Osteoarthritis is a common chronic degenerative disease, which is currently the main drug therapy.Hyaluronic acid (HA) is a kind of glycosaminoglycan in the interstitial cells, which has the character of viscoelasticity, lubricity, biocompatibility,biodegradability and anti-inflammatory. It is wide applicated in the treatment of osteoarthritis.However, the half-life of the common hyaluronic acid injected into the joint cavity is shorter, patients need frequent dosing and the compliance is poor, research on new uses of hyaluronic acid formulations and clinical pharmacy workers is the new direction of research.In this paper, the recent advance of HA on function, safety, effectivity and novel application in osteoarthritis therapy are summarized.

Objective To investigate the clinical application of iodine-enhanced image of dual-source computed tomography (DSCT) in distinguishing benign and malignant thyroid nodules.Methods Thirty patients with thyroid nodules underwent DSCT imaging with dual-source computed tomography.All thyroid nodules were confirmed by operation or biopsy.Iodine concentration in the thyroid nodule and normal thyroid tissue were calculated and not enhanced.A receiver operator characteristic curve in SPSS software was utilized to select critical value of optimum sensitivity and specificity.The data were retrospectively analyzed.Results There were 30 patients with 40 thyroid nodules (17 malignant nodules,23 benign nodules).The range of iodine concentration in malignant nodules was -2.4-0.9 mg/ml(median-0.5 mg/ml),and that in normal thyroid tissue was-0.9-2.2 mg/ml (median 0.7 mg/ml).The range of iodine concentration in benign nodules was 1.5-4.4 mg/ml(median 2.4 mg/ml),and that in normal thyroid tissue was 1.5-4.3 mg/ml (median 2.6 mg/ml).Among them,the iodine concentration in the solid part of benign nodules was significantly higher than that in malignant nodules,the difference was statistically significant(Z=-3.23,P=0.21).When critical value was 0.15 mg/ml,sensitivity was 82.40％,specificity was 81.00％.Conclusion Iodine-enhanced images with DSCT in non-enhanced weighted images may be an implement tool for differential diagnosis of benign and malignant nodules of the thyroid gland.

AIM:To evaluate the availability and our experience of intraoperative image-guidance in endoscopic nasocular operation.METHODS:Seven cases of endoscopic nasal surgery with intraoperative image-guidance were retropectively reviewed,including 3 cases of optic nerve injury;3 cases of foreign object of optic behind the eyeball;1 case of retrobulbar tumor(angeioma).RESULTS:The preoperative preparatory time would take 15 minutes,including coordination,head holder localization,conventional instrument registration.In our cases,the localization accuracy between 3-D image landmarks of navigation system and actual anatomical landmarks was less than 1.3mm.The optic nerve and other anatomical points could be orientated accurately in intraoperative procedures.No complication occurred.CONCLUSION:Nasal endoscope combined with imageguidance systems provides accurate anatomical localization of anterior skull base with enlarged operation field.It is possible for surgeons to observe important anatomical structures during endoscopic surgery.It could increase the effectiveness and decrease surgical complications,especially in complicated cases.

Objective To explore the operation indication of fracture of rib with fracture internal-fixation.Methods The clinical data of 103 cases with Fracture of rib,treated by fracture internal-fixation(n =49)and conservative treatment (n =54) respectively,were retrospectively analyzed.Results The hospital stay time,VAS scores and the healing time of surgical group were lower than that of non-surgical group.Fracture internal-fixation could significantly reduce the incidence of lung infection,deformities of chest and delayed hemathorax.Conclusions Internal fixation of fracture is much better than other routine therapies for fracture of ribs.The patients with indication of operation should operate actively.

Objective To study the chemical composition from leaves of Smallanthus sonchifolius.Methods Some chromatography methods were used in the isolation procedure,while the structures were determined on the aids of NMR and MS spectral analyses.Results A new compound,together with five known compounds,was isolated from the ethanolic extract of the leaves.The new compound is characterized as 5,8-dihydroxyl-(5H,8H)-?-ionol(Ⅰ).Other compounds are obtained for the first time from the title plant and identified as ent-kaurane-3?,16?,17-triol(Ⅱ),entkaurane-16?,17-diol-19-oic acid(Ⅲ),3,4-dihydroxybenzaldehyde(Ⅳ),1-pentacosanol(Ⅴ),and 1-octacosanol(Ⅵ),respectively.Conclusion Compounds Ⅰ-Ⅵ are isolated from the plants of genus Smallanthus for the first time.Compound Ⅰ is a ?-ionol derivate firstly isolated from genus Smallanthus.It is named as sonchifolol.

ObjectiveTo investigate the clinical value of transvaginal elastography in diagnosing cervical cancers.MethodsTotally,124 patients of cervical lesions with definite pathological results were enrolled.Elastograms were collected and the strain ratios of the benign and malignant lesions were record and compared.ROC curve was used to find the best cut-off point.ResultsElastography was useful in differentiating benign and malignant lesions by different color.Values of strain ratio of different pathological lesions were statistically different ( P ＜0.01).The mean value of strain ratio was 2.71 ± 1.56 for benign lesions and 8.32 ± 4.11 for malignant ones.The best cut-off point was 4.99 basing on the ROC curve.The sensitivity and specificity were 80.7％ and 89.6％,respectively.ConclusionsReal-time transvaginal elastography was a new way in differential diagnosing cervical cancers from benign lesions of the cervix.

Objective To evaluate the clinical value of spectral CT monochromatic imaging in improvement of imaging quality of bronchial arteries.Methods We retrospevtively analyzed the chest CT images in 38 patients who underwent the contrast-enhanced spectral CT.These images included a set of 140 kVp polychromatic images and default 70 keV monochromatic images.Using a standard Gemstone Spectral Imaging (GSI)viewer at an advanced workstation (AW4.6),an optimal energy level (in keV)for obtai-ning the best CNR of the bronchial artery could be automatically obtained.The SNR,CNR and objective imaging quality score for these 3 imaging sets (140 kVp,70 keV and optimal energy level)were obtained and compared with one-way ANOVA .Results The optimal energy levels for obtaining the best CNR were (62.58±2.74)keV.The SNR of the 140 kVp polychromatic images,70 keV monochromatic images,and the optimal keV monochromatic images were 1 6.44±5.85,20.96 ±8.32 and 24.91 ±9.91,the CNR were 13.30±5.45,1 7.25±6.97 and 20.67±8.62,and the subjective imaging quality scores were 1.97 ±0.82,3.24±0.75 and 4.47±0.60,respectively,exhibiting significant differences among groups (F =10.1 7,10.1 7 and 1 1 1.12,P <0.00).The optimal monochromatic group was superior to the 70 keV group and the 140 kVp mixed-energy group.Conclusion Monochromatic images at approximately 62 keV in dual-energy spectral CTA yields the best CNR and highest diagnostic confidence for imaging bronchial ar-teries,which may improve imaging quality for imaging bronchial arteries.

Objective To assess the effects of health management on high-risk diabetic populations.Methods A total of 307 diabetic high-risk adults from 6 communities of Tianjin were recruited by using diabetes risk screening technology.Three-month intensive health management and nine-month follow-up were conducted in this participants.Paired t test for continuous variables and paired contingency table x2 test were used for data analysis.Results Energy intake (1989.8 vs.1766.4 kcal,t =6.84,P ＜0.05),effective exercises (120.4 vs.157.5 kcal,t =-5.00,P ＜ 0.05),body weight (73.0 vs.71.5 kg,t =6.92,P ＜0.05),systolic blood pressure (130.4 vs.124.6 mm Hg (1 mm Hg =0.133 kPa),t =8.36,P ＜0.05),diastolic blood pressure (81.8 vs.78.4 mm Hg,t =7.40,P ＜ 0.05),serum total cholesterol (5.21 vs.5.08 mmol/L,t =2.73,P ＜ 0.05),fasting plasma glucose (6.4 vs.5.8 mmol/L,t =16.37,P ＜ 0.05)and 2 h postprandial blood glucose (7.7 vs.6.9 mmol/L,t =9.67,P ＜ 0.05) were significantly improved after the intervention.Conclusions Community-based health management may provide an effective way to prevent and control the risk factors of diabetes.

Objective To assess the role of health education in outcomes of diabetes mellitus among high-risk populations.Methods The community physicians who participated this investigation received standardized training,and 307 community residents at high risk of developing diabetes obtained three-month intense health education and nine-month follow-up study.Paired t-test,and Analysis of Variance were used for data analysis.Results After systematic health education,professional level of community physicians was improved.Cognitive level of health knowledge was also significantly improved (5.5 vs 12.6,t=-28.511,P＜0.05).In addition,health knowledge of variant age (F=4.036,P＜0.05),education level (F=15.27,P＜0.05) and occupation (F=9.80,P＜0.05) subgroups was significantly increased.In comparison with baselines,the scores of each age subgroups (F=0.204,P＞0.05) showed no significant differences,although scores of different education level (F=4.71,P＜0.05) and occupation (F=4.87,P＜0.05) subgroups were significantly different.The risk factors of diabetes were effectively controlled.Conclusions Health education should be the key to health management of diabetes,which plays important roles in improving cognitive level of health knowledge among populations at high risk of developing diabetes and reducing the incidence of this condition.

Objective To evaluate the effectiveness of Percu Twist (PT) tracheostomy comparing with that of operative tracheostomy(OT)in intensive care unit(ICU). Methods Related data were retrieved from CBM,CNKI,Wanfang Data,VIP,PubMed,EMBASE,CENTRAL,and Web of Science from the time of their establishment to May 15th 2014,and the data of randomized controlled trials(RCTs)concerning PT and OT were selected. The risk of bias assessment and data extraction were performed by two independent reviewers. Meta analysis was conducted using RevMan 5.2 software. Results A total of 12 RCTs were identified,and 893 patients in ICU were involved. The results of Meta-analysis showed that PT could significantly shorten the operation time〔mean difference (MD)=-15.11,95% confidence interval(95%CI)=-17.14 to -13.07,P<0.000 01〕,reduce the volume of blood loss(MD=-17.59,95%CI=-21.90 to-13.28,P<0.000 01),reduce the size of incision(MD=-2.20, 95%CI=-2.57 to -1.82,P<0.000 01),shor ten the time of healing(MD=-3.60,95%CI=-4.15 to -3.05, P<0.000 01),and reduce complications such as infection of the wound〔odds ratio(OR)=0.20,95%CI=0.10-0.44,P<0.000 1〕and cutaneous emphysema/mediastinal emphysema(OR=0.22,95%CI=0.10-0.47,P<0.000 1)compared with OT group. The funnel plot suggested that publication bias might be found among 12 researches. Conclusions PT was shown to be more effective than OT in ICU with lower incidence of complications. As number of RCT cases is still small with unsatis factory quality,further clinical use is warranted for a better assessment.