Objective To explore the diagnostic value of 18F-FDG PET-CT in lymphoma associated hemophagocytic syndrome (HSP).Methods Retrospective analysis of 30 patients with HPS who underwent 18F-FDG PET-CT detection,and was also compared to pathologically confirmed lymphoma associated HPS to evaluate its diagnostic sensitivity,specificity,positive predictive value and negative predictive value,and to analyze the characteristics of PET-CT imaging in lymphoma associated HPS.Results In the 30 patients,the sensitivity,specificity,positive predictive value and negative predictive value in detecting lymphoma associated HPS by 18F-FDG PET-CT were 85.71％ (12/14),93.75 ％ (15/16),92.31％ (12/13) and 88.24 ％(15/17),respectively.The sensitivities of PET-CT between T-cell and B-cell lymphoma related HPS had no significant difference (P =0.066).In superficial lymph nodes,supraclavicular lymph nodes were the most commonly involved.In deeper tissues and organs,spleen was the most commonly involved site,followed by liver,abdominal retroperitoneal lymph nodes and bone marrow.Conclusion 18F-FDG PET-CT has a high sensitivity and specificity in the detection of lymphoma associated HPS,and may provide valuable information for diagnosis and treatment.

Objective To analyze the clinical characteristics,treatment and prognosis of primary lymphoma of bone (PLB).Methods Retrospective analysis of 9 cases with newly diagnosed PLB was performed.The primary lesion was located in bone and no evidence of lesion was found in other tissues.All the lesions were confirmed by histological examination and immunohistochemical staining.The clinical manifestation and radiological appearance of all cases were non-specific.Results 9 patients were enrolled in the current study including 6 males and 3 females with average age of 34 years old (15-71 years old).All cases had suffered local pain or edema as initial symptom.Single bone infiltration was detected in 7 patients,while multiple bones infiltration was noticed in 2 patients.The lesion distribution was as follows:4 lesions were situated in pelvis (3 in ilium and 1 in sacral),1 in femur,1 in humerus,1 in scapula,and 2 in spine.2 cases were treated with radiotherapy and chemotherapy,3 cases were treated with chemotherapy and hematopoietic stem cell transplantation,1 case was treated with chemotherapy and surgery,and 3 cases received chemotherapy alone.With in a median follow-up of 8 months,6 patients showed overall response (including 5 cases of complete response and 1 case of partial response).Conclusions PLB is a rare condition,and the diagnostic criteria and treatment are still not well defined.Early diagnosis and prompt treatment usually achieves satisfactory prognosis.The possibility of PLB must be concerned for patients with bone pain,soft tissue swelling or unexplained fractures,and pathological examination should be carried on as soon as possible.

BACKGROUND:Patella-patellar tendon junction (PPTJ) injuries are a common disease in athletes and vulnerable to re-injury. Post-injury training is a double-edged sword. OBJECTIVE:To examine the effect of post-injury resting days on the quality of healing in PPTJ in view of histomorphology, expression levels of growth factor and collagen, and muscle tension. METHODS:Forty New Zealand white rabbits were randomly divided into control, and five post-injury training groups representing different time to restart training after acute injury:the rabbits restarted training at 24 (PIT24), 48 (PIT48), 72 (PIT72), 96 (PIT96) and 120 (PIT120) hours, respectively. All post-injury training groups received acupuncture at the PPTJ and then underwent 4-week low-intensity training. Afterwards, all rabbits were killed to take specimens for hematoxylin-eosin, safranin O and immuohistochemical staining. The muscle tension and hardness were detected using Myoton-3. The thickness of fibrous cartilage zones, cell density, as well as the expression levels of vascular endothelial growth factor and collagen were measured on Metamorph software. RESULTS AND CONCLUSION:Compared with the control group, in the PIT groups, the collagens arranged in disorder, and decreased cell density, increased mucopolysaccharide andrising tidephenomenon appeared. The fibrocartilage in the PIT24 and PIT120 groups was significantly thicker than that in the control group (P<0.05). The ratio of collagen type Ⅰ/Ⅲ was significantly decreased in the PIT24 and PIT48 groups compared with the control group (P<0.05), and the highest in the PIT72 group. The expression level of vascular endothelial growth factor in the PIT48, PIT72 and PIT96 groups was significantly higher than that in the control group (P<0.05). The muscle tension was negatively correlated with the collagen ratio (r=-0.538;P<0.01) and chondrocyte density (r=-0.570;P<0.01), while muscle hardness was positively correlated with the expression level of vascular endothelial growth factor (r=0.613;P<0.01). Our results suggest that different resting time makes significant differences in the PPTJ healing and the 72-hour resting is the best choice. Moreover, muscular properties are related to the cel density, collagen synthesis and growth factor expression, which can be used as a non-invasive indicator to guide post-injury training and prevent recurrence.

BACKGROUND: Although overuse-induced patella-patellar tendon junction injury is a common disease, its pathogenesis and healing mechanism remain unclear.OBJECTIVE: To establish an overuse-induced injury animal model by a repetitive traction at the patellar tendon insertion,and to explore its pathogenesis and healing mechanism based on histomorphology and growth factor expression levels.METHODS: Twenty-eight New Zealand rabbits were randomly divided into four groups: the rabbit left and right posterior limbs without any intervention as controls (n=4); cyclic loading training targeting the left posterior limb was done in model,healing and training groups (n=8 per group) for 4 weeks. Afterwards, the rabbits in the model group were killed immediately, rabbits in the healing group relaxed for another 4 weeks and then were killed, while rabbits in the training group were subjected to 4-week low-intensity training. The histological changes and growth factor expression levels during patella-patellar tendon junction injury and healing after load training were observed.RESULTS AND CONCLUSION: Compared with the control group, in the model group, the cells and collagenous fibers arranged in disorder, and the tidemark disappeared. The healing and training groups healed incompletely, but showed better histological changes than the model group. The thickness of fibrocartilage and basic fibroblast growth factor level in the control group were significantly lower than those in the other three groups (P < 0.05). The cell density and vascular endothelial growth factor level in the model group were significantly higher than those in the control and healing groups (P < 0.05). These results show that the animal model of overuse-induced patella-patellar tendon junction injury cannot return to normal after 4 weeks of rest, but the low-intensity training is conductive to healing quality.

Objective To evaluate Chinese nurses' perception of the nursing work environment and to compare the differences among the eight economic regions in mainland China.Thus,policy-makers and nursing managers can optimize and coordinate resources based on the results of this study.Methods Chinese version of Nursing Working Environment Scale was used in the study.A total of 19,000 nurses from 31 provinces and municipalities in mainland China were investigated.Descriptive analysis,cluster analysis and nuclear density estimation were conducted.Results The average score of the nursing work environment was 4.1 points,which means nurses were somewhat satisfied with their work conditions.Specifically,nurses were most dissatisfied with the basic safeguard dimension (3.4 points),followed by sufficient manpower (3.9 points),career development (4.0) and leadership and management(4.0)dimensions.In addition,the eight economic regions could be divided into three categories(P＜0.01)according to the differences of the nursing work environment.The first category included the northeast,northern coastal and middle reaches of the Yellow River economic zone;the second category included eastern coastal economic zone;and the third category included the southern coast,the middle reaches of the Yangtze River,southwest and northwest economic zone.Conclusion The development of the nursing work environment in the vast majority of mainland China is unbalanced and the regional differences are obvious.

Objective To investigate the therapeutic effects of emodin on acute cholestatic hepatitis and mec-hanism thereof. Methods Fifty Sprague - Dawley (SD)rats were randomly divided into 5 groups and were treated with emodin,ursodeoxycholic acid,dexamethasone,or normal saline respectively for 4 days. On the fifth day gastric perfusion of alpha - naphthylisothiocyanate(ANIT)was performed to establish models of choiestatic hepatitis. Four to six hours after the establishment of model the above mentioned agents were given continuously. Forty - eight hours after the model establishment blood samples were collected from abdominal aorta to examine the total bilirubin(TB),direct bilirubin (DB),alanine aminotransferase(ALT),total bile acid(TBA),aspartate aminotransferase(AST),alkaline phosphatase (ALP),gamma glutamine transferase(GGT). Specimen of liver was collected to undergo pathological examination. Real - time PCR was used to detect the mRNA expression of farnesoid X receptor(FXR),small heterodimer partner (SHP ),bile salt export pump (BSEP ),uridine diphosphate glucuronosyltransferase 2 family polypeptide B4 (UGT2B4). Results The serum levels of total bilirubin (TB),direct bilirubin (DB),alanine aminotransferase (ALT),total bile acids (TBA),aspartate aminotransferase (AST),and alkaline phosphatase (ALP)of the model group were respectively (68. 1 ± 26. 1)μmol/ L,(46. 3 ± 20. 1)μmol/ L,(483 ± 228)U/ L,(159. 1 ± 57. 9)μmol/L,(2. 0 ± 0. 5)U/ L,(996 ± 382)U/ L,(324 ± 120)U/ L. The levels of TB,DB,ALT,TBA,AST,ALP of the emodin group were respectively (15. 0 ± 8. 7)μmol/ L,(10. 8 ± 3. 9)μmol/ L,(147 ± 71)U/ L,(60. 1 ± 22. 7)μmol/ L, (295 ± 104)U/ L,(222 ± 59)U/ L,and were all significantly lower than those of the model group (all P < 0. 05). The levels of TB,DB,ALT,TBA,AST,GGT,ALP of the emodin group were all significantly lower than those of the ursode-oxycholic acid group (all P < 0. 05). The levels of TB,DB,ALT,TBA,GGT,AST were all significantly lower than those of the dexamethasone group (all P < 0. 01). The expression levels of FXR,SHP,BSEP,UGT2B4 mRNA in the emodin group (1. 087 ± 0. 285,0. 892 ± 0. 390,0. 902 ± 0. 149,1. 785 ± 0. 403)were all significantly higher than those of the model group (0. 152 ±0. 088,0. 559 ±0. 194,0. 561 ±0. 123,0. 177 ±0. 039,all P <0. 05). Conclusions By decreasing the levels of TB,DB,ALT,TBA,AST,ALP and reducing pathological changes,emodin has a protective effect on cholestatic hepatitis. It has better effects than ursodeoxycholic acid and dexamethasone. These effects may be due to promoting FXR,SHP,BSEP and UGT2B4 expression.

ObjectiveTo evaluate the efficacy and safety of Qingyusan capsules in the long-term treatment of mild to moderate active ulcerative colitis （UC） with the syndrome of large intestine dampness-heat. MethodA randomized， controlled design was adopted， and 88 patients with mild to moderate UC and syndrome of large intestine dampness-heat were randomized into a Qingyusan （Qingyusan capsules， 0.8 g·d^-1） group and a control （mesalazine， 0.4 g·d^-1） group， with 44 patients in each group. Three and one patients dropped out in the control and Qingyusan groups， respectively， during the 32 weeks of treatment. The clinical remission rate， mucosal healing rate， and modified Mayo score， TCM symptom score， and short inflammatory bowel disease questionnaire （SIBDQ） score before and after treatment were compared between the two groups. The colonoscopic and pathological changes were observed， and the clinical safety was compared between the two groups. ResultAfter treatment， the clinical remission rate and mucosal healing rate in the Qingyusan group were 72.1% （31/43） and 74.4% （32/43）， respectively， which were higher than those ［26.8% （11/41） and 41.5% （17/41）， respectively］ in the control group （χ²=17.200， χ²=10.843， respectively， both P<0.01）. The treatment in both groups decreased the modified Mayo score， partial Mayo score， and TCM symptom score （P<0.05）， and the decreases in the Qingyusan group were higher than those in the control group （P<0.01）. After treatment， the SIBDQ scores in both groups increased （P<0.05）， and the increase was more pronounced in the Qingyusan group than in the control group （P<0.01）. There was no difference in the incidence of adverse events between the two groups. ConclusionThe clinical efficacy of Qingyusan capsules is remarkable in the long-term treatment of UC with the syndrome of large intestine dampness-heat. Particularly， Qingyusan capsules demonstrates advantages in inducing and maintaining clinical remission， promoting mucosal healing， alleviating TCM symptoms， and enhancing the survival quality of patients， with high safety.

OBJECTIVETo analyze the clinical manifestations, laboratory data, therapy, and prognosis in patients with hemophagocytic lymphohistiocytosis (HLH).

METHODSA retrospective study was carried out in 192 adult patients with HLH between 2003 and 2013.

RESULTSOf the 192 cases, 70 cases were secondary to cancer and 64 cases secondary to infection. According to HLH-2004 criteria, the coincidence rate of indices were: fever (98.96%), high level of serum ferritin (94.27%), increased level of soluble interleukin- 2 receptor(sCD25) (94.79%), decreased or absent activity of NK cells (94.27%), cytopenias (80.73%), splenomegaly (80.21%), emophagocytosis in bone marrow, spleen or lymph nodes (74.48%), hypofibrinogenemia (50.52%), hypertriglyceridemia (37.50%). In addition, 94.27% of patients were presented with liver dysfunction, 96.35% with infections, and 75.52% with coagulopathy. Incidences of central nervous system symptoms and rash were 19.27% and 20.31%, respectively. Among cancer, infection and rheumatic group, there were statistically differences on white blood cells (WBC), platelet (PLT), sCD25, alanine aminotransferase, aspartate aminotransferase, total bilirubin and globulin(GLO) (P<0.05). The differences of WBC, PLT, albumin (ALB), GLO, brain natriuretic peptide, creatinine, urea nitrogen between survival group and death group had statistical significance.

CONCLUSIONThe secondary HLH occurs from various underlined diseases. Cancer, especially T- cell lymphoma, is the main cause, Secondly, it is EB virus infection. The diagnostic sensitive indicators are Persistent fever, higher level of serum ferritin, low or absent NK-cell activity, and increased sCD25 were the most valuable parameters for diagnosis. Cytopenias were not common in early phase of HLH secondary to rheumatic diseases. WBC, PLT, ALB, GLO could be used as the preliminary parameters for diagnosis. Cardiac insufficiency, renal insufficiency and coagulation dysfunction play important roles in prognosis.

Adult ; Bone Marrow ; Fever ; Humans ; Killer Cells, Natural ; Lymphohistiocytosis, Hemophagocytic ; Prognosis ; Retrospective Studies