This paper presents a description about training of post-graduate students majoring in rheumatology.The essential knowledge and theory are highly stressed,and the clinical skill,comprehensive ability are also emphasized to encouraging students to bring forth new ideas.Besides cooperation and team spirit are encouraged through group and pair work.

Communication is very important in education.This paper combine common factors in effected educative communication with common problems in communication between teachers and students.From systemic and analyzing point of view,discuss promotion of communicative quality that contains surroundings and methods and so on.

0 05). Positive expression rates of Fas and bcl-2 were 60 0% and 92 9% respectively and Fas increased along with the escalation of the pathological grading (?=0 584,P0 05). Conclusions DNA ploidy aberration,Fas and bcl-2 overexpression could play an important role in the development of esophageal carcinoma .

Objective To explore the distribution of temperament types and its related influencing factors of school-age twins.Method Childhood temperament were evaluated by standardized Middle Childhood Temperament Questionnaire (MCTQ) in a total of 125 pairs of 8 to 12 years old twins,and temperament related factors were measured by FACES Ⅱ-CV.Results The majority of temperament types of school-age twins were easy and intermediate-low.Easy,intermediate-low,difficult,intermediate-high and start-to-warm up took a percent of 41.6％,38.0％,11.2％,6.4％ and 2.8％,respectively.The heritability of temperament types was 0.454.The distribution of temperament types were influenced by the family cohesion,parenting rearing style,zygotic,age,father's occupation,mother's educational level and the method of delivery.Conclusion The temperament types of school-age twins were both influenced by genetic and environmental factors.

ObjectiveIn order to confirm the value of high resolution frequency(HFUS) ultrasonography in the early diagnosis of psoriatic arthritis(PsA).MethodsTwenty-nine patients with psoriatic arthritis reporting sixty-nine finger pain and 30 patients with rheumatoid arthritis reporting seventy finger pain and 20 healthy volunteers underwent X-ray and US evaluation.The ultrasonographic characteristics and blood flows in the joints were checked with high resolution ultrasonography.Bilateraljoints were compared each other in every patient.Comparisons between groups were tested by x2 test.ResultsSonographic positive signs were found in all the involved joints in 29 PsA patients,joint effusion in 42 fingers (61％).Synovial thickening was found in 38 fingers (55％).Bone erosions were found in 28 fingers(41％),tenosynovitis were found in 40 fingers (58％),soft tissue inflammation was revealed in 29 fingers (42％).Enthesitis were foundin 30 fingers (43％).In RA patients,joint effusion was found in 52 fingers (74％) and synovial thickening in 48 fingers (69％).Bone erosions were found in 33 fingers (47％).Tenosynovitis,soft tissue inflammation and enthesitis were not found in RA patients.ConclusionHigh resolution ultrasonography is an easy,safe and effective method for the early diagnosis of pathological changes of small joints in psoriatic arthritis.

Objective To investigate the value of the joint detection of Troponin T(TnT),highsensitivity C-reactive protein (hs-CRP) and N-terminal probrain natriuretic peptide (NT-proBNP) for the clinical diagnosis of acute coronary syndrome(ACS) in elderly patients.Methods The adequate serum samples were collected in each group:unstable angina (UA) (49 cases),non-ST segment elevations myocardial infarction(NSTEMI) (48 cases),acute myocardial infarction(AMI) (37 cases)and healthy control (45 cases).The levels of TnT and NT-proBNP were measured by electrochemiluminescent double antibody sandwich method,and hs CRP by immune transmission turbidity.The roles of individual and joint detection of the three indicators were analyzed by ROC curve and Logistic regression model.Results Except for TnT in UA group,the serum TnT,NT-proBNP and hs-CRP levels were significantly higher in three ACS groups than in healthy control group (P＜0.05).The largest areas under the ROC curve (AUC) of individual TnT,NT-proBNP,hs-CRP testing and the joint detection for UA were 0.583±0.059,0.786±0.047,0.620±0.058 and 0.787±0.046,for NSTEMI were 0.967±0.022,0.978±0.015,0.897±0.032 and 0.991 ±0.009,for AMI were 0.971 ± 0.024,0.961 ± 0.021,0.874 ± 0.043 and 0.999 ± 0.002,therefore,the area under the ROC curve of the joint detection was increased to some degree as compared with individual TnT,NT-proBNP,hs-CRP testing.Similarly,the best sensitivity and specificity of individual TnT,NT-proBNP,hs-CRP testing and the joint detection for UA were 16.7％ and 100.0％,54.2％ and 91.1％,54.2％ and 75.6％,50％ and 95.6％; for NSTEMI were 93.5％ and 100.0％,95.7％ and 97.8％,67.4％ and 97.8％,95.7％ and 100.0％; for AMI were 94.1％ and 100.0％,91.2％ and 97.8％,67.8％ and 97.8％,100.0％ and 97.8％,respectively.Conclusions Joint detection of TnT,NT-proBNP,hs-CRP can significantly improve the diagnosis of UA; for NSTEMI and other AMI,it can be achieved the optimism of sensitivity and specificity,but its effect of distinguishing NSTEMI and AMI is little.

From the perspectives of social equitable exchange theory, contents and features of exchange between medical staff and patients in the doctor-patient relationship as well as their evalua-tion on social equitable exchange theory were analyzed according to basic features of doctor-patient relationship. Suggestions were proposed from government, industry, hospital and medical staff.

Objective To observe the effect of arsenic trioxide on the apoptosis of synovium and IL-l, TNF-? in CIA rat. Methods Seventy-two rats were divided into normal control, model, and As2O3 treatment groups. The experimental models of collagen induced arthritis rats were used as the experimental moldels. The knees′ synovium, cartilage and bone tissue of the rat were taken out, then observed with light microscope and electron microscope and apoptosis were measured by TUNEL after the 15th day of treatment. Meanwhile the level of IL-1 and TNF-? were measured with ELISA kit. Results The pathological injury were improved and the apoptosis of synoviocytes were increased in the As2O3 treatment group, compared with the model group. IL-1 and TNF-? levels were decreased in the arsenic trioxide treatment groups, especially in the Ⅴ and Ⅵ groups (P

Objective To investigate the effects of dexmedetomidine on renal function in patients with hemorrhagic shock undergoing emergency surgery.Methods Sixty patients (27 males, 33 females) with hemorrhagic shock, aged 18-69 years, ASA physical status Ⅲ or Ⅳ, required emergency surgery under general anesthesia, were randomized into two groups (n=30 each): dexmedetomidine group (group D) and control group (group C).The patients in group D receiving a loading dose of dexmedetomidine (0.5 μg/kg within 10 min) after the induction of anesthesia followed by a continuous infusion rate of 0.4 μg·kg-1·h-1 till 30 min before the end of surgery, while those in group C received equal volume of normal saline.Venous blood were obtained immediately before beginning of surgery (T1), immediately after surgery (T2), 24 h after surgery (T3) and 72 h after surgery (T4) for detecting the concentrations of the serum creatinine (Scr) and blood urea nitrogen (BUN), the contents of neutrophil gelatinase-associated lipocalin (NGAL) and high mobility group box-1 (HMGB1).The range ability of the concentration of the serum Scr from T4 to T1 (ΔScr) and the content of the serum HMGB1 from T4 to T1 (ΔHMGB1) were also calculated and recorded.Hemodynamic index (including MAP, HR) and arterial blood gas results were recorded during surgery.Results Compared with T1, MAP, CVP and BE were increased, meanwhile, HR and Lac were decreased at T2, but there was no statistically significant difference between the two groups.No statistical difference was found in BUN at any time point between group D and group C.Compared with T1, Scr decreased in both groups at T2-T4.The ΔScr in group D was higher than that in group C at T4 (P＜0.05).The content of serum NGAL at T4 in group D was significantly dropped when compared with T1 (P＜0.01) and was lower than that in group C (P＜0.05).Compared with T1, the content of serum HMGB1 was significantly decreased in both groups at T2 (P＜0.05);the content of serum HMGB1 at T3 in group C was significantly increased and was higher than that in group D;the ΔHMGB1 in group C was higher than that in group D.Conclusion Hemorrhagic shock could induce acute kidney injury.Perioperative continuous infusion of dexmedetomidine facilitated renal function recovery after ischemia-reperfusion injury in patients with hemorrhagic shock through inhibiting the elevation of serum HMGB1.

ObjectiveThe expression and significance of interleukin(IL)-17 in a murine model of experimental systemic sclerosis(SSc) was studied and its correlation with transforming growth factor-beta 1 (TGF-β1) was explored.Methods Thirty female BALB/c mice were randomly divided into 3 groups,including a control group, bleomycin(BLM) injection for 4 weeks group(model 1 group) and a termination injection of BLM 4 weeks group(model 2 group).The pathological changes of skin and lung were detected.The mRNA expressions of IL-17A,RORγt,TGF-β1 mRNA were evaluated by real-time PCR.Enzyme linked immunosorbent assay was used to measure the levels of IL-17 and TGF-β1 in the serum and bronchoalveolar lavage fluid(BALF).Comparisons among groups were performed by variance analysis.ResultsSkin and lung of the model groups showed evident inflammatory cell infiltration and increased deposition of collagen fibers.The score of dermal inflammation and lung fibrosis was significantly higher in the model 1 and model 2 groups (2.5±0.8,3.0±1.8), (2.4±0.8,3.1±1.2) as compared to that of the control group (0.9±0.7,0.9±1.0),(F=12.19,8.367,25.11,4.641; all P＜0.05).The amount of hydroxyproline was markedly increased in the model groups than in the control group.Compared with those of the control group,the mRNA levels of IL-17A,RORγt,TGF- 31 in the skin and lung of the model 1 group were higher.The levels of IL-17 in serum and BALF of the model 1 group was significantly increased and the levels of TGF- β1 were increased in BALF and decreased in the serum (all P＜0.05).The mRNA levels of IL-17A in skin and lung had a positive correlation with the mRNA levels of TGF- β1,score of dermal inflammation and lung fibrosis.The levels of IL-17 in serum had a positive correlation with hydroxyproline of the skin and lung.ConclusionIL-17 may participate in systemic immune-mediated inflammation and changes of skin and lung in SSc and when combined with TGF-β1 togetter will cause damage to skin and lung in SSc.