OBJECTIVE:To compare the effects of iguratimod combined with methotrexate and diacerein respectively on relat-ed indexes of refractory rheumatoid arthritis (RRA). METHODS:98 RRA patients were randomly divided into control group (48 cases)and observation group(50 cases). Control group received Iguratimod tablet 25 mg,twice a day+Methotrexate tablet with ini-tial dose of 10 mg,once a week,increased to 12.5 mg after 2 weeks,increased to 15 mg in the second courses,once a week. Ob-servation group received Iguratimod tablet(the same dosage and usage with control group)+Diacerein granule 50 mg,twice a day. 4-week was a course,they were treated for 6 courses. Morning stiffness time,the numbers of 28 joints tenderness and swelling,28 joint disease activity score (DAS28),erythrocyte sedimentation rate (ESR),rheumatoid factor (RF),IL-1,vascular endothelial growth factor (VEGF),tumor necrosis factor (TNF)-α,C-reaction protein (CRP),malondialdehyde (MDA),superoxide dis-mutase(SOD),total antioxidant capacity(TAOC),early peak flow(peak E),left ventricular late flow peak flow(peak A),E/A and left ventricular ejection fraction(LVEF)before and after treatment,and the incidence of adverse reactions in 2 groups were ob-served. RESULTS:Before treatment,morning stiffness time,the numbers of 28 joints tenderness and swelling,DAS28 score, ESR,RF,IL-1,TNF-α,CRP,VEGF,MDA,TAOC and peak A in 2 groups were significantly lower than before treatment,and observation group was significantly lower than control group;SOD,peak E,E/A and LVEF in 2 groups were significantly higher than before treatment,and observation group was significantly higher than control group,with statistical significances (P<0.05). And there was no significant difference in the incidence of adverse reactions (P>0.05). CONCLUSIONS:Iguratimod combined with diacerein is superior to iguratimod combined with methotrexate in improving cardiac function,oxidation-antioxidant imbalance play and reducing inflammatory reactions in the treatment of RRA,with similar safety.

We analyzed retrospectively the result of postoperative RT by electron beam in 314 patients with breast cancer after a radical or modified mastectomy between 1976～1992. The radiation portals covered the supraclavicular, the axillary and the internal mammary lymph node chains and chest wall. D T40～50Gy/4～5w was delivered. The local regional failure and factors affecting the survival rates, such as the clinical stage, the status of axillary lymph nodes and radiation dose were analyzed. The symptomatic radiation pneumonitis (9.4%) was discussed.

BACKGROUND: Posterior internal fixation and fusion system is a main method for chronic back pain caused by intervertebral disc degeneration, but more postoperative adverse reactions occur. Dynamic stabilization system can reduce adjacent-segment degeneration, and theoretically, repair intervertebral disc degeneration.OBJECTIVE: To investigate the efficacy and safety of K-rod dynamic stabilization system in the repair of lumbar degenerative diseases.METHODS/DESIGN: We conducted a prospective, single-center, self-controlled, clinical trial at the Orthopedic Hospital of Shenyang, China. Sixty-seven patients with lumbar degenerative diseases were enrolled, and treated with K-rod dynamic stabilization system. All patients were followed for 2 years. The primary outcome was the changes in the Oswestry dysfunction index scores at baseline, 3, 6, 12 and 24 months postoperatively. The secondary outcomes were the ratio of height vertebral space to body and lumbar lordotic angle at baseline, 3, 12 and 24 hours postoperatively; the visual analogue scale scores for back pain and morphological changes in the lumbar vertebrae on x-ray preoperatively and 3, 6, 12 and 24 months after surgery; the incidence of adverse reactions at 3, 6, 12 and 24 months postoperatively.This trial has been registered at ClinicalTrials.gov (identifier: NCT03214042). The study protocol has been approved by the Ethics Committee of Orthopedic Hospital of Shenyang. All protocols will be performed in accordance with the Ethical Principles for Medical Research Involving Human Subjects in the Declaration of Helsinki. Written informed consent was provided by each patient after they indicated that they fully understood the treatment plan.DISCUSSION: This trial was designed to investigate the efficacy and safety of K-rod dynamic stabilization system for lumbar degenerative diseases, thus providing reference for its clinical application. Partial results demonstrated that the Oswestry Dysfunction Index and Visual Analogue Scale scores at 24 months postoperatively were significantly improved (P < 0.01), but the ratio of height vertebral space to body and lumbar lordotic angle did not differ significantly at different time points (P > 0.01). These results suggest that K-rod dynamic stabilization system can alleviate pain and improve lumbar function in the patients with lumbar degenerative diseases.

Purpose To investigate the clinical value of MR PROSET technique in showing and diagnosing in lumbarsacral nerve root diseases.Materials and Methods Conventional MRI sequence and PROSET sequence coronal images were performed in lumbosacral nerve roots of 15 healthy volunteers and 47 low back pain patients,each case performed 3D maximum intensity projection (3D MIP) post-processed.Spinal nerveroots were observed.Results The PROSET could show dura,dura sheath,spinal nerveroot,ganlias,segments of the nerves posterior to the ganglions well and could be observed from multiple aspects by the 3D MIP.Among the 47 cases of luber nerve root disease,PROSET could show the level of the invasion and compression to the ganglias.Conclusion According to the PROSET technique and conventional MRI picture,can provide the satisfied proof to the diagnosis of lumbosacral nerve root diseases.

Objective To investigate the value of X-ray,CT and MRI in diagnosing early spinal tuberculosis by constructing lum-bar vertebra tuberculosis model in New Zealand rabbits.Methods Forty healthy New Zealand rabbits were randomly divided into the infected group (n=30)and the control group (n= 10).All rabbits were performed lumbar vertebra surgery,and then underwent imaging and histopathologic examination at 4,6,8 weeks respectively.Results The sensitivity of X-ray,CT and MRI in detecting tuberculosis lesions were 46.13%,76.3%,and 92.3%,respectively.MRI and CT were better than X-ray for displaying the de-struction range limited in a single vertebra (P <0.05).Combination with routine MRI and diffusion-weighted imaging (DWI)could find the vertebra tuberculosis at the early stage.According to the HE staining,pus cells,epithelioid cells or necrosis were seen in the tissue sections of vertebra and paraspinal soft tissues in the infected group.Conclusion X-ray,CT and MRI could provide some information for the early diagnosis of spinal tuberculosis,and MRI is more sensitive.

Objective To explore the efficacy of group cognitive behavioral therapy for improving depressive symptoms and social functional in patients with major depressive disorder.Methods A total of 160 patients with major depressive disorder were randomly divided into intervention group (n=80) and control group (n=80).Intervention group was treated with conventional antidepressants combined with group cognitive behavioral therapy.Control group was treated with one conventional antidepressants.All participants were assessed with Hamilton Depression Scale (HAMD)and Scale of Social function of Psychosis Inpatients (SSFPI) before and 8 weeks after the treatment.Results After 8 weeks treatment,the scores of HAMD (14.76±9.48) was significantly reduced and the scores of SSFPI(30.09±4.34) were significantly increased in intervention group compared with the baseline ((37.91± 10.58),(12.40±2.56),all P＜0.01).The scores of HAMD were significantly lower and the scores of SSFPI were significantly higher in intervention group than that in control group((20.71±7.85),(22.63±3.63),all P＜0.01).Conclusion Group cognitive behavioral therapy is effective for major depressive disorder patients by reducing depressive symptom and improving social function.

Objective To investigate the serum levels of uric acid (UA) in bipolar disorder patients and their clini?cal significance. Methods Serum levels of UA was measured in 126 bipolar disorder patients including 77 mania pa?tients and 49 depression patients, 69 first-episode schizophrenic patients and 126 healthy controls (control group). Bipo?lar disorder patients was assessed by using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Scale (HAMD). Results The serum UA levels were significantly higher in bipolar group [(349.34 ± 107.21) μmol/L] than in schizophrenic group [(319.71±84.48)μmol/L] and in control group [(280.94±71.90)μmol/L] (P<0.01). There were signifi?cant differences in serum UA levels between manic episode and depressive episode [(366.45 ± 104.01) μmol/L vs. (322.45±107.69)μmol/L]. The serum UA levels were higher in both manic episode and depressive episode groups than in control group (P<0.01). The serum UA levels was not significantly different between patients with and without medication (P>0.05). Correlation analysis indicated that the correlation of serum UA levels with YMRS scores and HAMD scores was not significant in bipolar disorder patients (P>0.05). Conclusions Patients with bipolar disorder has elevated serum uric acid levels which may be a biomarkers of bipolar disorder.

Objective To investigate the clinical diagnostic values of quantitative DTI and MRS in AIDS-related cerebral tuberculosis. Methods 17 cases confirmed with AIDS and brain tuberculosis,16 volunteers were recruited to perform routine MRI,DTI and MRS sequences. Morphological characteristics of lesions were observed.ADC,FA,rADC,rFA,NAA/Cho,NAA/Cr and Cho/Cr of the lesions solid areas,edematous areas,normal areas and contralateral corresponding normal areas were measured and their variances in different areas were analyzed. Results Significant differences of the values were observed among the three regions of AIDS-related brain tuberculosis,the results of multiple comparisons between the three areas had statistical significances (P <0.05)excepted NAA/Cr between edematous and contralateral areas.ADC,FA,rADC,rFA,NAA/Cho,NAA/Cr on solid areas were lower than that on edematous areas,Cho/Cr on solid areas was higher than that on other two areas.The diagnostic efficiency of rFA value to distinguish solid and edematous areas was the highest by ROC analysis(P <0.05).The normal areas of the two groups had statistical significances(P <0.05)excepted Cho/Cr.Conclusion DTI is valuable to display the lesions micro-structure changes and MRS can reflect the early pathology metabolites changes of AIDS-related tuberculosis.

Objective To investigate the significance of test of receptor activator of nuclear factor?kappa B(NF?κB)ligand(RANKL)in serum and urine for the diagnosis of osteoporosis. Methods A total of 53 patients with osteoporosis(the experimental group)and 45 healthy controls(the normal control group)were recruited in this study. The expression levels of RANKL in serum and urine was measured and compared by enzyme?linked immunosorbent assay. Results The serum and urine levels of RANKL in the experimental group were significantly higher than those in the normal control group(P<0.01). The areas under receiver operating characteristic(ROC)curve of serum and urine RANKL were 0.898 and 0.734, respectively. The combined detection of serum and urine RANKL and Ca2+reached a high sensitivity of 89.5%and a specificity of 86.1%for diagno?sis of osteoporosis. Conclusion RANKL may be closely associated with the progression of osteoporosis. Serum and urine RANKL test may be help?ful in the diagnosis of osteoporosis.

Objective To explore the association between serum levels of homocysteine (Hcy) and relation factors in the patients with manic episodes of bipolar Ⅰ disorder(BD).Methods The case-control study was used for this study.A total of 73 inpatients with manic episodes of BD(patient group) and 39 healthy individuals (control group) were enrolled.Diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition(DSM-Ⅳ) criteria.Serum levels of Hcy was measured by enzymatic cycling assay.Young Mania Rating Scale(YMRS) were used to assess the severity of clinical symptoms of patients.Results There was a statistical difference in serum Hcy levels between patient group ((16.89± 14.67)μmol/L) and control group ((10.61±6.46) μmol/L) (P＜0.01),and serum Hcy levels was higher in men((20.42± 16.52) μmol/L) than that in women((10.87±8.02) μmol/L) in patients group(P＜0.05).The prevalence rate of high Hcy was 35.6％ in the patient group and 13.5％ in the control group(P＜0.05).Correlation analysis showed body mass index(BMI) had positive correlation with serum levels of Hcy (r=0.317,P＜0.05).Stepwise multiple regression analysis showed male,BMI were associated with serum levels of Hcy among the patients (all P＜ 0.05).Conclusion Serum Hcy levels in the patients with manic episodes of bipolar Ⅰ disorder increase,and it is associated with gender and BMI.