Objective To compare the advantages and disadvantages of internal jugular vein and subclavian vein puncture approach by clinical and anatomical ways so as to explore the best way of establishing a central venous access to guide clinical work .Methods The 120 patients who were admitted into our hospital from January 2014 to January 2016 were randomly divided into the internal jugular vein group and the subclavian vein group with 60 cases in each group according to puncture approach , and the puncture were operated by the same group of physicians .The learning curve ,puncture success rate ,completion time ,complication rates and other indicators of the two groups were evalua-ted.Results The operating completion time of internal jugular vein puncture group was (22.00 ±5.58)minutes,the success rate was 52%, the learning curve was 12 cases;while the subclavian vein puncture group was (11.60 ±2.67)minutes,93% and 3 cases respectively,and the differences were statistically significant between the two groups (P<0.05).The total complication rate of the internal jugular vein punc-ture group was 58%while the subclavian vein group was 12%, and the difference was statistically significant (P<0.05).Conclusion Dif-ficulty,safety and complication rates of subclavian vein puncture approach were better than those of the internal jugular vein puncture ap -proach.Therefore, subclavian vein puncture approach should be the first choice when there’s a need to establish central venous access for rescuing severe patients such as shock .

Objective To investigate the effect of clearing away heat and activating blood decoctions on salivary gland function of patients with Sj?gren's Syndromes (SS). Methods 24 cases of SS (SS group) and 7 cases of normal control (normal group) were tested with salivary gland scintigraphy using 99mTCO4-, and 11 cases of patients were re-tested after treatment. Results The introjection fraction (IF) of salivary gland had no statistical difference between the two groups, while the evacuation fraction (EF) was lower in SS group than in normal group (P

OBJECTIVE:To optimize the extraction and purification technology of resveratrol from Polygonum cuspidatum. METHODS:By alkali extraction and acid precipitation,an orthogonal experiment was conducted to optimize the extraction and purification technology taking the ratio of the CaO to the raw material,the ratio of solid material to the extraction solvent,the kinds of acid and the extraction time as factors and the weighted mean of the content and yield as comprehensive score index.RESULTS:The optimal extraction and purification technology was as follows:the ratio of CaO to the solid material was 9:100;the ratio of solid material to solvent was 1:8;the acid was hydrochloric acid and the extraction time was 45 min.CONCLUSION:The optimized extraction and purification technology of resveratrol from Polygonum cuspidatum is characterized by energy source - saving and simple in operation,and it is suitable for industrial production.

Objective To discuss the relationship between BMP-2 protein and possible mechanism and to compare the postive rate of two different imaging examinations in evaluating the epiphyseal plate involved by osteosarcoma.Methods Radiographic and MRI features of epiphyseal plate extension by osteosarcoma confirmed by pathology in 36 cases were analysed retrospectively.The expression of BMP-2 was detected with immunohistochemical SABC method in different part of specimen.Results The diagnostic accurate rate in evaluating the epiphyaeal plate extension from osteosarcoma by X-ray and MRI was 44.44% and 100% respectively.The positive reactive rate of BMP-2 in tumor body,epiphyseal plate soak district,normal epiphyseal plate and normal tissue nearby the tumor was 88.89%(32/36),99.44%(34/36),10.00%(1/10) and 20.00%(2/10) respectively.Conclusion MRI is more sensitive to radiography in evaluating the epiphyseal plate involved by osteosarcoma,the higher positive reactive rate of BMP-2 protein is correlated to the epiphyseal plate extension of osteosarcoma.

Objective To investigate the effects of two different methods of double-lumen endotracheal intubation in minimally invasive thoracoscopic surgery. Methods Based on different methods of endotracheal intubation,120 patients with bullae and spontaneous pneumo-thorax were randomly divided into the single left intubation group (60 cases) and the left and right intubation group (60 cases). The opera-tion time,blood loss,chest drainage volume,the time of pulmonary air leaks,white blood cell count and other indexes of the two groups were evaluated. Results The proportion of patients whose atelectasis degree was over 50% in the left and right intubation group occupied 48%, and it occupied 32% in patients whose atelectasis degree was over 70%. While the corresponding data in the single left intubation group were 5. 00% and 93% respectively. The differences were statistically significant (P<0. 01). The operative time and postoperative indicators of the single left intubation group were more significantly lower than those in the left and right intubation group. Conclusion The left double-lu-men endotracheal intubation has obvious advantages in maintenance and control of lung expansion and pulmonary ventilation during surgery, and it should be used in video assisted thoracoscopy surgery.

OBJECTIVE: To observe the effect of Fufang Sishen Decoction (FFSSD) on arrhythmia after virus myocarditis. METHODS: One hundred and two cases of arrhythmia after virus myocarditis were randomly divided into two groups. The treatment group was treated with FFSSD, 6 g, b.i.d.; and the control group with propafenone, 150 mg, q 8 h. The therapeutic effects were observed in 4 weeks. RESULTS: The total anti-arrhythmia effects of FFSSD and propafenone were 71.9% and 78.9% respectively (P>0.05). FFSSD took effects relatively slowly with mild and lasting effect. CONCLUSION: The curative effect of FFSSD in treating arrhythmia after virus myocarditis is confirmed. FFSSD has no obvious side effects.

Objective:To analyse the anatomical change of the human temporomandibular joint(TMJ) in the position of mandibular lateral displacement and to provide the anatomical data for temporomandibular disorder.Methods:3 of the 8 samples of selected fresh cadavers were adjusted to mandibular lateral displacement position, and 5 to edge-to-edge occlusion position,then samples were fixed and sectioned according to coronal and sagittal planes by using plastination technique. The feature of the thin plastination sections of the TMJ in the mandibular lateral displacement position and were compared with that in edge-to-edge occlusion position.Results:On the working side in mandibular lateral displacement position, condylar moved backwords,upwards and outside in the articular fossa. Articular discs of TMJ did not move following condylar movement,but posterior band of the articular disc was suppressed by the condylar and articular fossa. On the non-working side in mandibular lateral displacement position, condylar moved ahead,downwards and inwards along posterior incline of articular tuberculum,then articular discs did not move,and middle band of articular discs was suppressed by the condyle and articular tuberculum.Conclusions:The TMJ disc does not shift as TMJ condylar process turns in articular fossa.When the condylar turns and slides at the same time,the articular discs shift.

Objective To analse MRI appearances and diagnostic value of giant cell tumor of bone.Methods MRI features of giant cell tumor of bone proved by pathology in 14 cases were reviewed.Results The lesions located at distal femur in 7 cases,at approximal tibia in 3 cases,at distal humerus,approximal femur,thoracic vertebrae and sacrum in 1 case respectively.The characteristic appearances of MRI were cystic and solid masses,there was fluid-fluid level within tumors in company with bleeding.Tumors were slight low or low signal intensity on T1WI,slight high signal intensity on T2WI.Conclusion MRI is of significant value in diagnosis of bone giant cell tumor.

Objective:In general, patients with seropositive rheumatoid arthritis (RA) are considered to show an aggressive disease course. However, the relationship between the two subgroups in disease severity is controversial. Our study is aimed to compare the clinical characteristics and prognosis of double-seropositive and seronegative RA in China through a real-world large scale study.Methods:RA patients who met the 1987 American College of Rheumatology (ACR) classification criteria or the 2010 ACR/European Anti-Rheumatism Alliance RA classification criteria, and who attended the 10 hospitals across the country from September 2015 to January 2020, were enrolled. According to the serological status, patients were divided into 4 subgroups [rheumatoid factor (RF)(-) anti-cyclic citrullinated peptide (CCP) antibody (-), RF(+), RF(+) anti-CCP antibody(+), anti-CCP antibody(+)] and compared the disease characteristics and treatment response. One-way analysis of variance was used for measurement data that conformed to normal distribution, Kruskal-Wallis H test was used for measurement data that did not conform to normal distribution; paired t test was used for comparison before and after treatment within the group if the data was normally distributed else paired rank sum test was used; χ2 test was used for count data. Results:① A total of 2 461 patients were included, including 1 813 RF(+) anti-CCP antibody(+) patients (73.67%), 129 RF(+) patients (5.24%), 245 RF(-) anti-CCP antibody(-) patients (9.96%), 74 anti-CCP antibody(+) patients (11.13%). ② Regardless of the CCP status, RF(+) patients had an early age of onset [RF(-) anti-CCP antibody(-) (51±14) years old, anti-CCP antibody(+) (50±15) years old, RF(+) anti-CCP antibody(+) (48±14) years old, RF(+)(48±13) years old, F=3.003, P=0.029], longer disease duration [RF(-) anti-CCP antibody(-) 50 (20, 126) months, anti-CCP antibody(+) 60(24, 150) months, RF(+) anti-CCP antibody(+) 89(35, 179) months, RF(+) 83(25, 160) months, H=22.001, P<0.01], more joint swelling counts (SJC) [RF(-) anti-CCP antibody(-) 2(0, 6), Anti-CCP antibody(+) 2(0, 5), RF(+) anti-CCP antibody(+) 2(0, 7), RF(+) 2(0, 6), H=8.939, P=0.03] and tender joint counts (TJC) [RF(-) anti-CCP antibody(-) 3(0, 8), anti-CCP antibody(+) 2(0, 6), RF(+) anti-CCP antibody(+) 3(1, 9), RF(+) 2(0, 8), H=11.341, P=0.01] and the morning stiff time was longer [RF(-) anti-CCP antibody(-) 30(0, 60) min, anti-CCP antibody(+) 20(0, 60) min, RF(+) anti-CCP antibody(+) 30(10, 60) min, RF(+) 30(10, 60) min, H=13.32, P<0.01]; ESR [RF(-) anti-CCP antibody(-) 17(9, 38) mm/1 h, anti-CCP antibody(+) 20(10, 35) mm/1 h, RF(+) anti-CCP antibody(+) 26(14, 45) mm/1 h, RF(+) 28(14, 50) mm/1 h, H=37.084, P<0.01] and CRP [RF(-) anti-CCP antibody(-) 2.3 (0.8, 15.9) mm/L, Anti-CCP antibody(+) 2.7(0.7, 12.1) mm/L, RF(+) anti-CCP antibody(+) 5.2(1.3, 17.2) mm/L, RF (+) 5.2(0.9, 16.2) mm/L, H=22.141, P<0.01] of the RF(+)patients were significantly higher than RF(-) patients, and RF(+) patients had higher disease severity(DAS28-ESR) [RF(-) anti-CCP antibody(-) (4.0±1.8), anti-CCP antibody(+) (3.8±1.6), RF(+) anti-CCP antibody(+) (4.3±1.8), RF(+) (4.1±1.7), F=7.269, P<0.01]. ③ The RF(+) anti-CCP antibody(+) patients were divided into 4 subgroups, and it was found that RF-H anti-CCP antibody-L patients had higher disease severity [RF-H anti-CCP antibody-H 4.3(2.9, 5.6), RF-L anti-CCP antibody-L 4.5(3.0, 5.7), RF-H anti-CCP antibody-L 4.9(3.1, 6.2), RF-L anti-CCP antibody-H 2.8(1.8, 3.9), H=20.374, P<0.01]. ④ After 3-month follow up, the clinical characteristics of the four groups were improved, but there was no significant difference in the improvement of the four groups, indicating that the RF and anti-CCP antibody status did not affect the remission within 3 months. Conclusion:Among RA patients, the disease activity of RA patients is closely related to RF and the RF(+) patients have more severe disease than RF(-) patients. Patients with higher RF titer also have more severe disease than that of patients with low RF titer. After 3 months of medication treatment, the antibody status does not affect the disease remission rate.

OBJECTIVE To study the mechanism of Suyu tongfeng prescription against gouty arthritis . METHODS Male SD rats were randomly divided into normal control group ，model group ，colchicine tablets group （positive control drug ，0.3 mg/kg） and high -dose，medium-dose and low -dose groups （5，2.5，1.25 g/kg）of Suyu tongfeng prescription according to body mass ，with 10 rats in each group . The rats in the administration group were orally given the corresponding drugs once a day （10 mL/kg）for 7 consecutive days . Rats in the normal control group and model group were given equal volume of water intragastrically . On the 6th day，1 h after administration ，except for normal control group ，the rats in other groups were injected with sodium urate into the joint to replicate the gouty arthritis model . The degree of joint swelling and the score of inflammatory indexes were measured at 2， 6 and 24 h after the establishment of the model . One hour after the last administration ，the activity of oxidative stress related indicators [superoxide dismutase （SOD），xanthine oxidase （XOD），malondialdehyde（MDA）] and the levels of inflammatory factors [interleukin 1β（IL-1β），IL-18，tumor necrosis factor α were detected in the serum . The histopathological changes of ankle joints in each group were observed ；the expressions level of thioredoxin interacting protein （TXNIP）， mail：150120239@qq.com NOD like receptor thermoprotein domain related protein 3 （NLRP3），apoptosis related spot like protein （ASC）in the @qq.com ankle joint of rats were detected . RESULTS After intervened with Suyu tongfeng prescription ，the swelling degree of joints ，the score of inflammation indexes ，the edema of synovial tissue and the amount of inflammatory cells were reduced . The activity of SOD in Suyu tongfeng prescription high -dose group was increased significantly（P＜0.01），while the activities of XOD and MDA as well as the levels of IL -1β，IL-18 and TNF -α were all decreased significantly（P＜0.01）. The level of ROS and the protein expressions of TXNIP ，NLRP3 and ASC in ankle joint were all decreased significantly （P＜0.05 or P＜0.01）. The activities/levels of the above indexes were also significantly reversed in the middle-dose and low -dose groups of Suyu tongfeng prescription （P＜0.05 or P＜0.01）. CONCLUSIONS Suyu tongfeng prescription can inhibit the activation of NLRP 3 inflammasome through ROS/TXNIP/NLRP 3 signaling pathway ，and then play the role of anti -gouty arthritis .