Objective To investigate the clinical significance of ANCA in the disease activity of patients with SLE.Methods A total of 1 025 SLE patients were recruited and were divided into inactive and active groups according to SLEDAI score.Demographic characteristics,clinical symptoms,autoantibodies,routine laboratory tests and renal pathology were also recorded and compared between the two groups.Results All patients were divided into inactive group(n = 750)and active group(n = 250).The occurrence of renal,pulmonary,cutaneous,arthritis manifestations were significantly higher than those of the inactive group(all P<0.05).All patients were tested for ANCA,and the most common pattern being perinuclear or p-ANCA,the percentage of p-ANCA seroposi-tive increased greatly with the increased disease activity(P<0.05).The autoantibodies were further analyzed between the two groups,25 patients had reactivity to MPO,but no patient had reactivity to PR3.Also,there were significant differences in anti-dsDNA antibody,anti-nucleosome antibody between the two groups(P<0.05).In the active group,patients with p-ANCA seropositive exhibited higher serum beta-2-microglobulin(β2-MG),titers of anti-dsDNA antibody,SLEDAI scores,lower albumin,C3,and C4 levels(P<0.05).Meanwhile,p-ANCA was associated with IL-6,which increased significantly with the increase of SLEDAI score.In addition,patients with p-ANCA seropositive had more occurrence of lupus nephritis,but it had no association with the renal pathology.Conclusion The appearance of p-ANCA in SLE patients indicated more severe disease activity status.

Objective: To setup a custom-made gait simulator, and to provide an efficient tool for biomechanics research of ankle and foot. Methods: From November 2017 to April 2018, a total of 6 fresh frozen specimens of the foot and ankle were collected. The donated specimens, free of diseases in the foot and ankle part, were from the Department of Anatomy, Shanghai Medical College of Fudan University. Donors were 3 males and 3 females, aged from 48 to 69 years old, with an average age of 58.8 years old. The nine tendons in the foot were divided into 4 bundles, including anterior group comprised of tibialis anterior (TA), extensor hallucis longus (EHL) and extensor digitorum longus (EDL). Posterior group comprised of Achilles's tendon (AT). Medial group comprised of tibialis posterior (TP), flexor hallucis longus (FHL), and flexor digitorum longus (FDL). Lateral group comprised of peroneus brevis (PB) and peroneus longus (PL). A custom-made gait simulator was set up by using four independent electro motors to actuate 4 bands of tendons in the foot and another six motors to control tibia to achieve 6 degree-freedom parallel mechanism. And a hydraulic machine was used to provide axial pressure along tibia. Gait cycle of six fresh frozen cadaver feet was reproduced using this machine, and the kinematics data of ankle movement and ground reaction force (GRF) data was collected. By comparing the data above with the normal human gait data, the simulation results were analyzed to explore the clinical usage of this machine. Results: On the sagittal plane, the ankle appeared to plantarflexion at the beginning of gait, and then turned to dorsiflexion after the max plantar flexion (about 10°) at 18% of gait cycle. At the 40% gait cycle, ankle joint was in neutral position and reached its max dorsiflexion (about 22°) at 83% gait cycle. On the coronal plane, ankle joint appeared inversion at the beginning and eversion afterwards with 10° range of change. On the horizontal plane, movement of ankle joint was small. Results showed that the first peak of vertical ground reaction force can reach to 1.1-1.3 times of bodyweight at 25% of gait cycle and the second peak appeared little lower at 70% of gait cycle. The GRF in posterior direction reached its peak at 30%, and then turned to anterior with its peak at 83% gait cycle. The GRF had small variation at the internal to external direction.All of the coefficients of multiple correlations (CMC) of GRF and ankle joint movements were close to or greater than 0.90. Conclusion This custom-made gait simulator has good gait simulation ability with high intra repeatability in respect of ankle rotation and ground reaction force, and can satisfy the request for ankle and foot biomechanics research.

Objective: To explore the mid-term efficacy of derotation of talus and medial column fusion for stage II-V Müller-Weiss disease (MWD). Methods: Data of thirty-six patients (38 feet) with MWD treated by derotation of talus and talona-vicular (TN) or talonavicular-cuneiform (TNC) arthrodesis in our center during January 2008 to December 2016 were retrospective-ly analyzed. There were 3 males (3 feet) and 33 females (35 feet) with an average age of 54.0±9.2 years old (range, 32-80 years old); there were 11 right feet and 27 left feet. According to Maceira and Rochera staging system, there were 9 stage II cases, 11 stage III cases, 10 stage IV cases and 8 stage V cases. The external rotation of talus was intensively focused. After the TN articular surface was debrided, an "H" shape plate and a hollow lag screw were used to firmly fix the TN or TNC joint. American Orthopae-dic Foot and Ankle Society Scale (AOFAS), visual analog scale (VAS) and relative radiological parameters were evaluated preoper-atively and during follow-up. Results: The mean follow-up duration was 37.2 months (range, 25-113 months). The latest follow-up showed satisfactory outcomes. Overall, AOFAS score was improved from 41.3±11.3 points (range, 20-56 points) preoperatively to 85.5±7.1 points (range, 68-100 points) postoperatively (Z=5.16, P< 0.001), and the VAS score was reduced from 5.6±1.5 points (range, 3-8 points) preoperatively to 0.8±1.2 points (range, 0-4 points) postoperatively (Z=5.19, P< 0.001). These differences of functional score and pain evaluation were statistically significant. The Tomeno-Méary angle decreased from-6.6°±12.2° to 0.5°±2.9° (Z=3.43, P=0.001); the calcaneal pitch angle increased from 13.5°±3.9° to 22.1°±3.4°(t=10.12, P< 0.001), and the talarnavic-ular coverage angle decreased from 27.1°±5.9° to 7.6°±3.3°(Z=5.16, P< 0.001). The AP talar-first metatarsal angle decreased from-16.0°±10.7° to-7.0°±8.5°(t=5.49, P< 0.001). The differences of radiological parameters were statistically significant. Conclusion The mid-term results showed that the TN or TNC joint fusion could achieve a favorable clinical and radiological outcome for MWD patients. Even for the patients with severe deformities (stage II-V), such treatment strategy could also achieve satisfacto-ry deformity correction and functional improvement. Intraoperative restoration of talus rotation is the key to normal alignment of the subtalar joint/TN joint.

Neurogenic bowel dysfunction (NBD) manifested as constipation and fecal incontinence often occurs after spinal cord injury (SCI).NBD affects patients' quality of life and is an urgent clinical problem to be solved.The mechanism of NBD is related to central and autonomic nervous system dysfunction,intestinal nervous system dysfunction,changes in intestinal microorganism composition and abnormal content of neurotransmitters.The evaluation method of NBD is mainly based on scoring and imaging,which lacks unified criteria,and the treatment method for NBD is the combination of traditional Chinese and Western medicine.The author summarizes the mechanism,evaluation method,treatment and nursing of NBD in order to provide new insight into these aspects to improve clinical efficacy.

Surgery management is key to surgical quality control. The authors presented the IT system design for surgery anesthesia of the children′s hospital of Fudan University, featuring all-process information support by means of IT development and process reengineering. Such a process comprises perioperative patient handover, medication, surgical safety check, and intraoperative care. This surgery anesthesia system development has interconnected hospital information systems within and beyond operation rooms in terms of informationization. It proves that the system can effectively enhance safety and convenience of surgery related works and supervision, reducing error exposure of surgical operations and ensuring patient safety.

Objective To investigate the colonization of Gram-negative bacilli carrying mcr-1 gene in intestinal tracts of inpatients and people having physical examination for further elucidating the molecular and epidemiological features of mcr-1 gene. Methods A total of 1263 and 750 fecal specimens were col-lected from inpatients in the First Affiliated Hospital of Guangzhou Medical University and people having physical examination in the Kingmed Physical Examination Centre, respectively. Drug-resistant bacteria were isolated using Maconkey agar supplemented with colistin. PCR was performed to detect the bacteria carrying mcr-1 gene. Multilocus sequence typing ( MLST) and enterobacterial repetitive intergenic consensus-PCR ( ERIC-PCR) were used for homology analysis. The transferability of mcr-1 gene was verified by plasmid transfer assays. Plasmids of mcr-1-carrying strains were typed by PCR-based replicon typing techniques. Twelve virulence-related genes were also detected by PCR. Results Ninety-two colistin-resistant strains were isolated from the 1263 samples from inpatients(7. 3％, 92/1263) and two of them were positive for mcr-1 gene ( one strain also carried the blaNDM-5 gene) . Thirty-six colistin-resistant strains were isolated from the 750 samples of physical examination group (4. 8％, 36/750) and one of them carried the mcr-1 gene. MLST analysis showed that three mcr-1-carrying Escherichia coli strains ( minimum inhibitory concentration of colistin:8 μg/ml) belonged to three different sequence types. Moreover, they exhibited different banding patterns in ERIC-PCR analysis. All of the mcr-1-carrying isolates could transfer mcr-1 gene to the recipient strains successfully. Six types of incompatibility plasmids were detected in the mcr-1-carrying isolates ( IncFⅡ, IncX2, IncHI2, IncFIB, IncX4 and IncX1). Virulence-related genes fimH, iutA and fyuA were detec-ted in all mcr-1-carrying Escherichia coli strains. Conclusions Colistin-resistant strains and mcr-1 gene are prevalent in inpatients and people having physical examination, which brings potential risk for the control of clinical infections.

OBJECTIVETo evaluate the differences in the clinical therapeutic effects on spasmodic hemiplegia after stroke among the alliance therapy of scalp acupuncture, music therapy combined with rehabilitation, the simple rehabilitation therapy and the combination of music therapy and rehabilitation.

METHODSA total of 76 patients of post-stroke spasmodic hemiplegia were randomized into a rehabilitation group (25 cases), a combination group with music therapy and rehabilitation (25 cases) and an alliance therapy group with scalp acupuncture, music therapy and rehabilitation (26 cases). In the rehabilitation group, the routine rehabilitation therapy was applied, including the removal of various incentives that cause spasm, the correction of body position and the physical therapy. In the combination group, the music therapy was added on the basis of the treatment as the rehabilitation group. The music physician used the rhythmic auditory stimulation, the patterned sensory enhancement and the therapeutic instrumental music playing to set up the task in the treatment. In the alliance therapy group, scalp acupuncture was added on the basis of the treatment as the combination group. The anterior oblique line of vertex-tempora (MS 6) and the posterior oblique line of vertex-tempora (MS 7) on the contralateral side were selected and stimulated with penetrating needling technique. The needles were retained. During the needling retaining, the needles were rotated once every 10 min, for 2 min each time. The treatment was given one session a day, totally for 5 sessions a week, continuously for 4 weeks. The Fugl-Meyer assessment (FMA), Barthel index (BI) and the modified Ashworth scale (MAS) of the affected elbow and the passive knee movement at static condition were observed in the patients before and after treatment.

RESULTSThe results of FMA, BI and MAS were not different before treatment in the patients among the three groups (all>0.05), indicating the comparability among groups. After treatment, FMA and BI scores were all increased apparently in the three groups as compared with those before treatment (all<0.05). MAS grade was reduced remarkably as compared with that before treatment (all<0.05). After treatment, FMA and BI scores in the alliance therapy group were higher than those in the combination group and the rehabilitation group (all<0.05). FMA and BI scores in the combination group were higher than those in the rehabilitation group (both<0.05). MAS grade in the alliance therapy group was lower than those in the combination group and the rehabilitation group (both<0.05). MAS grade in the combination group was lower than that in the rehabilitation group (<0.05).

CONCLUSIONThe alliance therapy with scalp acupuncture, music therapy and rehabilitation achieve the remarkable clinical therapeutic effects on post-stroke spasmodic hemiplegia as compared with the routine rehabilitation and the combination of music therapy and rehabilitation.

Objective To observe the macular morphology and circumpapillary retinal nerve fiber layer thickness (RNFL) in Parkinson's disease (PD) evaluated by spectral-domain optical coherence tomography (SD-OCT). Methods A total of 37 patients (74 eyes) with PD were in the PD group, 32 age-and sex-matched healthy subjects (64 eyes) in the control group. All subjects underwent SD-OCT examination with 5 line scanning, macular cube 512×128 scanning and optic disc volume 200×200 scanning. The retinal thickness, central foveal thickness (CFT), macular volume and thickness of circumpapillary, superior, inferior, nasal, and temporal of RNFL between two groups were comparatively analyzed. The relationship between SD-OCT parameters and age, disease duration, scores of Hoehn-Yahr and unified PD rating scale (UPDRS) in PD patients was analyzed by Pearson correlation analysis. Results Both of the retinal thickness and macular volume in PD group were significantly reduced than those in control group (t=?2.546,?3.410;P=0.012, 0.001). There was no difference of CFT (t=?0.463, P=0.644) and the thickness of circumpapillary (t=?1.645, P=0.102), superior (t=?0.775, P=0.439), inferior (t=?1.844, P=0.067), nasal (t=?0.344, P=0.732) and temporal (t=?0.541, P=0.590) of RNFL between two groups. The retinal thickness, macular volume, CFT and the thickness of circumpapillary, superior, inferior, nasal, temporal of RNFL had no relationship with age, disease duration and scores of Hoehn-Yahr and UPDRS in PD patients (P>0.05). Conclusions In PD patients, the retinal thickness and macular volume are decreased, however, the circumpapillary RNFL have no obvious alterations.

Objective To explore the influence of different preservation conditions and time period on the testing results of Alzheimer's disease(AD) associated neuronal thread protein(AD7C-NTP) in urine specimen.Methods From Oct.2015 to Jan.2016,urine specimen were collected from 50 AD patients,and divided into three groups,according to the different storage temperature,including room temperature group,4 ℃ group and-20 ℃ group.Preservatives were added into specimen of 4 ℃ preservation group and-20 ℃ preservation group.AD7C-NTP level was detected at different preservation time of all specimen.Results The testing results of AD7C-NTP in specimen of room temperature group and 4 ℃ groups,detected within three days,were not significantly different with initial detection value(P>0.05).After seven days,the testing results in specimen of 4 ℃ group were not significantly different with initial detection value(P>0.05).However,after one day,the testing results in specimen of-20 ℃ group were significantly different with initial detection value(P<0.05).Contrast with 4 ℃ without preservative group,the adding of preservative could not increase the stability of AD7C-NTP.The adding of preservative in specimen of-20 ℃ could obviously increase stability,but the deviation of testing results was beyond acceptable limits.Conclusion 4 ℃ without preservatives could be the optimal storage condition for detection of AD7C-NTP in the urine.

Objective To investigate the substantia nigra (SN) and brainstem raphe (BR) echogenic features of Parkinson's disease (PD) patients with musculoskeletal pain.Methods A total of 115 PD patients recruited in the Second Affiliated Hospital of Soochow University from October 2014 to May 2016 were assessed with the following rating scales:Unified Parkinson's Disease Rating Scale (UPDRS),Hoehn and Yahr Staging Scale (H/Y),Hamilton Rating Scale for Depression (HRSD),Beck Depression Inventory Ⅱ (BDI-Ⅱ) and Visual Analogue Scale (VAS).All the subjects underwent transcranial sonography during the clinical evaluation.And the patients were divided into PD with musculoskeletal pain (n =54) and PD without musculoskeletal pain (n =61) groups,or PD with depression(n =74) and PD without depression(n =41) groups.Results Compared with PD patients without pain,PD patients with musculoskeletal pain had higher scores of UPDRS-Ⅱ,-Ⅲ,HRSD,BDI,NMSQ and H/Y (UPDRS-Ⅱ score:12.56 ±6.01 vs 8.79 ±4.38,t =-3.801,P ＜0.01;UPDRS-Ⅲ score:24.43 ± 12.43 vs 20.07 ± 11.12,t=-1.986,P=0.049;HRSD score:11.65-±6.94 vs 8.38-±5.36,t=-2.844,P=0.005;BDI score:14.09 ±6.20 vs 9.74 ±6.00,t =-3.826,P ＜0.01;NMSQ score:8.57 ± 4.06 vs 5.60 ± 3.38,t=4.193,P＜0.01;H/Y:2.0(1.5,2.6) vs 1.5(1.0,2.0),Z=-3.011,P=0.003).Positive BR was more frequent in depressed than in non-depressed PD patients without pain (63.6％ vs 14.3％;x2 =15.25,P ＜0.01).Positive BR was positively associated with sex(r =0.228,P =0.014),age(r =0.184,P =0.049),disease duration (r =0.196,P =0.035),and depression (r =0.396,P ＜ 0.01).However,positive BR did not correlate with musculoskeletal pain.No correlation was found between positive SN and clinical characteristics of PD patients.Conclusions PD patients with musculoskeletal pain have worse activity of daily living,more severe motor symptoms,more non-motor symptoms,and are more depressed.SN and BR echogenecity do not correlate with musculoskeletal pain,however,hypoechogenic or interrupted BR is associated with depression in PD patients.