Objective To compare the clinical features and treatment between elderly onset rheumatoid arthritis(EORA)and young onset rheumatoid arthritis(YORA).Methods The EORA patients (n=60)and the YORA patients (n =90)were compared regarding sex ratio,activity of pathogenetic condition,disease severity,extra-articular manifestations,complications,laboratory indexes,and therapeutic schedules.Results The female/male ratio was 36/24(1.50 ∶ 1.0)in group EORA,and 69/21(3.3 ∶ 1.0)in group YORA,with higher female/male ratio in in group YORA.The frequency of morning stiffness,proximal interphalangeal joint involvement and metacarpophalangeal joint involvement were lower in group EORA(53.3 ％,46.676％ and 61.67 ％) than in group YORA (72.2 ％,77.8 ％,81.11％) (x2 =5.521,15.385,6.960,P =0.018,0.000,0.008 respectively).Large joints involvement at onset of rheumatoid arthritis was higher in group EORA(38.33 ％)than in group YORA(18.89 ％)(x2=6.960,P=0.008).The joint swollen and tender counts were comparatively less (16.51 ± 7.34) and (15.92 ± 8.44) in group EORA than in group YORA(22.46 ± 7.58) and (23.8 ± 8.93) (t =5.080、5.740,all P =0.000) respectively.The accumulated disease activity score(DAS28)was higher in group EORA(5.86± 1.57)than in YORA(4.92± 1.64) (t=3.360,P =0.001).HAQ score was lower in group EORA(0.83 ± 0.85)than in group YORA (1.16±0.91) (t=2.43,P =0.02).Comorbid conditions such as osteoarthritis,osteoporosis,cardiovascular disease and chronic renal insufficiency were more frequent in group EORA (51.7 ％,31.7 ％,18.3 ％ and 15.00％)than in group YORA(27.8％,15.6％,5.6％ and 4.4％)(x2 =11.722,5.445,6.168,5.067,P=0.001,0.020,0.013,0.024).The positive rate of RF were more higher in YORA(70.00％)than in group EORA (48.33％)(x2 =7.126 P=0.008).The synthetic or biologic traditional DMARDs (disease modifying antirheumatic drugs)were widely used in group YORA(78.9％ and 31.1％)than in group EORA(40.0％ and 10.0％)(x2 =14.940,9.153,P =0.000,0.002).The more frequently used program with glucocorticoids hormonal therapy was received in group EORA(38.3 ％)than in group YORA(20.00 ％)(x2 =6.092 P=0.014) Conclusions EORA patients differs from YORA patients in many of ways,including a more balanced gender distribution,atypical presentation at onset of disease,more frequent involvement of large joints,seronegativity in a higher percentage,and less frequent positivity of anti CCP-antibody,which makes diagnosis more difficult in the earlier period.Therapy of EORA with DMARDs should be instituted based on disease activity,if there is no contraindication.

Objective To explore clinical value of optimizing the contrast medium injection protocol for dual-source CT high-pitch spiral acquisition in children with complex congenital heart disease.Methods Sixty patients with complex congenital heart disease were prospectively recruited and randomly divided into group A and group B by the random number table method.Patients in group A received a conventional contrast medium injection protocol,i.e.a diluted contrast material with fast and slow rate respectively,and then a flush with normal saline.The volume of contrast medium was 2.0 ml/kg.Patients in group B received an optimized injection protocol,i.e.a four-phase diluted contrast material with contrast/ saline ratio of 8:2,6:4,4:6,2:8 respectively.The volume of contrast medium was 1.0-1.5 ml/kg.Attenuation and noise were measured in superior vena cava,right atrium,right ventricle,the main pulmonary artery,left atrium,left ventricle,ascending and the descending aorta in the two groups and compared by t test.The image uniformity was assessed by t test.Subjective image quality and artifacts of superior vena cava were analyzed by the Mann-Whitney U test.Diagnostic accuracy was evaluated by x2 test.All the patients undergone the surgical treatment and demonstrated 121 abnormalities (22 species) of internal and external heart structure,i.e.56 in group A and 65 in group B.Results There was no significant difference in diagnostic accuracy between group A and group B (A:96.9％,52/56,vs.B:96.4％,62/65;x2=0.28,P=0.59).While,significant difference was found in the amount of consumed iodine between the two groups [A:(15.7±6.5) ml vs.B:(10.4±2.4) ml;t=4.14,P＜0.01].Furthermore,the image uniformity in group B was statistically higher than that in group A[A:(36.5± 18.0)HU vs.B:(272.0± 124.5)HU;t=10.30,P＜0.01].As for subjective image quality,no significant difference were observed (A:3.3±0.5 vs.B:3.5±0.5;Z=396.00,P=0.39);while significant difference was found in artifacts of superior vena cava (A:3.2±0.9 vs.B:3.7 ± 0.7;Z=300.50,P=0.02).Conclusion The optimized contrast medium injection protocol for children with complex congenital heart disease could eliminate the image artifacts of superior vena cava and improve the image quality.

Objective To evaluate the level of IL-17 in rheumatoid arthritis(RA)and explore its clinic value.Methods Serum were collected from 84 RA patients.IL-17 was detected by ELISA.C reactive protein(CRP),glucose-6-phosphate isomerase(GPI),rheumatoid factor(RF),anti-cyclic citrullinated peptide(Anti-CCP)antibody,IL-1? and tumor necrosis factor-?(TNF-?)were assayed,too.The correlations between IL-17 and clinical manifestations as well as laboratory findings were analyzed.Results The serum level of IL-17 in active RA patients was(113.8?21.7)ng/L,significantly higher than that of non-active RA[(76.3?11.9)ng/L,P0.05).There were positive correlations between IL-17 and clinic index,for example swelling joints,tenderness joints and X-ray phase of joints.Conclusion High expression of IL-17 was shown in RA,and related with disease activity.

Objective To investigate the present incidence and the risk factors of retinopathy of prematurity (ROP).Methods The clinical data of 1 356 premature infants who were born in our hospital from Dec 2008 to Feb 2011 with birth weight of 2 500 g or less and gestational age of 37 weeks or less were analyzed retrospectively,and divided into ROP group(n =208) and without ROP group(n =1 148).They were screened for ROP from 4 ～ 6 weeks of chronological age or 32 weeks of postmenstrual age.Results In 1 356 cases,there were 208 cases with ROP,the incident rate was 15.34％,of which 36 cases were severe diseases (2.65％).Compared with the infants without ROP,the development of ROP was correlated with birth weight [(1 528 ±243) g vs (1 960 ± 187) g],gestational age [(30.92 ±0.72) weeks vs (32.87 ± 1.28) weeks],oxygen uptake time ＞ 8 d (123 cases vs 865 cases),pulmonary surfactants (18 cases vs 216 cases),septicemia (42 cases vs 154 cases),in utero distress (63 cases vs 511 cases) and anemia (64 cases vs 237 cases) (P ＜ 0.05).Logistic regression analysis suggested that birth weight,gestational age,oxygen uptake time ＞8 d,septicemia and pulmonary surfactants were significant risk factors associated with the development of ROP(P ＜ 0.05).Meanwhile,there were significant differences in the incidence of infants with ROP at different birth weight and different gestational age (P ＜ 0.05).Conclusion The birth weight and gestational age are lower,the incidence of ROP is higher and the disease is more serious.The probability of ROP,particularly severe ROP,is highest in the most immature infants while it is lower in the least immature ones.

A total of 58 patients with simple septic shock were recruited from intensive care unit and divided into control group (n =28) and treatment group (n =30) according to treatment modalities.The control group was routinely treated.The treatment group received continuous veno-venous hemofiltration (CVVH) for 10-14 days plus routine measures.After 3 days,the score of acute physiology and chronic health evaluation-Ⅱ (APACHE-Ⅱ) of the treatment group was better than that of the control group (P ＜ 0.01).And sequential organ failure assessment (SOFA),left ventricular end diastolic diameter (LVEDD),left ventricular end systolic diameter (LVEDS) and left ventricular ejection fraction (LVEF) improved significantly (P ＜ 0.05).And the relevant blood biochemical parameters improved significantly better than the control group (P ＜ 0.05).In the group CVVH,there were mortality (n =7,23％) and multiple organ failure (MODS) (n =6,20％) ; In the control group,mortality (n =14,50％) and MODS (n =13,46％).The mortality rate had inter-group differences of statistical significance (x2 =4.38,P ＜0.05).Thus early volume resuscitation plus CVVH had excellent curative efficacies for septic shock.

Objective To examine the effect of labouring in water on analgesia of vaginal delivery.Methods From June 2009 to February 2011,38 women who had volunteered to deliver in water in the obstetrical department were set as the observation group,another 70 women who chose vaginal delivery were named as the control group in the corresponding period.The items of labor pain,satisfaction with the birth experience,length of labor and neonatal outcomes were compared.Results The pain level of the observation group after labouring in water decreased compared with that before immersion in water.The delivery course was not influenced with a high rate of vaginal delivery.Conclusions Labouring in water can alleviate delivery pain,increase rate of vaginal delivery with no influence on delivery course and outcome of mothers and infants.It is a safe and effective analgesia method which should be widely applied.

AIM: To observe the changes of morphology, the activity of myeloperoxidase (MPO) and membrane pump activities of spleen tissue in acute renal failure (ARF) rabbits, and to inquire into the role of spleen on pathogenesis of immune function disorders during ARF. METHODS: 42 rabbits were divided into control group, HgCl_2 group and glycerinum group. The ARF model was established by hypodermic injection of 1% HgCl_2 at dose of 1.3 mL/kg in HgCl_2 group, intramuscularly injection of 50% glycerinum at dose of 10 mL/kg in glycerinum group, respectively, and the animals were divided into the 12 h, 24 h, 48 h secondary groups (6 rabbits each group). At different time points, the rabbits were cannulated to facilitate the collection of blood sample to examine the biochemical indexes of renal function. The spleen microscopic sections were prepared for observing the morphology. The spleen homogenate was made for determining the activities of MPO and membrane pumping. RESULTS: Pathological sections of spleen showed that the different degree of congestion was found and spleen trabecula was increased in two model groups at multiple-time points. The MPO activity of spleen homogenate in HgCl_2 group and glycerinum group at all time points were obviously higher than that in control group, and at 24 h, the MPO activitie in two model groups was significantly increased than that in the same group at 12 h and 48 h. The activities of Na~+-K~+-ATPase, Ca~(2+)-ATPase, Mg~(2+)-ATPase, Ca~(2+)-Mg~(2+)-ATPase of spleen homogenate in two model groups at multiple time points were significantly lower than those in control group. Following ARF development, the ATPase activitie in two model groups at 48 h was lower than that at 12 h except the Mg~(2+)-ATPase in glycerinum group. CONCLUSION: Spleen as an immune organ has histological damage, arrest of polymorphonuclear neutrophils and dysfunction of membrane pump during the development of ARF in rabbits, leading to immune disorders.

Objective To evaluate the effects of Deng Zhan Sheng Mai (DZSM) capsule, a compound made of Chinese herbs, on secondary and tertiary prevention of ischemic stroke. Methods A hospital-based randomized open-blinded clinical trial was conducted among people with a prior history of ischemic stroke. Hospitals were assigned to treatment group, in which all of the participants took DZSM capsules for 3 months, or control group, in which no DZSM capsules was administrated. The primary endpoint was the reduction of levels of blood lipids, fasting blood glucose (FBG) and fibrinogen in the 3rd month. The secondary endpoints were recurrence of stroke, incidence of cardiovascular event (CVD) and all-cause mortality in the 18th month. Results 495 people were enrolled in the treatment group and 504 in the control group, respectively. In the 3rd month, the levels of total cholesterol(TC),FBG and fibrinogen were significantly reduced by 1.7%,4.3 and 8.2%(t values were 4.13,6.65 and 8.50 respectively),and the levels of HDL-C and HDL-C/TC were increased by 7.6%and 1 1.6%(t values were 2.15 and 3.67)in the treatment group, respectively(all P＜0.05＝.The levels of TC,HDL-C and HDL-C/TC decreased significantly in the eontrol group(all P＜0.05＝.The incidence of recurrent stroke and CVD events were lower in the treatment group than those in the control group, but the differences did not reach the significant levels. The prevalence of post-stroke depression (PSD) was also decreased in the 3rd mouth while it remained stable in the controls (P for trend equals to 0.0027). The mortality was significantly lower in the treatment group (P=0.008). Conclusion The levels of TC,FBG and fibrinogen as well as the prevalence of PSD and all-cause mortality have decreased significantly in treatment group treated with DZSM capsule for 3 months as compared with the control group.

Objective To estimate the prevalence and related risk factors of post-stroke depression (PSD) in ischemic stroke survivors from community-based medical centers in urban areas of Beijing.Methods Five community-based medical centers in urban areas of Beijing were selected.Patients with first-ever or recurrent ischemic stroke were evaluated from January 2003 to December 2006. The prevalence of PSD was evaluated by Self-Rating Depression Scale (SDS), and the information on the onset of stroke, vascular risk factors and living style was also collected.Results Totally 1089 stroke patients were registered, 1074 cases among which had complete information and met inclusion criteria. The mean age of the patients was (65.0 ± 8.9) years with a median stroke course of 13.0 months. The overall prevalence of PSD was 49.9% (536/1074), and the proportions of mild, moderate and major PSD were 52.2%, 36.0% and 11.8%, respectively. There were no significant differences in prevalence of PSD among different stages of stroke and the prevalence of PSD was 51.3% within 6 months after stroke onset, 47. 1% during 6-18 months and 53.2% after 18months. Low education, activities of Daily Living (ADL) dependence, cognition impairment and recurrence of stroke were independent risk factors for PSD.Conclusions The prevalence of PSD among ischemic stroke patients is higher in community-based medical centers, but most of PSD patients are mild or moderate. More effective early intervention should be adopted to decrease PSD,promote the recovery of neural function and improve their quality of life.

In order to adapt to the training target of medical laboratory technology professionals under the condition of five to four educational system,we reformed the experimental teaching of medical laboratory technology.The experiment teaching was divided three phases (traditional classroom teaching + simulated clinical laboratory training + clinical laboratory teaching).Classroom teaching focused on the cultivation of students' basic skills test;simulation laboratory training focused on strengthening the students' operating skills and basic post ability and professional quality;hospital laboratory teaching focused on strengthening the students' ability of medical laboratory management,test comprehensive analysis and scientific research.The reform practice of two sessions of the students showed that the students' examination skills and comprehensive quality improved significantly,which could better adapt to the social demand for technical personnel.