Objective To explore the efficacy of hormone replacement therapy (HRT) for rheumatoid arthritis (RA).Methods The literature about HRT in the treatment of rheumatoid arthritis were searched.Eleven papers were subjected to a Meta-analysis and a heterogeneity test was conducted to evaluate the efficacy of HRT.Results HRT reduced the level of erythrocyte sedimentation rate (ESR) in RA patients (P=0.016),the SMD was-0.22(-0.40,-0.04); improved bone mineral density (BMD) in RA patients (P=0.022),the WMD was 2.83(0.41,5.26); decreased clinical parameters for disease activity evaluations of RA patients (P=0.048),the SMD was-0.19 (-0.38,0.00); decreased the level of C-reactive protein (CRP) in RA patients,the SMD was-0.08 (-0.37,0.21),but the difference was not statistically significant (P=0.591).Conclusion The findings from this Meta-analysis indicate that HRT can reduce the ESR level,improve clinical indexes and improve BMD level of RA patients.HRT may suppress disease activity and osteoporosis of RA patients,so it may be used as an auxiliary therapy in the treatment of RA.

Objective: To observe the clinical efficacy of acupoint injection of Chuankezhi plus acupoint sticking treatment for bronchial asthma, and provide clinical evidence for the synergy of the two therapies, and explore their synergistic mechanism. Methods: A total of 70 patients were randomized into an acupoint injection plus sticking group and an acupiont sticking group by the random number table, with 35 cases in each group. The treatment took place in July and August. The acupoint injection plus sticking group was treated with acupoint injection and acupiont sticking, while the acupiont sticking group was treated only with acupiont sticking therapy. The treatment course was 4 weeks. After the treatment, the scores of symptom scale in the two groups before treatment, 3 months and 6 months after the treatment were observed. Results: During the treatment, there were 5 dropouts in the acupoint injection plus sticking group with 30 cases remained, and 4 dropouts in the acupiont sticking group with 31 cases remained. Before the treatment, there was no significant difference in the total scores of symptom scale between the two groups. Three months after the treatment, the total scores of symptom scale of both groups were lower than those before treatment, and the intra-group differences were statistically significant (bothP<0.05). In the inter-group comparison, there was no significant difference in the difference values of the scores before treatment and 3 months after treatment (P>0.05). Six months after the treatment, the total scores of symptom scale in both groups were lower than those before treatment, and the intra-group differences were statistically significant (bothP<0.05), so were the differences in the difference values of the scores before treatment and 6 months after treatment (bothP<0.05). Conclusion: Acupoint injection of Chuankezhi plus acupoint sticking or acupoint sticking alone both can improve the symptoms of patients with bronchial asthma. Acupoint injection of Chuankezhi plus acupoint sticking has a higher total effective rate than single acupoint sticking therapy.

ObjectiveTo explore the deficits of acoustic startle reflex (ASR) and prepulse inhibition (PPI) of acoustic startle reflex in single prolonged stress rats.MethodsSixty Sprague Dawley rats were randomly divided into control 1,7,14 d groups and stress 1,7,14 d groups.All stressed rats received single prolonged stress while all control rats were left in their home cage.Behavioral changes in these rats were analyzed in ASR and PPI paradigm.ASR and PPI were carried out on day 2,8,15,respectively.ResultsThere were no differences of ASR and PPI among control 1,7,14 d groups (P ＞ 0.05).ASR of stress 1 d group ( (92.49 ± 31.54) g) was higher than that of control 1 d group((64.48 ± 17.95)g,P＜0.05) while PPI of stress 1 d group((28.60 ±29.02)％) was lower than that of control 1 d group( (41.60 ± 15.10)％,P ＜ 0.05 ).There were no differences of ASR between control 7 d group and stress 7 d group,control 14 d group and stress 14 d group (P＞ 0.05 ).Compared with control 7 d group ( (41.30 ± 12.79) ％ ),PPI in stress 7 d group ( ( 17.95 ± 31.79) ％ ) was reduced (P ＜ 0.05 ).Compared with control 14 d group ( (41.16 ± 12.25 ) ％ ),PPI in stress 14 d group( ( 13.71 ± 32.48) ％ ) was reduced (P ＜ 0.05).ConclusionEffects of stress on ASR in rats increased in early period,while the impaired PPI may last for a long time.

Objective To discuss the risk factors and outcome of abnormal lung function in adult congenital heart disease .Meth‐ods 327 patients with adult congenital heart disease undergoinglung function testing between January ,2009 to December ,2011 in our hospital were enrolled .Accorded to the severity of lung dysfunction based on predicted values of forced vital capacity (FVC) ,pa‐tients were divided into 3 groups :group A(normal lung function ,predicted FVC >70% ) ,group B(mildly impaired lung function , predicted FVC 60% -70% ) ,group C(moderately to severely impaired lung function ,predicted FVC <60% ) ,all the patients were followed‐up to January in 2013 ,the baseline characteristics and outcome were recorded ,the associate factors of moderately to se‐verely impaired lung function in adult congenital heart disease were analyzed through Logistic regression analysis ,the risk factors of death in adult congenital heart disease were analyzed through Cox regression analysis ,and Kaplan‐Meier curve compared survival rate of patients in the 3 groups .Results Lung function was abnormal in 167 patients(51 .1% ) with adult congenital heart disease , in which moderately to severely impaired were 96 patients(29 .4% ) .BMI ,smoke and enlarged cardiothoracic ratio were independent associate factors of moderately to severely impaired lung function in adult congenital heart disease (P<0 .05) .NYHA Ⅲ - Ⅳ and moderate to severe impairment of lung function were independent predictors of death in adult congenital heart disease .There were significant difference of the survival rate between group A and group C ,group B and group C(P<0 .05) ,but it was not significantly different between group A and group B(P>0 .05) .Conclusion Lung function impairment is common in patients with adult congen‐ital heart disease ,and moderate to severe impairment of lung function seriously impact the outcome of the patients .

Objective:To investigate the characteristics of magnetic resonance imaging and clinical application of multi-modality magnetic resonance imaging (MRI) for evaluating the response of neoadjuvant chemotherapy (NACT) in inflammatory breast cancer (IBC).Methods:A total of 36 IBC patients were enrolled in the study.The morphological, hemodynamic and diffusion-weighted imaging features of MRI were analyzed. Eleven patients underwent MRI examination before and after NAT. The imaging changes were analyzed and the efficacy of NACT was evaluated.Results:There were 38 identified breast carcinoma in these 36 cases, among which abnormal skin thickening and enhancement, extensive edema was found in 37 breast lesions. Enhancement of breast lesions in 25 cases was non-mass-like enhancement. Diffusion limitation was found in all lesions. The number of vessels in affected side was more than that in healthy side in MIP images. Thirty three cases had axillary lymph node enlargement.The sensitivity and specificity of MRI in evaluating residual breast tumors and vascular thrombus were high, but the evaluation of axillary lymph nodes was relatively low.Conclusions:Multi-modal MRI can be used for early and accurate diagnosis of IBC. It can also be used to predict and evaluate the effect of neoadjuvant chemotherapy.

Objective To compare the clinical results of endovenous laser treatment(EVLT),radiofrequency endovenous occlusion(RFO)and conventional stripping combined with transilluminated powered phlebectomy(TIPP)for lower extremity varicose vein.Methods From Jun 2004 to Jan 2007,200 cases(232 limbs)were treated by EVLT with TIPP,80 cases(88 limbs)by RFO with TIPP,and 180 cases(202 limbs)by conventional stripping with TIPP.Operation time,number of the incision made,intraoperative bleeding,postoperative hospital stay,complications,and one-year recurrence rate were compared with each other. Results Operation time was longer(41±8)min in RFO group than that in other two groups.Postoperative hospital stay was shorter in EVLT group(1.2±0.4 d)and RFO group (2.1±0.8 d)than that in stripping and TIPP group(P＜0.05).Patients in stripping group also suffered from more intra-operative bleeding more often incidental nervus saphenus injury and more incision numbers when compared with other two groups(P＜0.05).There was no significant difierence in one-year recurrence rate among patients in the three groups. Conclusions The clinical efficacy is almost the same among the three groups in terms of eradication of the varicose veins.EVLT and RFO are safe and minimal invasive for the treatment of lower extremity varicose vein.

Objective To study the clinical use of the ulnar-basilic arteriovenous fistula as a long-term vascular access in patients with hemodialysis.Methods The clinical data of 36 patients with 1-year follow-up who had a wrist ulnar-basilic arteriovenous fistula formed in China-Japan Friendship Hospital from January 2013 and December 2014 were retrospectively analyzed.The outcomes for this study including the surgical results,complication rate of ulnar-basilic arteriovenous fistula,immediate patency rate,average maturation time,1-year primary patency rate and true patency rate were analyzed.Results Thirty-four cases patients got successful ulnar-basilic arteriovenous fistula formed with palpable vascular thrill.There were no death cases and no severe cardio-cerebrovascular complications.No infection,heart failure,distal swelling and ischemia occurred.The immediate patency of ulnar-basilic arteriovenous fistula was 94.4%(34/36),the average maturation time was (67±4) d,1-year primary patency rate was 63.9%(23/36),and true patency rate was 67.6%(24/36).Conclusion Ulnar-basilic arteriovenous fistula with adequate 1-year primary patency and low risk of infection and complications can be a viable alternative as the hemodialysis vascular access.

Objective Corruption is the most common cadaver phenomenon in forensic practice and an important basis for inferring time of death(PMI),but the definition of corruption degree and the construction of model inference models have always been difficult in the practice of forensic science.Methods In this study,the late postmortem phenomena were observed.Meanwhile,the microbial flora structure of gut and gravesoil and the nature of gravesoil were detected,for analyzing the changes before and after the key moment of abdominal rupture which naturally happened during the cadaver decay.Results The results found that from the macroscopic and microscopic levels,there were significant differences in cadaver decay,including microbial flora structure and gravesoil properties before and after the key moment of the natural abdominal rupture during cadaver decay.The phenomena are highly observable and can be accurately judged by forensic examinations,as well as related means in the field of biology and physiochemistry.In this study,this critical event was called Rupture Point.Conclusion The Rupture Point can be used as an important node for the assessment of cadaver decay degree in the practice of forensic medicine.It can be utilized for a cut-off point as well when constructing PMI inference models based on microbial flora structure changes.The accuracy of PMI inference models can be improved when the models were constructed in segments.

ObjectiveTo investigate the effects of ziprasidone on the behavior and the expression of pERK1/2 in posttraumatic stress disorder(PTSD) model rats.Methods 24 adult male SD rats weighing (200 ±20) g were randomly divided into four groups (n =6):control group,single prolonged stress and foot shock (SPS&S) group,ziprasidone group and ziprasidone + U0126 group.The fear response to environment,high alertness,and anxiety & depression behavior of rats were tested by the open field,elevated plus-maze,and the expression of pERK1/2 was measured by Western blot.ResultsIn open field test(OFT),the SPS&S group( (76.23 ± 54.76) cm for horizontal motion distance,(4.60 ± 1.14) for the number of entering central region) showed significant difference compared with control group ( (343.77 ± 74.22 ) cm,( 12.40 ± 3.36 ) ) or ziprasidone group ( ( 274.98± 83.56) cm,( 12.00 ± 2.92) ) (P ＜ 0.01 ),but showed no significant difference with ziprasidone + U0126 group ( ( 138.14 ± 41.98) cm,(5.00 ± 1.58) ) (P ＞ 0.05 ).The results of elevated plus maze (EPM) were in accordance with the results of OFT.The expression of pERK1/2 in SPS&S group and ziprasidone + U0126 group showed significant decrease when compared with control group or ziprasidone group (P ＜ 0.01 ).ConclusionZiprasidone can obviously improve fear response to environment,high alterness and anxiety & depression behavior of rats,and these effects of ziprasidone may be carried out by up-regulation the expression of pERK1/2.

In order to improve the clinical skills of medical students,the First Clinical School of Tongji Medical College,Huazhong University of Science and Technology strengthened the construction of teaching base,teaching materials,teaching team,curriculum and assessment methods,and established a comprehensive experimental teaching system of clinical skills.