Objective To observe the therapeutic effects of different doses of recombinant human tumor necrosis factor-receptor Ⅱ:IgG Fc fusion protein (rhTNFR:Fc) on rheumatoid arthritis (RA). Methods Seventy-six patients with RA were randomly divided into rhTNFR:Fc treatment group A (n=22; rhTNFR:Fc 25 mg, twice/week and methotrexate 10 mg/week), rhTNFR:Fc treatment group B (n=24; rhTNFR:Fc 12.5mg, twice/week and methotrexate 10 mg/week) and control group (n=30; methotrexate 10 mg/week). Joint function related parameters including number of swollen joints, number of tenderness, pain degree, time of morning stiffness, Health Assessment Questionnaire (HAQ) score, erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor were detected before and 2, 4, 6, 8, 12, 16 and 24 weeks after treatment in all the patients. After being treated for 3 months, the changes of joint function related paramters were evaluated and compared among groups. ACR20, ACR50 and ACR70 criteria were employed to evaluate the therapeutic effects. Results There was no significant difference in joint function related parameters among three groups before treatment (P＞0.05), while those improved significantly after treatment for 3 months (P<0.05), with more favorable results in rhTNFR:Fc treatment group A and B than in control group (P<0.05). The percent of patients with ACR50 in rhTNFR:Fc treatment group A was significantly higher than that in rhTNFR:Fc treatment group B 2 and 4 weeks after treatment (P<0.05), while there was no significant difference in total effect between these two groups 8, 12, 16 and 24 weeks after treatment(P＞0.05). Conclusion Small dose of rhTNFR:Fc in combination with methotrexate may yield effective and economical results for treatment of RA.

Objective To evaluate the efficacy and safety of etanercept in treatment of ankylosing spondylitis. MethodsEighty-six patients were randomized into experiment group and control group (n=43). Patients in experiment group were treated with non-steroidal antiinflammatory drugs (NSAIDs) and etanercept (25 mg, twice/week, subcutaneous injection in the upper arm), and those in control group were managed with NSAIDs and sulfasalazine. Reexaminations were performed after treatment for 3 months, and the prevalence of low back pain, time of morning stiffness, Bath ankylosing spondylitis disease activity index(BASDAI), Bath ankylosing spondylitis functional index(BASFI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were analysed, and the prevalence of adverse effects was observed. ResultsCompared with those at administration, the prevalences of low back pain significantly reduced (P<0.05 or P<0.01), the time of morning stiffness significantly decreased (P<0.05), BASDAI and BASFI significantly improved, and ESR and CRP significantly decreased 3 months after treatment in both groups (P<0.05). After treatment for three months, the clinical parameters in experiment group were more favourable than those in control group (P<0.05). There was no significant difference in the prevalence of adverse effects between two groups (P>0.05). Conclusion Etanercept has favourable short-term therapeutic effects on ankylosing spondylitis with minor adverse effects.

Objective To explore urban middle students' learning strategies, as well as to provide substantial evidences for learning strategies counselling in middle schools. Methods The differences between sexes,among grades and between class types were examined by t test and MANOVA for 466 middle school students. Resukts The participants'total learning strategies level (3.17±0.52) was slightly higher than midpoint "3" of moderate level. Significant score differences of total learning strategies was found between genders((3.11 ±0.54)vs(3.22±0.48), t=2.30, P＜0.05) and among grades ((3.26±0.51)vs(3.09±0.51), t=3.50, P＜0.01). Interaction of grade and class type on learning strategies was significant (F=7.997,P＜0.01). Conclusion Learning strategies level of middle school students exist genders and grades,and grade and cla.ss type have interaction obviously.

After the development of domestic embedded subject service and its domestic and foreign main models were described, following suggestions were put forward: thinking approach teaching contents and multiple elementary assessment system should be designed based on OBE theory with medical postgraduate general practical medical literature novelty assessment course as its starting point, excellent students should be trained as scientific information detectors by improving their information literacy and practical ability through small scale blended teaching, the professional bottleneck of librarians and talent team construction should be solved by cultivating subject service team for different subjects and strengthening the contacts between different subjects.

Objective To study protective effects of acanthoic acid ( AA) against acute liver injury. Methods Sixty mice were randomly divided into six groups (n=10 each),including normal control group,model control group,positive control group (N-acetyl -L- cysteine,NAC,300 mg·kg-1),and AA at small (50 mg·kg-1),middle (100 mg·kg-1),and high (200 mg·kg-1 ) dose groups. Each group received respective treatment for 3 days and fasted for 16 h before the last dose. All animals except of the normal control group were treated with tacrine (35 mg·kg-1 ) 1 h after the treatments. Hepatic pathological and serum biochemical changes were observed. Results The high-dose of AA significantly reduced the levels of AST (143±46) U·L-1 ,ALT (32±9) U·L-1 ,LDH (1 218±312) U·L-1 ,MDA (3. 24±0. 48) μmol·g-1 ,and GSH (417±15) mg·g-1 compared with the model control group (P<0. 05 or P<0. 01). Liver injury was also ameliorated in AA high dose group.Conclusion AA has a protective effect on acute liver injury in mice.

The target of offering medical literature novelty assessment course for medical postgraduates was analyzed with the problems in its teaching and the significance of its teaching reform pointed out.Its teaching contents, teaching methods, examination methods and its assessment system reform were described with suggestions proposed for its successful reform.

Objective To explore the bacterial flora distribution characteristics and drug resistance of pus bacterial culture in a‐cute mastitis and to analyze thechange trend of drug resistance spectrum to provide a evidence‐based basis for the rational use of an‐timicrobial agents in clinic .Methods The pus collected from 207 cases of acute mastitis was conducted the bacterial culture .The bacterial identification and antibacterial susceptibility test were performed by adopting the manual experiment combined with the DL‐96 system .Partial drug susceptibility test was performed by combining with the K‐B method .Results Among 207 specimens , 82 strains of pathogenic bacteria were detected with the detection rate of 39 .6% ,including 51 strains (62 .2% ) of staphylococcus aureus ,7 strains (8 .5% ) of pseudomonas aeruginosa ,4 strains (4 .9% ) of staphylococcus intermedius ,4 strains (4 .9% ) of staphy‐lococcus epidermis ,3 strains (3 .7% ) of acid‐producing klebsiella bacteria and each 1 strain of staphylococcus hemolyticus and other 13 kinds of bacterium .The resistance rates of staphylococcus aureus to azithromycin ,erythromycin and clarithromycin were 92 .2% ,84 .3% and 84 .3% respectively ,indicating that macrolides drugs had a higher overall drug resistance rate and were not suitable for selection and use;the resistance rates of moxifloxacin and ciprofloxacin were 3 .9% and 4 .1% respectively ,the MRSA detection rate was 27 .5% .The resistance rates of Pseudomonas aeruginosa to ticarcillin/clavulanic acid was 85 .7% ;the drug resitance rate of cefoperazone was 83 .3% ;which of gentamycin and amikacin was 71 .4% ;which of aztreonam was 14 .3% ;which of ceftazidime was 28 .6% and which of meropenem was 28 .6% .Conclusion The majority of detected bacteria in pus from the pa‐tients with acute mastitis are Staphylococcus aureus ,followed by pseudomonas aeruginosa ,which is different from that reported by other literatures ,showing the bacterial distribution has regional difference .Staphylococcus aureus has high resistance rate to macrol‐ides antibacterial drugs ,but is highly sensitive to ciprofloxacin and moxifloxacin;Pseudomonas aeruginosa has higher resistant rate to ticarcillin/clavulanic and cefoperazone ,but it is highly sensitive to aztreonam ,ceftazidime and meropenem .Empirical medication should be comprehensively considered by combining with drug resistance spectrum of Staphylococcus aureus and Pseudomonas aeruginosa ,and the sensitive drugs should be selected according to the drug susceptibility results after the antimicrobial susceptibili‐ty test for conducting the targeted medication .

Objective To observe the curative effect of erythrocyte separation in the treatment of patients with polycythemia vera (PV). Methods Sixty- five patients with P- were selected, and the patients were divided into control group (20 cases) and observation group (45 cases) according to the treatment method. All patients of 2 groups were treated with oral hydroxyurea and intramuscular interferon, but the patients of observation group combined with erythrocyte separation. The hemoglobin and hematocrit (HCT) before and after treatment and untoward reaction were compared between 2 groups. Results There were no statistical differences in hemoglobin and HCT before treatment between 2 groups:(196 ± 17) g/L vs. (182 ± 23) g/L and 0.606 ± 0.049 vs. 0.578 ± 0.066, P>0.05. The hemoglobin and HCT levels after treatment in observation group were significantly lower than those in control group:(153 ± 27) g/L vs. (168 ± 14) g/L and 0.490 ± 0.050 vs. 0.539 ± 0.054, and there were statistical differences (P<0.05). There was no obvious untoward reaction in 2 groups. Conclusions Erythrocyte separation is one of first choices for PV. It is safe and effective, and has less obvious untoward reaction.

ObjectiveTo explore relations between self-control and aggressive behavior in college students.Methods 310 students were surveyed with Buss-Perry aggression questionnaire and self-control questionnaire(SCQ).Results①High score group in SCQ was higher with physical aggression,verbal aggression,anger,hostility and aggression scores ( respectively ( 25.86 ± 5.04 ),( 15.27 ± 2.76 ),( 20.12 ± 4.26 ),( 23.87 ±4.45 ),( 85.11 ± 11.75 ) ) than the low group ( respectively (20.26 ± 5.04 ),( 14.04 ± 3.35 ),( 13.76 ± 4.68 ),( 19.37 ±5.31 ),(67.43 ± 13.56) ),the difference was statistically significant (P＜ 0.01 ).②Self-control scores had significant positive correlations with aggressive behavior scores( r=0.60,P＜ 0.01 ).③Self-control dimension (self-emotional,simplistic tendency,impulsive risk-taking) were significant predictors of aggressive behavior(P ＜0.01 ).ConclusionSelf-control is closely related with aggressive behavior,and it is a significant predictor of aggressive behavior.

Objective To survey the biliary flora in patients with obstructive jaundice due to pancreatic head cancer,also the multiple factors which affect the positive findings of bile culture in these patients.Methods The information of 65 patients with obstruetive jaundice due to pancreatic head eancer,who admitted to surgery in Huashan Hospital from Oetober 2007 to October 2008 were reviewed retrospectively.The factors which may potentially affect the detection of bile pathogen in patients with malignant obstructive jaundice were studied with univarite analysis and muhivariate analysis,including age,history of biliary surgery,yellow stained time,serum alanihe aminotransferase level,serum bilirubin level,CA19-9 level,tumor size,site of obstruction,with or without clinical manifestations of biliary infection,and APACHE Ⅱ score.Results Twenty-five positive cultures happened in 65 bile samples (38.5％),including 21 strains of Gram-negative baeilli (72.4％),6 strains of Gram-positive bacteria (20.7％),and 2 strains of fungi (6.9％).Univariate analysis showed that the relevant factors which may affect the rate of positive bile culture in patients with malignant obstructive jaundice were age,history of biliary surgery,biliary obstruction site,biliary tract infection symptoms and APACHE Ⅱ score.Multivariate analysis showed that age,history of biliary surgery,biliary obstruction site and APACHE Ⅱ seore were independent risk factors.Conctusion Age,history of biliary surgery,biliary obstruction site and APACHE Ⅱ score were independent risk factors which led to positive findings of bile cultures in patients with obstructive jaundice due to pancreatic head cancer.