Objective To observe the effect of combination therapies with methotrexate, sulfasalazine and hydroxychloroquine on hyperlipemia of rheumatoid arthritis.Method From 2009 November to 2010 November, 68 RA inpatients and outpatients in the department of rheumatism of our hospital were randomly divided into two groups: A group and B group, 34 cases in each group. The patients in A group were given combination of methotrexate, sulfasalazine, hydroxychloroquine sulfate for the treatment of RA,patients in B group, based on A group's treatment, were treated by xuezhikang. Some indexes were observed in two group before treatment and 6 months after treatment, including cholesterolTC,low density lipoprotein cholesterol LDL-C , triglyceride TG , high density lipoprotein cholesterol HDL-C , swelling index, joint pain index, time of morning stiffness, C-reactive protein CRP , erythrocyte sedimentation rate ESR and DAS28. Results After 6 months’ treatment, the serum levels of TC, TG,, LDL-C, both in two groups of patients, were lower than those before treatment, and HDL-C was higher than that before treatment, there were significant differences (P<0.05 or P<0.01) . After 6 months of treatment,DAS28,ESR,CRP,joint tenderness,joint swelling and morning stiffness time, both in two groups RA patients, significantly reduced compared with before treatment, there were a very significant difference (P<0.05 or P<0.01) .After treatment, the above indexes had no statistically significant difference between two groups (P>0.05) . Conclusion RA patients have abnormal blood lipid levels, disease-modifying anti-rheumatic drugs have effect on blood lipid during remission joint disease in RA patients.

Objective To explore the effects of psychological intervention on negative emotions and quality of life in patients with rheumatoid arthritis (RA).Methods A total of 112 patients with rheumatoid arthritis were divided into two groups:the intervention group and the control group.All patients were given drugs for treatment of RA.Additionally,patients in the intervcntion group were received psychological intervention.Zung's self-rating depression scale (SDS),Zung's self-rating anxiety scale (SAS),RA disease activity score (DAS28),visual analog scale (VAS),disability index of health assessment questionnaire (HAQ-DI) were assessed,and the related laboratory parameters such as erythrocyte sedimentation rate (ESR),C reactive protein (CRP),rheumatoid factor (RF)were determined.Results 6 months after the treatment,there were significant differences in SDS and SAS between the treatment group and the control group [SDS:(31.7±4.7)scores vs.(29.6±4.4)scores; SAS:(34.7±5.3)scoresvs.(32.6±5.1)scores; t=2.441,-2.119,both P＜0.05].The patients with tender joints,joint swelling and morning stiffness time were less in the treatment group than in control group [(5±3) vs.(7±4),(4±3) vs.(5±3),(36±16) min vs.(42±19)min.respectively,t=2.054,2.393,1.995,all P＜0.05].The scores of HAQ-DI,VAS and DAS28were lower in the treatment group than in control group [(0.89±0.73) vs.(1.20±0.77),(6.1±1.6) vs.(6.8±1.8),(3.2±1.7) vs.(3.9±1.9),respectively,t=2.136,2.406,2.135,all P＜0.05].There was a significant difference in CRP between the treatment group and the control group [(34±14) mg/L vs.(37± 17)mg/L,t=2.406,P＜0.05].Conclusions Psychological intervention can improve the negative emotions and quality of life in patients with rheumatoid arthritis.

Objective:To understand the current situation about pre-registered medical practitioner's ineligible practice from a legal point of view and provides references forthe Law of Medical Practitioners.Methods:The sur-vey is based on cluster sampling method which centralized the selected large clinical teaching hospitals which have launched the standardized residents training.The research is focused in Beijing and involves three kinds of people in-cluding the pre-registered medical practitioners, clinical teaching teachers and health administrators.The descriptive statistics and the Comparison rates between groups by chi-square test rates were adopted.Meanwhile, the 764 medi-cal malpractice cases from the past three years were analyzed in the Courts of the People of Haidian and the Beijing Chaoyang Districts.Results:The clinical trainees“pre-registration” made illegal situations such as independent vis-its, finding a single worker on duty, independent patient disposal, invasive technology's independent operation, inde-pendently writing the medical records, and the absence of tutors on the supervision sites.All of these mischiefs en-hanced the occurrence of medical disputes.Suggestions: Based on the current situation, it is necessary to establish the legal qualifications for the“pre-registered” trainees engaged in the accredited clinical work legislation, physician qualification examination, and in so many angles.Proposing solutions based on legal issues about “the practitioner guidance” should also be efficient.

Objective To investigate the application and effect of aerobic exercise of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD).Methods Ninety-four hospitalized patients with COPD from June 2011 to June 2012 were enrolled.The clinical curative effect and safety of aerobic exercise of pulmonary rehabilitation in patients with COPD were observed and compared.Results After 3 months treatment,first second forced expiratory volume (FEV1) and forced vital capacity (FVC) were increased compared with those before treatment [(3.25 ± 0.49) L vs.(2.59 ± 0.55) L,(1.95 ± 0.41) L vs.(1.44 ± 0.48) L],and there were significant differences (P ＜ 0.05).There was no significant difference in FEV1/FVC before and after treatment (P ＞ 0.05).After 3 months treatment,arterial partial pressure of oxygen and arterial oxygen saturation were increased compared with those before treatment [(87.61 ± 8.56) mm Hg(1 mm Hg =0.133 kPa) vs.(63.88 ± 8.79) mm Hg,0.9648 ±0.0449 vs.0.7632 ± 0.0477],partial pressure of arterial carbon dioxide was decreased compared with that before treatment [(30.57 ± 9.47) mm Hg vs.(49.23 ± 9.54) mm Hg],and there were significant differences (P ＜ 0.05).There was no signifi.cant difference in blood pressure and heart rate before and after treatment (P＞ 0.05).No obvious adverse reactions were observed.Conclusions The aerobic exercise of pulmonary rehabilitation can improve significantly lung function.It is safe and rehable,and has less adverse reaction in patients with COPD.It is worthy of promotion and use.

Objective To investigate the therapeutic efficacy of combining Kangfuxin solution with compound Bingpengsan on patients with diabetes mellitus complicated with pressure sores. Methods Fifty-two diabetes mellitus patients complicated with pressure sores admitted in Department of Emergency in the PLA 155th Central Hospital were divided into observation group and control group by lot method,26 cases in each group. Observation group was treated by combining Kangfuxin solution with compound Bingpengsan,the control group was given Mepliex application therapy,they all had change of dressing once a day. After treatment for 20 days,the therapeutic efficacy of pressure sore,healing time and frequency of changing dressing were observed. Results The total effective rate in observation group was significantly higher than that of control group〔96.1%(25/26)vs. 80.6%(21/26),P<0.05〕, in the observation group,the pressure sore healing time was significantly shorter than that of the control group(day:Ⅱstage:9.5±1.7 vs. 13.0±2.1,Ⅲstage:13.1±3.1 vs. 18.1±5.1,Ⅳstage:15.3±3.7 vs. 19.6±5.9,all P<0.05)and the number of times of changing dressing was significantly reduced compared with that of control group (times:Ⅱ stage:16.39±1.89 vs. 19.32±2.26,Ⅲ stage:19.56±2.52 vs. 22.36±2.69,Ⅳ stage:23.54±2.86 vs. 26.47±3.96,all P<0.05). Conclusion The Kangfuxin solution combined with compound Bingpengsan for treatment of deep pressure ulcers in patients with diabetes mellitus has significant effect,its cure rate is relatively high,the pressure sore healing time is reduced and the patients' suffering is alleviated.

ObjectiveTo investigate the clinical characteristics of the inpatients suffering from dengue fever in order to provide references for better diagnosis and treatment.Methods The clinical data of 158 dengue fever patients admitted to the First Affiliated Hospital of Sun Yat-Sen University from July 23rd to October 31st, 2014 during the 2014 epidemic in Guangzhou area were retrospectively analyzed, including general clinical manifestations, conventional examinations, pathogenesis, and prognosis.Results The mean age of the 158 patients was (56±20) years, with half of them over 60 years old (79 cases). Among them, 94 (59.49%) were male.① The common manifestations included fever (100%), headache (70.89%), myalgia/bone soreness (62.03%), and skin rash (54.43%). Bleeding and plasma leakage were found in 25.95% and 14.56% of the patients respectively.② Laboratory examination:leucopenia (75.32%) and thrombocytopenia (77.85%) were found, and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were elevated in 57.59% and 77.85% of the patients respectively. However, elevation of blood hematocrit was rare (1.27%).③ It was found that in the acute phase (0 - 5 days of the onset), serum dengue virus antibody IgM (DF-IgM) was positive in 63.54% of the patients (61/96), and 92.62% (113/122) of patients were dengue virus RNA (DENA-RNA) positive.④ The rate of comorbidity in this study was 55.06% (87/158), including hypertension (27.22%) and type 2 diabetes (15.82%), which were the two most common co-morbidities.⑤ All the patients were given supportive therapy to prevent complications. They were also isolated for more than 5 days after onset, and at least for 24 hours after subsidence of fever in addition.⑥ The criteria for the diagnosis of severe dengue were fulfilled in 18 patients (11.39%). One patient died of massive hemorrhage from gastro-intestinal tract, and 1 patient voluntarily left hospital with untreated multiple organ dysfunction syndrome (MODS). Another 2 patients of dengue fever died from primary cardio-cerebrovascular disease, and the remaining 154 patients (97.47%) fully recovered with supportive therapy and complication prevention measures.Conclusions The clinical manifestations of inpatients with dengue fever in this study were typical, and they manifested a higher incidence of severe illness. DENA-RNA could be a sensitive indicator for early pathogenic diagnosis. With symptomatic and supportive therapy, most patients had a good outcome. However, early diagnosis and clinical interventions of severe dengue still need further studies.

Objective To evaluate the diagnostic performance of a point-of-care testing for sensitive cardiac troponin Ⅰ (POCT-cTnI) in early diagnosis of chest pain patients who had a high pretest probability of acute myocardial infarction (AMI).Methods Total of 127 patients with new-onset chest pain at the emergency department were enrolled.Blood samples were drawn for the routine blood test,and determined POCT-cTnI and central laboratory testing for high sensitive cardiac troponin T (CLT-hscTnT) at admission,three and then at six hours after admission.All patients were divided into AMI group and non-AMI group according to the final diagnosis,which was adjudicated independently by two physicians who reviewed all available medical records for the 90-day follow-up period,and they were unaware of the results of the investigational assays of cardiac troponins.The receiver operating characteristic (ROC) curves were constructed to assess and compare the diagnostic performance of AMI of two cardiac troponin assays.The comparison of areas under the ROC curves (AUC) was performed by DeLong test,and the sensitivity,specificity,negative predictive values (NPV) and positive predictive values (PPV) for the target markers were calculated by applying a maker-specific cutoff value.Results The final diagnosis of AMI was made in 40 of 127 patients (31.5 ％).The diagnostic accuracy of the two assays oBtained at presentation,as quantified by AUC,was no statistically differences (AUC for POCT-cTnⅠ,0.901,95％ CI,0.901 to 0.947;and for CLT-hscTnT,0.907,95％ CI,0.842 to 0.951;Z =0.235,P =0.745).The AUC for POCT-cTnI at 3 hours after admission was significantly higher than that on admission (0.931 vs.0.858;Z =-2.038,P =0.042),while there was on further improvement at 6 hours after admission (0.931 vs.0.949;Z =-1.435,P =0.151).With use of POCT-cTnI (cutoff value 0.023 ng/mL,which was the 99th percentile upper reference limit) on adimission,the clinical sensitivity was 77.5％,and the specificity was 94.2％.A single sample of POCT-cTnI at 3 hours after admission improved the diagnostic accuracy,with a sensitivity of 96.4％,a specificity of 92.0％,and a NPV of 98.6％,a PPV of 81.8％.While,with use of CLT-hscTnT (cutoff value 0.014 ng/mL,was the 99th percentile upper reference limit) at 3 hours after admission,the NPV reached to 100％.Conclusions The use of a POCT-cTnI assay in chest pain patients can identify and exclude the AMI rapidly and exactly at three hours after admission,and the diagnostic performance is equivalent to CLT-hscTnT.

Objective To preliminarily evaluate the effect of glycyrrhetinic acid on the proliferation and apoptosis of keratinocytes in patients with psoriasis,and to explore its possible mechanisms.Methods Keratinocytes were isolated from patients with psoriasis,and subjected to a primary culture in vitro.After 2-3 passages,the keratinocytes were divided into several groups to be treated with glycyrrhetinic acid at final concentrations of 0 (control group),1,2,4,8 and 10 mg/L (glycyrrhetinic acid groups),respectively.After 24-72 hours of treatment,MTS assay was performed to evaluate the effect of glycyrrhetinic acid on the proliferation of keratinocytes,and flow cytometry was conducted to detect the apoptosis of keratinocytes after 24-hour treatment with glycyrrhetinic acid at different concentrations.Real-time fluorescence-based PCR was performed to determine the expression of miR-21 in keratinocytes.Results After 24-72 hours of treatment with 1-10 mg/L glycyrrhetinic acid,the proliferation activity of keratinocytes significantly decreased along with the increase in the treatment duration and concentrations of glycyrrhizinic acid.After 24-hour treatment with 1,2,4,8,10 mg/L glycyrrhetinic acid,the apoptosis rates of keratinocytes increased to (9.64 ± 0.86)％,(25.24 ± 2.93)％,(27.68 ± 3.70)％,(35.55 ± 4.23)％ and (38.89 ± 2.31)％ respectively.As LSD-t test showed,the apoptosis rates of keratinocytes were significantly higher in all the glycyrrhetinic acid groups than in the control group (10.09％ ± 0.69％,all P ＜ 0.01),except the 1 mg/L glycyrrhetinic acid group.After 24-hour treatment with 1,2 and 4 mg/L glycyrrhetinic acid,the miR-21 expression (2-△△Ct) significantly decreased (0.24 ± 0.04,0.22 ± 0.07,0.17 ± 0.05,respectively) compared with the control group (0.92 ± 0.12,F =213.10,P ＜ 0.05).After 18-,24-and 48-hour treatment with 2 mg/L glycyrrhetinic acid,the miR-21 expression significantly decreased (0.55 ± 0.02,0.22 ± 0.06 and 0.15 ± 0.06 respectively) compared with the control group (0.98 ± 0.02,F =238.10,P ＜ 0.05).Conclusion Glycyrrhetinic acid can inhibit the proliferation of keratinocytes from psoriatic patients,but promote the apoptosis,likely by down-regulation of miR-21 expression.

Objective:To investigate the effect of hematopoietic stem cell transplantationon(HSCT)survival outcomes in older patients with myeloid neoplasms.Methods:We retrospectively analyzed the treatment outcomes of 54 patients aged≥55 years with myeloid neoplasms who underwent HSCT between January 2018 and May 2023 at Zhujiang Hospital of Southern Medical University.Results:Among the 54 pa-tients,45 had acute myeloid leukemia(AML)and 9 had myelodysplastic syndrome.The median age of the patients was 57.5(55-68)years.Fifty-three patients underwent hematopoietic reconstitution,with a median time to neutrophil reconstitution of 13(8-24)days and median time to platelet reconstitution of 15(9-75)days.The cumulative incidence was 23.3%for acute graft-versus-host disease(GVHD)and 24.6%for 3-year chronic GVHD.With a median follow-up of 28.2 months,the 3-year cumulative relapse rate(CIR)was 18%and 3-year non-relapse mortality rate was 28.3%.The 3-year relapse-free survival(RFS)rate was 58.2%and 3-year overall survival(OS)rate was 56.5%.Conclu-sions:HSCT is an effective and safe therapy for achieving long-term survival in older patients with myeloid tumors.

Objective:To explore the impact of sleep duration, physical exercise, and their interactions on the risk of dyslipidemia in older adults aged ≥80 (the oldest old) in China.Methods:The study subjects were the oldest old from four rounds of Healthy Aging and Biomarkers Cohort Study (2008-2009, 2011-2012, 2014 and 2017-2018). The information about their demographic characteristics, lifestyles, physical examination results and others were collected, and fasting venous blood samples were collected from them for blood lipid testing. Competing risk model was used to analyze the causal associations of sleep duration and physical exercise with the risk for dyslipidemia. Restricted cubic spline (RCS) function was used to explore the dose-response relationship between sleep duration and the risk for dyslipidemia. Additive and multiplicative interaction model were used to explore the interaction of sleep duration and physical exercise on the risk for dyslipidemia.Results:The average age of 1 809 subjects was (93.1±7.7) years, 65.1% of them were women. The average sleep duration of the subjects was (8.0±2.5) hours/day, 28.1% of them had sleep duration for less than 7 hours/day, and 27.2% had sleep for duration more than 9 hours/day at baseline survey. During the 9-year cumulative follow-up of 6 150.6 person years (follow-up of average 3.4 years for one person), there were 304 new cases of dyslipidemia, with an incidence density of 4 942.6/100 000 person years. The results of competitive risk model analysis showed that compared with those who slept for 7-9 hours/day, the risk for dyslipidemia in oldest old with sleep duration >9 hours/day increased by 22% ( HR=1.22, 95% CI: 1.07-1.39). Compared with the oldest old having no physical exercise, the risk for dyslipidemia in the oldest old having physical exercise decreased by 33% ( HR=0.67, 95% CI: 0.57-0.78). The RCS function showed a linear positive dose-response relationship between sleep duration and the risk for hyperlipidemia. The interaction analysis showed that physical exercise and sleep duration had an antagonistic effect on the risk for hyperlipidemia. Conclusion:Physical exercise could reduce the adverse effects of prolonged sleep on blood lipids in the oldest old.