Objective:To study the changes of serum IL 1?,IL 6,IL 8,TNF ? and sIL 2R and its relationship with disease activity in adult Still disease patients.Methods:Serum levels of IL 1?,IL 6,IL 8,TNF ? and sIL 2R were assessed by ELISA in 18 adult Still disease patients before and one month after treatment with prednisone.Results: Active adult Still disease patients had significant elevated erythrocyte sedimentation rate (ESR) and serum levels of C reactive protein (CRP),IL 1?,IL 6,IL 8,TNF ? and sIL 2R.After one month treatment with prednisone,ESR and serum levels of CRP,IL 6,TNF ? and sIL 2R significantly decreased.There was a significant correlation between ESR values and serum IL 6,TNF ? and sIL 2R levels,and between serum CRP levels and IL 6,TNF ? and sIL 2R levels.Serum IgG,IgA and IgM levels in active adult Still disease patients were similar to those in healthy controls.Conclusion: There are no changes in serum immunoglobulins but significant increases of serum IL 1?,IL 6,IL 8,TNF ? and sIL 2R levels in active adult Still disease.Serum levels of IL 6,TNF ? and sIL 2R are related to the activity of adult Still disease.

Objective To analysis of risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis.Methods From January 2001 to December 2008, 2277 patients with rheumatic mitral stenosis underwent operations in our hospital. There were 737 males and 1540 female, the age ranged from 19 to 84 years [average (50.9 ±10.2) years]. Left atrial thrombosis group (554 cases) and no thrombosis group (1723 cases) were divided, retrospectively collected data were analyzed with univariate and multivariate Logistic regression. Results 12 bvariables, including age, mitral valve orifice area, left atrial diameter, left ventricular diastole diameter, CRP, gender , degree of mitral stenosis, or regurgitation, degree of bicuspid regurgitation, degree of pulmonary hypertension, atrial fibrillation and heart function had statistic difference between two groups. With multivariate Logistic regression for these 12 factors, age, mitral valve orifice area, left atrial diameter, degree of mitral regurgitation and atrial fibrillation were found to be the affecting factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Conclusion For patients with rheumatic mitral stenosis, age, mitral valve orifice area, left atrial diameter and atrial fibrillation are the risk factors for left atrial thrombosis. Mitral regurgitation is a protective factor for left atrial thrombosis.

Objective:To study the causes of misdiagnosis of patients with POEMS syndrome and to discuss the clues for its early diagnosis.Methods:The clinical and laboratory data of 26 inpatients with POEMS syndrome,who were treated in Changhai hospital over the last decade,were retrospectively analyzed.Results:The misdiagnosis rate of our group was 100%. The misdiagnosis was made in(3.31?0.97)hospitals and in(3.31?0.93)clinical departments;the misdiagnosis period was (19.42?10.86)months and it had been misdiagnosed as 18 other diseases.The initial symptoms included polyneuropathy in 21 (80.8%)cases,edema of lower extremity in 22(84.6%)cases,and body weight loss in 8(30.8%)cases.The typical clinical symptoms included polyneuropathy in 26(100%)cases and organomegaly in 24(92.3%).Two cases had newly-identified uterine hypertrophy,one had adrenal gland hypertrophy,and one had gastric wall thickening mimicking advanced gastric cancer.Hypothyroidism,impotence,skin pigmentation and sclerosis occurred in 76.9%(20/26),60%(6/10),92.3%(24/ 26)and 65.4%(17/26)cases,respectively.Monoclonal plasma cell proliferation was documented in 18(81.8%);M proteins were positive in 14(63.6%)cases by serum immunofixation,and only 2(9.1%)cases also positive by serum protein electrophoresis.One patient was positive of M protein by urine immunofixation and one had abnormal infiltration of plasma cells in the gastric wall.Lymph node biopsy were performed in 8 patients and 3 were found to have Castleman disease;the other 5 cases had lymphocyte infiltration,with 3 complicated with plasma cell proliferation.Nerve biopsy in 4 cases all revealed axonal degeneration and one patient complicated with demyelination.Bone marrow biopsy in 5 cases revealed plasmacytosis in 2 cases and myeloma in one.Excessive radioactivity resorption was found in 10 of the 16 cases(62.5%)and abnormal plasma cells were detected in 2 cases by bone aspiration guided by radioisotope bone scan.Conclusion:Misdiagnosis of POEMS syndrome is very common.Polyneuropathy,edema of lower extremity and body weight loss are the common early symptoms of POEMS syndrome. Early diagnosis can be made by having an intimate knowledge of the progression of the disease and by detecting M protein through various approaches.

Objective This study was designed to investigate the expression changes of osteopro-tegerin (OPG), tartrate-resistant acid phosphatase (TRAP) and vascular endothelial growth factor (VEGF) mRNA in collagen induced arthritis(CIA) rats. Methods After CIA was induced in Sprague-Dawley rats, the experimental animals were treated with PBS or rAAV-EGFP or rAAV-hOPG (100 μl/day) intra-articular injection for 10 days. Messenger RNAs (mRNAs) were obtained from CIA synovium 40days after first immun-ization. Reverse transcriptase-polymerase chain reactions (RT-PCR) were carried out to detect the mRNA encoding OPG, TRAP, VEGF and β-actin, which acted as inner control. The genes detected clearly by RT-PCR were quantified using real-time PCR. Results The expression of all genes was confirmed by specific single bands in RT-PCR. Real-time PCR showed that the expression levels of TRAP and VEGF were increased, whereas those of OPG mRNA were decreased in CIA group compared with normal controls. The intra-articular gene transduction markedly increased the gene copies of OPG by 128.21% (P<0.01). The expression change of OPG in synovium also caused the decrease of the expression levels of TRAP and VEGF by 58.79% (P<0.01)and 17.85% (P>0.05) respectively, however, the expression change of VEGF was not statistically significant. Conclusion OPG gene mediated by rAAV can be successfully tranfered to knee joint synovium in vivo. The results of this study suggest that gene transfer using rAAV-OPG may be a feasible and effective therapeutic approach to treat or prevent joint destruction in inflammatory arthritis.

Objective Using an in vivo adeno-associated virus(AAV)-mediated gene transfer technique,this study was designed to evaluate the protective effects of human osteoprotegerin(OPG)transgene against joint destruction in collagen induced arthritis(CIA)model.MethodsAfter CIA was established in the Sprague-Dawley rats,the experimental animals were treated with PBS or rAAV-EGFP or rAAV-hOPG (100μl/d)intra-articular injection 25 days after arthritis induction for 10 days.Paraffin-embedded joints were then analyzed histologically.The joint destruction was evaluated by Larsen Score.The protein expression of OPG,IL-1,MMP-3 was identified by enzyme-linked immunosorbent assay(ELISA).Results Suecessful trans-gene expression was confirmed by the detection of OPG by ELISA and positive fluorescence of the frozen joint section. Image analysis revealed that the expression of OPG significantly protected against joint destruction by 30% compared with the CIA group. Conclusion OPG gene transfer mediated by rAAV effectively protects against bone destruction induced by CIA model. Those data suggest that gene transferring using rAAV-OPG may be a feasible and effective therapeutic approach to treat or prevent joint destruction in inflammatory arthritis.

Objective To explore the effects of no convulsions electric shock treatment on cognitive function in patients with schizophrenia. Methods Sixty patients with schizophrenia from Jan 2012 to Apr 2014 were randomly divided into two groups. Observation group patients were treated with MECT and new anti-psychotic while control groups just with new anti-psychotic. The corresponding index were compared. Results The first treatment week: BANS scores of the observation group were significantly higher,while PANSS,TESS etc were significantly lower than the control group (vi-sual spatial structure was opposite) (P﹤0.05); Connect test completion time and errors numbers of control group were significantly lower than the one of observation group(P﹤0.05). One week after treatment:RBANS scores of observation group was significantly higher,while the PANSS, TESS scores were significantly lower than the control group(P﹤0.05);Connect test completion time of control group were significantly higher than the one of observation group. Conclusion Schizophrenia patients with non-convulsive electric shock treatment,have a greatly recovery,but the presence of cogni-tive function exist reversible injury.

ObjectiveTo evaluate the adverse events occurred during tumour necrosis factor (TNF)-αblocker treatment in Chinese Han population patients with ankylosing spondylitis (AS).MethodsThis study had enrolled 369 Chinese Han population patients with ankylosing spondylitis.They all received TNF-αblocker treatment in the hospital.All 1011 administration were recorded in total.All of them were evaluated for adverse events 2 hours after injection,126 of them had received long-term TNF-α blocker injection,and they were followed-up at week 8,12,52,104.Mild immediate adverse events and long-term adverse events were all counted.SPSS 10.0 software package was used for Fisher's exact test.ResultsThree hundred and sixty-nine patients had 1011 administrations in total,652 had received rhTNFR:Fc,316 had infliximab,21had etanercept,22 had adalimumab injections.Adverse events 2 hours after injection were:17 (2.6％) for rhTNFR:Fc,12 (3.8％) for infliximab,0 for etanercept,1 (4.5％) for adalimumab.Twenty adverse events were mild(12 for rhTNFR:Fc,9 for infliximab),5 events were moderate(3 for rhTNFR:Fc,1 for infliximab,1 for adalimumab),4 events were severe(2 for rhTNFR:Fc,2 for infliximab).The frequency of adverse events were comparable between rhTNFR:Fc and Infliximab injection in immediate adverse reactions (P=0.31).One hundred and twenty-six (69 rhTNFR:Fc,57 infliximab) patients had long-term usage,and were followed-up at week 8,12,52,104,39 patients had adverse reactions:20 (51.3％) for rhTNFR:Fc,19(48.7％) for infliximab.Thirty-seven patients had infectious events(94.9％ ),1 neurological event(2.6％),and 1 patient had tuberculosis relapse (2.6％).Outcomes were comparable with rhTNFR:Fc and infliximab in long-term usage(P=0.69).ConclusionAttention should be paid to the above events in Chinese Han patients with ankylosing spondylitis who were treated with TNF-α blocker treatment.Special attention should be paid to those patients who are in their third or fourth injection.The occurrence of immediate reaction or long-term adverse events between rhTNFR:Fc and infliximab are comparable.

Objective To compare the clinical efficacy of ibuprofen arginate,a new nonsteroidal antiinflammatory drug,with that of ibuprofen,in patients with rheumatoid arthritis or knee osteoarthritis and to evaluate the safety and tolerability of ibuprofen argihate.Methods This is a muhicenter,random,open,active comparator-controlled,parallel clinical trail in which 171 patients with rheumatoid arthritis or knee osteoarthritis were enrolled.Patients were randomized to 2 groups:400 mg of ibuprofen arginate three times daily and 400 mg of ibuprofen three times daily respectively.Clinical efficacy and safety were evaluated after 4-week treatment.Results Ibuprofen arginate,at dosages of 400 mg three times daily,had shown significant efficacy in relieving pain,tenderness and swelling of joints and there was no significant difference when compared to that of ibuprofen.There was no difference in clinical adverse effects between the two groups and no serious adverse effects were repofled.But ibuprofen arginate could initiate effectiveness more rapidly than ibuprofen in both rheumatoid arthritisand osteoarthritis patients.Conclusion Ibuprofen arginate has the same clinical efficacy and safety profiles as itmprofen in treating rheumatoid arthritis and osteoarthritis.However,its onset is more rapid than ibuprofen.

OBJECTIVE:To investigate the effects and safety of gamma globulin combined with phototherapy on serum preal-bumin(PAB)and total bile acid(TBA)of ABO hemolytic children. METHODS:A total of 90 ABO hemolytic children in our hos-pital during Feb. 2014-Sept. 2016 were selected as research objects and divided into observation group and control group according to random number table,with 45 cases in each group. Both groups were given routine active correction of hypoxia and pretreatment for possible hypoglycemia and hypothermia. Control group was additionally given phototherapy with wavelength of 425-475 nm. Ob-servation group was additionally given Human immunoglobulin for intravenous injection (pH4) 1.0g/kg was added to normal saline 10 mL,ivgtt,on the basis of control group and treated for 1 d. The time of jaundice regression,phototherapy duration and hospital-ization time were compared between 2 groups,and the levels of PAB and TBA were compared before and after treatment. The occur-rence of ADR was recorded in 2 groups. RESULTS:The time of jaundice regression,phototherapy duration and hospitalization time in observation group were significantly shorter than control group,with statistical significance(P<0.05). Before treatment,there was no statistical significance in the levels of PAB or TBA between 2 groups(P>0.05). After treatment,the level of PAB was increased significantly in 2 groups,while the level of TBA was decreased significantly;the observation group was significantly better than the control group,with statistical significance(P<0.05). There was no statistical significance in the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:Gamma globulin combined with phototherapy can significantly shorten the time of clinical symptom im-provement,increase serum level of PAB whlie decrease serum level of TBA in ABO hemolytic children,with good safety.

The adjacent anatomy of the pelvis is complicated, with digestive, urinary, reproductive and other organs as well as important blood vessels and nerves. Therefore, accurate resection of pelvic tumors and precise reconstruction of defects after resection are extremely difficult. The development of medical 3D printing technology provides new ideas for precise resection and personalized reconstruction of pelvic tumors. The “triune” application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis in pelvic tumor limb salvage reconstruction treatment has achieved good clinical results. However, the current lack of normative guidance standards such as preparation and application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis restricts its promotion and application. The formulation of this consensus provides normative guidance for 3D printing personalized pelvic tumor limb salvage reconstruction treatment.