentration and total iron binding capacity increase in hyperthy‐roidism rats ,which demonstrate the iron utilization disorder .

Objective To compare the predicted efficiency ofmacular hole closure index (MHCI) calculated by 2 different methods for postoperative anatomical outcomes after idiopathic macular hole (MH) surgery.Methods This is a prospective exploratory clinical study.A total of 63 patients (63 eyes) with idiopathic MH,who received vitrectomy,inner limiting membrane peeling and gas tamponade,were enrolled in this study.All the patients received optical coherence tomography (OCT) examination at each visit to measure the MHCI using the formula MHCI=(M+N) /BASE,M and N is the distance from outer limiting membrane break points to the beginning points of detached photoreceptor from retinal pigment epithelium of both side of the hole,respectively.BASE is the length of MH base.MHCI1 was measured by built-in caliper of OCT software,MHCI2 was measured by ImageJ software.The minimum macular diameter (MHD) was measured by built-in caliper of OCT software.Based on the OCT images,the anatomical outcomes were classified grade A (bridge-like shape closure),grade B (complete closure) and grade C (poor closure).Grade A and B are considered as good closure,grade C as poor closure.Patients were followed up at 3,6 and 12 months after surgery.The closure grades at last visit were the final outcome.The relationship between MHCI 1,MHCI2 and closure grades was analyzed.And the predicted efficiency of MHD,MHCI1 and MHCI2 for anatomical outcomes after the surgery was studied.Results The mean MHCI1 was 0.68±0.21 (0.30-1.35),MHCI2 was 0.95±0.26 (0.41-1.55),and MHD was (476.24±210.18) μm (127-956 μm).MHCI1 and MHCI2 were both negative correlated with the closure grades (r=-0.665,-0.691;P＜0.001).The receiver operating characteristic (ROC) curve analysis ofMHCI1,MHCI2 and MHD for the prediction of good or poor closure showed that area under the curve (AUC) was 0.928,0.957 and 0.916 respectively,and 0.505,0.67 and 559 μm were set as the lower cut-offvalue.The sensitivity was 96.2％,92.3％ and 90.9％ respectively,and specificity was 81.8％,72.7％ and 76.9％ respectively.Accordingly,the ROC curve analysis for the prediction of grade A or B closure showed that AUC was 0.840,0.847 and 0.653 respectively,and 0.705,0.965 and 364 μm were set as the upper cut-off value.The sensitivity was 80.0％,82.9％,63.4％ respectively and specificity was 75.0％,85.7％,65.9％.Conclusion MHCI1 and MHCI2,measured by built-in caliper of OCT software or ImageJ software,both have good predictive efficiency for the anatomical outcomes of MH surgery.

Objective To investigate the clinical distribution situation and drug resistance change of Klebsiella pneumoniae in the Navy General Hospital during 2011‐2015 in order to provide reference for rational use of antibacterial agents in clinic .Methods The clinically isolated Klebsiella pneumoniae in this hospital during 2011‐2015 were selected and performed the analysis on the de‐tection rate ,department distribution ,specimens source ,resistance of antibacterial drugs and change trend of resistance to carbapen‐em antibacterial drugs .Results The number the detected Klebsiella pneumoniae strains and isolation rate during 2011 -2015 showed an increasing trend year by year ,the specimens sources were mainly from 10 departments of intensive care units(ICU) ,hy‐perbaric oxygen department ,respiratory department ,radiation oncology department ,kidney disease department ,etc .;the submitted specimens were dominated by sputum and urine ,accounting for 59 .7% and 21 .4% of submitted specimens ;the drug resistance of Klebsiella pneumoniae during 2011‐2015 showed the increasing trend year by year .Klebsiella pneumoniae had higher resistance rates to piperacillin ,ampicillin ,ampicillin/sulbactam and cefuroxime and had lower resistance rate to amikacin ,imipenem ,meropen‐em and tobramycin ;the resistance rates to imipenem and meropenem were increased year by year ,and pan‐drug resistant Klebsiella pneumoniae showed a rapidly rising trend .Conclusion The drug resistance of Klebsiella pneumonia is serious ,especially carbapene‐ms‐resistant Klebsiella pneumoniae is significantly increased in the recent years ,therefore its drug resistance monitoring should be strengthened for guiding rational drug use in clinic .

ABSTRACT:Objective To explore the changes of serum cytokine interleukin-17 (IL-17)in patients with chronic hepatitis B of different clinical types and its clinical significance.Methods We selected 30 cases of mild chronic hepatitis B,34 cases of moderate one,29 cases of severe one,38 cases of liver cirrhosis,and 21 cases of acute on chronic liver failure.Another 30 cases over the same period served as the healthy control group.Cytokine IL-1 7 level in peripheral blood was detected in each group,and all the groups except the control group were detected for liver function and HBV-DNA.These related serum markers were detected and the results were statistically analyzed.Results ① IL-17 in the peripheral blood was (8.103±2.061)ng/mL in healthy control group;(25.551 ±7.078)ng/mL,(45.442±18.358)ng/mL and (75.378±19.05)ng/mL in the groups with mild,moderate and severe chronic hepatitis B;and (97.16±17.066)ng/mL in acute on chronic liver failure group.Its levels gradually increased with the severity;and there were significantly different among the five groups and between every two groups (P<0.01).The peripheral blood level of IL-17 was (8.103±2.061)ng/mL in the healthy control group, (34.517±8.905)ng/mL in compensatory cirrhosis group,and (45.615±15.623)ng/mL in the decompensated cirrhosis group.These three groups had pairwise comparison,and the difference between every two groups was significant (P<0 .0 1 ).The peripheral blood level of IL-1 7 in the decompensated cirrhosis group increased compared with that in the compensatory group.③ In the 1 5 2 cases detected,serum IL-1 7 level and serum ALT,AST,TBIL,HBV-DNA levels were positively correlated,and serum PTA had negative correlation with the level of IL-1 7 .④ In the 2 1 cases of acute on chronic liver failure,the peripheral blood level of IL-1 7 did not significantly differ between antigen-e positive and negative groups (P=0.654).⑤ In 21 patients with chronic on acute liver failure,the level of IL-1 7 in peripheral serum and MELD scores showed a positive correlation by Pearson correlation analysis (r=0.533,P=0.013).Conclusion In patients with chronic hepatitis B,the level of IL-17 in peripheral serum increased with disease severity.Moreover,the level of IL-1 7 in peripheral blood may play a role in promoting the progression of cirrhosis and the development of acute on chronic liver failure.

Objective To explore the relationship between sleep quality and quality of life in patients with type 2 diabetes. Methods Multi-stage randomized cluster sampling was used in the survey and self-designed questionaire , Pittsburgh sleep quality index scale , diabetes specific quality of life scale and self-rating depression scale were adopted. Results The poor sleep quality rate was 33.6%. Compared with the group with 6~8 h sleep duration, the scores of physical function,psychological dimension,social relations and quality of life were higher in patients with < 6 h sleep duration (P < 0.01).The average quality of life score was significantly higher among the sleep disorder participants than the other groups(56.95 ± 14.57 vs 50.11 ± 11.08 vs 44.77 ± 9.61,P<0.01). After adjusting for age, gender, complications, course of disease and depression, etc. The correlation coefficient of sleep quality and quality of life was 3.92. Among them , the sleep quality and physical dimensions of the correlation coefficient is the largest(r=0.407,P<0.01). Conclusions It can be an effective method of improving their status of life quality by ameliorating their sleep quality , especially for the physical dimension.

Aim To establish method and main evaluation indexes of collagen induced arthritis ( CIA) model in DBA/1 mice. Methods CIA was induced by chicken type Ⅱcollagen ( C Ⅱ) in DBA/1mice. Arthritis was evaluated by arthritis index. X-ray of the paws was taken. Histology pathology of ankles and spleen was observed and scored. Results Immunization d31,the paws of CIA mice appeared red and swelling,the scores of arthritis index increased,the period of swelling peak was from d40 to d60; immunization d35,the weight of CIA mice began to decrease. X-ray of paws showed that the paw joints of CIA mice deformed,and there was osteophyte formation associated with osteolysis. Histo-logical pathology of ankle joints showed that the synovium of CIA mice were hyperplasia,cartilage was destroyed,pannus was formed,and inflammatory cells infiltrated into synovium. Histological pathology of spleen showed more germinal centers and lymphoid follicular hyperplasia were observed,cell density of lymphatic sheath increased,scores of ankle joints and spleen histological pathology in CIA mice were higher than those in normal mice significantly. Conclusions The methods of CIA model induced by chicken C Ⅱ in DBA /1 mouse were reliable and reproducible. CIA incidence was high. Arthritis index,X-ray of paws,ankle joints and spleen histological pathology and so on were the principal indexes of evaluation for CIA model.