Objective To detect the serum level of tartrate-resistant acid phosphatase 5b (TRACP5b) in patients with rheumatoid arthritis (RA) before and after infliximab treatment and analyze the relevance between TRACP-5b and activity indexes of RA.The effect of different medicines on bony erosion in RA and its possible mechanism were explored.Methods Patients were divided into two groups:16 patients were treated with inffiximab for 24 weeks (group 1 ),25 patients were treated with MTX for 24 weeks (group 2).The core indicators of RA activity were evaluated.Ranked test,grouped design and matched t test was used to examine the quantity data between groups,while numerate data was analyzed with qui-square test.Correlation between data was tested by Spearmen's and Pearson's tests.RestltsThe levels of TRACP-5b in patients with X-ray stagesⅠ ,Ⅱ ,Ⅲ ,Ⅳ were elevated at the baseline.The levels of TRACP-5b in phase Ⅲ and Ⅳ were [(3.34±1.07) U/L] and[(4.05±0.25) U/L] respectively,higher (P＜0.05) than those in phase Ⅰ[(1.69±0.48) U/L].At week 0,week 12,and week 24,the serum levels of TRACP-5b in group 1 were(3.07±1.32),(2.72±1.18),(2.16±1.09) U/L respectively,while the levels in week 12,and 24 were significantly lower than those of week 0(P＜0.05).A significant decrease of serum TRACP-5b level in group 1[(2.16±1.09 ) U/L]when compared to group two[ (3.05±0.93) U/L] after 24 weeks.TRACP=5b level was positively correlated with the course of disease (r=0.313,P=0.043 ),HAQ(r=0.443,P=0.007).Conclusion Infliximab can reduce TRACP-5b level in RA and inhibit inflammatory bone loss.TRACP-5b can be used to evaluate the efficacy of biological agents in treating RA.

AIM:To study the expression of matrix metalloproteinase-9(MMP-9),matrix metalloproteinase-2(MMP-2) and the tissue inhibitor of metalloproteinase(TIMP-1) in the lung tissue of the hypercapnia rat.METHODS:Forty Wistar rats were randomly divided into a control group (group A,n=20) and hypercapnia group (group B,n=20). Group B received mix gas exposure (6% CO_2,21% O_2,72% N_2) 7 h daily for 4 weeks. The parameters we would examine were as follow:arterial blood gas;the mean pulmonary artery pressure;MMP-2,MMP-9,TIMP-1,and NE activity in lung tissue. Masson pigmentation of elasticity fibre was analyzed by computer image analyzer. Histopathological changes of lung tissue were observed under light microscope. The protein expression of MMP (MMP-2,MMP-9) and TIMP (TIMP-1) in lung tissue were determined by immunocytochemistry.RESULTS:Decompensate respiratory acidosis (pH=7.20±0.04,PaCO_2=7.84±0.15) developed in group B. The mean pulmonary artery pressure were similar between groups B and A (P>0.05). Tissue edema in the lung,endothelial cell damage of the small blood vessels,pulmonary micro thrombus formations and increased pulmonary capillary permeability were observed in group B. NE activity increased significantly (P<0.01). However,no significant change of MMP-2,MMP-9,TIMP-1 activity was found in group B and group A (P>0.05). There was significant decrease in the relative content of elasticity fibre in lung tissue in group B compared to group A (P<0.01). The expression of MMP-2 protein in the lung tissue of group B was lower than that in group A (P<0.01),but the expression of both MMP-9 and TIMP-1 proteins in the lung tissue in group B were higher than those in group A (P<0.01).CONCLUSION:Hypercapnia rat model is successfully reproduced by exposure of animals to the mix gas exposure (6% CO_2,21% O_2,and 72% N_2). The pulmonary artery pressure is not affected by hypercapnia. High concentration of CO_2 causes increase of NE activity and decrease in the relative content of elasticity fibre. High concentration of CO_2 causes the increase of MMP-2 protein expression and decrease in the MMP-9 and TIMP-1 protein expression.

ObjectiveTo establish an analytical method with high sensitivity and wide range in biotin-avidin and time-resolved fluoroimmunoassay system for the quantitative detection of antinuclear antibody (ANA)-Ig (GAM).MethodsANA in standard preparation or sample was combined with solid nuclear antigen,biotinylation antibody and the europium(Eu3+)-labelled avidin to form the compounds of solid nuclear antigen-antibody-biotinylation antibody-SA-Eu3+.The fluorescence enhancement fluid was added to dis-sociate the Eu3+,the content of ANA was directly proportional to fluorescence intensity,the BAS-TRFLA was established for the quantitative detection of ANA-Ig (GAM).The sensitivity,specificity,reliability and range of detection were evaluated.Semm of 50 blood donor,105 patients with systemic lupus erythematosus (SLE),109 patients with rheumatoid arthritis(RA),25 patients with PBC,29 patients with Sj(o)gren's syndrome (SS),23 patients with scleroderma,25 patients with MCTD were included in this study.The positive rate was calculated.ResultsThe inner-group difference between high,medium and low densities mixture serum was 3.13％,3.74％ and 5.76％ and the inter-group precision rate was 5.31％,6.25％ and 7.46％ in BAS-TRFLA.The sensitivity of TRFIA was better than that of the ELISA method.The low detection limit was 2.24 U/ml.The mean recovery rate was 100.74％.The results measured by the TRFIA and ELISA methods were closely correlated(R2=0.978).The positive rate of blood donor,and patient with SLE,RA,PBC,SS,scleroderma and MCTD were 0,100％,23％,96％,38％,91％,92％ respectively.When compared with ELISA,the detection range of TRFIA was wider,and stability was better.ConclusionBAS-TRFIA is a stable method for detection of ANA with high sensitive and wide range of detection.It is important for the early diagnosis of autoimmune disease and monitoring the treatment efficacy of autoimmune disease.And this method may be widely used in clinical laboratories in the future.

Objective To explore the effect of the Internet technology′s application on the hand hygiene compliance of medical staff. Methods Establishing Internet+hand hygiene management model to implement Internet based hand hygiene supervisory and reminding, Internet based hand hygiene publicity and education, and Internet based hand hygiene feedback and communication. This model was applied in Guangdong Provincial Dermatology Hospital to intervene the hand hygiene related activities. Before and after the intervention, the hand hygiene compliance of medical staff in the trial hospital was observed with WHO hand hygiene monitoring table by directly manual observation. Thereafter, the changes of hand hygiene compliance before and after the intervention were compared based on the statistical analysis of test results. Results With the application of Internet+hand hygiene management model, the hand hygiene compliance of medical staff increased from 41.75% (324/776) before the intervention to 72.14% (554/768) after the intervention, and the difference was statistically significant (χ2=145.264, P<0.01). The hand hygiene compliance of both doctors and nurses was significantly increased (doctors: χ2=94.784, P<0.01;nurses:χ2=58.798, P<0.01). In all the five indications, i.e., before patient care, before an aseptic task, after exposure to blood/body fluids, after patient care, and after environmental contact, the hand hygiene compliance was 35.42%(68/192), 63.33%(38/60), 84.38%(54/64), 44.83%(130/290), and 20.00%(34/170) respectively before the intervention;it was 65.38%(102/156), 83.33%(120/144), 95.45%(105/110), 68.52%(148/216), and 55.63%(79/142) after the intervention; and the difference before and after the intervention was statistically significant (χ2=6.305-42.529;P<0.01 or 0.05). Most of the medical staff of the trial department supported this model. Conclusions Internet+ hand hygiene management model could significantly improve the hand hygiene compliance of medical staff and were very popular. And, the model is worth of application in more hospitals.

Objective To follow up the rehabilitation, education, and assistive devices utilization of school age children with cerebral palsy. Methods From 2012 to 2015, 80 children with cerebral palsy were called their parents with telephone and filled in the questionnaires. Results 69 children (85.25%) continued to receive rehabilitation, 11 children (13.75%) stopped rehabilitation. 42 children (56.25%) received education in ordinary schools, 15 children (18.75%) received education in special schools, 4 children (5.00%) were nursed in nursing institu-tion, 16 children (20.00%) stayed at home and did not receive any education. The main problem and needing at present were receiving reha-bilitation, receiving school education, relief the rehabilitation cost of more than one institution, etc. 61 children (76.25%) ever applied for as-sistive devices, 19 children (23.75%) did not. The feedback of application process in order were smoothly;applied, but didn't get;the assis-tive devices that received was inappropriate. 29 children (73.75%) needed assistive devices currently, 21 children (26.25%) did not. When asked the category of needed assistive devices at present, 19 parents (20%) answered that they did not know the category of assistive devices well or they did not know which kind of assistive devices they needed. Conclusion It is important to provide quality and quantity rehabilita-tion and education service, popularize the knowledge of assistive devices and their clinical application for cerebral palsy children. Assistive devices providing departments should do more communication with cerebral palsy children and their parents, in order to reduce the waste of resources, and increase the rational use of resources, and provide more benefits for children with disabilities.

Objective To develop a method for detecting anti-cyclic citrullinated peptide (anti-CCP)in the serum of rheumatoid arthritis patients. Methods The range of lineage correlation, precision and detection range of time-resolved fluoroimmunoassay (TRFIA) was analyzed. Thirty-two positive serum of antiCCP, and the sera from 50 health blood donors, 32 SLE patients, 26 patients with SS, 10 patients with scleroderma, 20 patients with MCTD and 18 patients with MS were tested in this study. The clinical specificity was assessed. The consistency between TRFIA and ELISA was analyzed by Mc Nemar test. Results Analyzed by SPSS 13.0 statistical software, the intra-batch precision (n=20) rate was 2%, 3% and 4% respectively, and the inter-batch precision (n=8) was 3%, 4% and 7% respectively for 3 different concentrations. The clinical specificity was 98%, 97%, 96%, 100%, 95% and 100% in the sera of healthy blood donors, SL,E, SS,scleroderma, MCTD and MS patients respectively. The correlation coefficient was 0.989.The average recovery rate was 101%, and the sensitivity was 1 U/ml. When compared with ELISA, the detection range of TRFIA was wider and also with betterstability. Conclusion TRFIA is a stable method with high sensitivity and wide detection range. It can be used to detect anti-CCP antibody. It is important for early diagnosis of RA and monitor the curative effect of RA. And this method has potential to be used in clinical diagnosis.

Objective To investigate the correlation between developmental function and pathological behavior in children with autism. Methods A total of 154 children with autism were tested with Revised Chinese Version Psycho-Educational Profile (C-PEP) during 2011 to 2014. Results The scores of fine movement, hand-eye coordination, and oral language of developmental function were lower in the girls than in the boys (t>2.120, P<0.05). Among the children with autism aged 2-7 years, the developmental function was better in the older group than in the younger group (P<0.05);however, it was not better in the children aged 8-10 years and>10 years than in those aged 6-7 years. There was no difference in the scores of pathological behavior between the girls and the boys (P>0.05). Some pathological behaviors were milder in the older group than in the younger group (P<0.05). The scores ofP(pass) in developmental function were positively correlated with the scores ofA(absence) in pathological behavior (P<0.01), and negatively correlated with the scores ofS(severe) in pathological behavior (P<0.01). The scores ofF(fail) in developmental function were negatively correlated with the scores ofA(absence) in patho-logical behavior (P<0.01), and positively correlated with the scores ofS(severe) in pathological behavior (P<0.01). Conclusion Develop-mental function of children with autism is highly correlated with pathological behavior, and the rehabilitation and education of children with autism aged above 7 years should be concerned.

Objective To explore the economic performance after the performance‐based reform at primary medical institutions in Zhejiang Province and put forward measures for improving primary medical services .Methods Questionnaire investigation was conducted among 84 primary medical institutions with staff over 20 .The financial statements of these institutions during 2009‐2014 were collected and studied as well .Results The average outpatients and emergency patients in 2014 increased 113.3% than that in 2009 .The total usage times of laboratory tests and other auxiliary examinations also increased(55.7% and 103.1% ,respectively ) ,yet with a decrease of inpatients.Moreover ,the proportion of income from traditional Chinese medicine (TCM )in gross income increased from 9.39% in 2009 to 17.14% in 2014 .The cost‐profit ratio of TCM drugs at half of such institutions exceeded 120% . Conclusions The performance‐based reform has motivated medical staffs of primary medical institutions and effectively vitalized such institutions.Rules and regulations of these institutions require further improvement .

Objective To investigate the effect of vocational rehabilitation and related factors in adult mental retarded persons in Beijing.Methods 152 mental retarded adult persons were investigated with Scale of Vocational Rehabilitation Effective for Adult with Mental Retarda⁃ tion. Results 59 (38.82%) persons improved their vocational ability after rehabilitation. The related factors of vocational rehabilitation included the causes of mental retardation and maladaptive behavior. Conclusion It is important for the vacational rehabilitation that the consultants deal with the maladaptive behavior appropriately.

Objective To investigate the needs of rehabilitations in persons with mental retardation in Beijing.Methods 738 persons with mental retardation surveyed in the Second China National Sample Survey on Disability were involved,their rehabilitation condition and requisition were evaluated.Results 63.69% of them needed rehabilitation in community and family,73.31% needed rehabilitation training,their needs on medical service were met,needs on rehabilitation training were above provided service,needs on assistance articles and utensils were low,and needs on employment were high.Conclusion The case management system for persons with mental retardation should be built to meet their rehabilitation requisitions on different age and grade with various approaches.