The value of dual energy computed tomography for the diagnosis of gout / 中华风湿病学杂志

Objective To evaluate the value of dual energy computed tomography (DECT) for the diagnosis of gout.Methods Twenty-fivc consccutive patients with gout were selected as the experimental group and 20 patients with rheumatoid arthritis (RA) were selected as the control group.DECT scans were performed for every patient (all peripheral joints for the experimental group and affected joints for the control group).And every patient with gout had X-ray examination of the involved joints.x2 test and t-test were used for statistical analysis.Results All 25 patients with gout showed urate deposits on their DECT scans,whereas none of 20 controls showed urate deposits (P＜0.01).DECT scans revealed a total of 184 areas of urate deposition in 25 patients,in which 107 (58.2％) were at feet and ankle,72 (39.1％) were at knees,4 (2.2％) were at hands and wrists,1 (0.5％) was at elbows,whereas physical examination only showed 64 areas of urate deposition,in which 38(59.4％) were at feet and ankle,24(37.5％) were at knees,2(3.1％) at hands and wrists,0 was at elbows(P＜0.01 ).Only 6 patients with gout showed nonspecific manifestations on X-ray.Conclusion DECT scans may have potential value for the diagnosis of gout since it could produce evident colour displays for urate deposits and help to identify subclinical tophus deposits.

Effects of Akt signal pathway on the expression of NF-κB in renal tubular epithelial cells / 中华急诊医学杂志

Objective To investigate the role of Akt signal pathway on the expression of monocyte chemoattractant protein-1 ( MCP-1 ) and nuclear transcription factor-κB (NF-κB) in renal tubular epithelial cells (HK-2) stimulated by albumin and to explore the mechanisms of action. Method The HK-2 cells were incubated in the presence of albumin (5,15,30 mg/mL) with or without Ly294002 (an inhibitor of Akt). Expression of mRNA was analyzed by reverse transcription-polymerase chain reaction (RT-PCR).Expression of Akt and protein MCP-1 were assessed by Western blot. Electrophoretic mobility shift assay (EMSA) was used to detect the activation of NF-κB. q-test was used to evaluate the differences in means between groups. Results Compared with control group, the expression of MCP-1 mRNA remarkly increased. [Control group: 0.233 ±0.01; BSA(5 mg/mL) group: 0.285 ±0.04; BSA( 15 mg/mL) group:0.387 ± 0.02; BSA ( 30 mg/mL) group: 0.473 ± 0.05; BSA ( 30 mg/mL) + Ly294002 group: 0. 325 ±0.05, P ＜ 0.05 ]. The expression of MCP-1 protein in renal interstitum of operation group were remarkly increased too. [ Control group: 100 ± 15.1; BSA ( 5 mg/mL) group: 148 ± 19.3; BSA ( 15 mg/mL) group: 176±20.7; BSA(30 mg/mL) group: 263 ± 18.1; BSA(30 mg/mL) + Ly294002 group: 175 ± 18.0, P ＜0.05 ]. Albumin stimulated the expression of MCP-1mRNA and protein in a dose-dependent manner. Albumin remarkably increased the activity of NF-κB. Albumin enhanced the expression of Akt. Ly294002 inhibited albumin-induced the expression of NF-κB and partially decreased the level of MCP-1. Apositive correlation was noted between NF-κB activation and MCP-1 expression( r = 0.68 ,P ＜ 0.01 ). Conclusions Albumin-induces MCP-1 and NF-κB production via Akt signal pathway in renal tubular epithelial cells.

Analysis of the vacuum sealing drainage technique combined with sural neurovascular pedicle fascio-cutaneous flap to repair deep wounds in the foot near the ankle joint with exposed bone and tendons / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the practical method of vacuum sealing drainage (VSD) technique combined with sural neurovascular pedicle fasciocutaneous flap to repair deep wounds in the foot near the ankle joint with exposed bone and tendons.</p><p><b>METHODS</b>From January 2006 to January 2009, 79 patients with deep wounds in the foot near the ankle joint with exposed bone and tendons were treated by VSD technique combined with sural neurovascular pedicle fasciocutaneous flap including 58 males and 21 females with an average age of 34 years old ranging from 7 to 59 years. There were 17 cases in low 1/3 part of leg and achilles tendon, 28 in lateral malleolus and lateral dorsum of foot, 21 in medial malleolus and medial dorsum of foot, 13 in heel and pelma. Firstly the wounds were debrided and cultivated by using VSD technique, then the soft tissue defections were repaired with sural neurovascular pedicle fasciocutaneous flap.</p><p><b>RESULTS</b>The area of flap was from 6 cm x 5 cm to 18 cm x 15 cm; All patients stayed in hospital for 14 to 30 days, 18 days in average. Living flaps of all patients were followed-up from 6 months to 3 years, the flaps of 2 patients were mostly necrotic, 3 were necrotic, 5 cases appeared obstacle of venous back streaming. The others survived with no infections.</p><p><b>CONCLUSION</b>The wound would become fresh and clean as soon as possible with VSD. The sural neurovascular pedicle fasciocutaneous flap could provide a good covering for the exposed wound. Therefore the wound healed faster with friction resistance and fine appearance. The time of hospitalization were greatly shortened after combined application.</p>

An evaluation of leflunomide in the treatment of class Ⅴ lupus nephritis / 中华风湿病学杂志

Objective To investigate the efficacy and safety of leflunomide as induction and mainten-ance therapy for class Ⅴ lupus nephritis. Methods Sixteen patients with lupus nephritis (of which, three proven with Ⅴ +Ⅲ, six with Ⅴ+Ⅳ ), proven by renal biopsies, were included in this study. ALL patients rec-eived LEF plus prednisone treatment. For induction therapy, all patients were given an initial loading dose of LEF 60 mg daily for three days, followed by 20 mg daily for the whole induction treatment period. Prednisone was given starting from 0.8 mg per kilogram daily, then tapered four weeks later. After twenty-four weeks, the dosages of LEF and prednisone were 10 mg/d, 5～10 mg/d respectively during maintenance therapy. We asses-sed total remission rates in the end of twenty-four weeks, as well as the changes of system lupus erythematosus disease activity index (SLEDAI), urinary protein per twenty-four hours (24 h Upr), serum albumin, serum creatinine level, complement C3, complement C4, C reactive protein, serum titer of ANA and anti-dsDNA be-fore treatment, 12 weeks, 24 weeks and 48 weeks after treatment respectively. Meanwhile, seven patients received repeated renal biopsies after completing induction therapy, so we compared pathological activity index (AI) and chroniciry index (CI) between pre-therapy and post-therapy at the same time. T and t' test were selected. Results Sixteen patients were followed-up. After 24 weeks induction therapy, the total remission rate was 75.0%; SLEDAI was significantly lower than pre-therapy [(15.4±3.5) vs (6.9±1.7), P<0.05]; 24 h Upr was also significantly lower than pre-therapy [(5.8±2.2) g vs (l.3±0.5) g, P<0.01 ]. Unfortunately, all seven patients performed repeated renal biopsies with class Ⅴ lupus nephritis again histologically, of which two were transformed other cater-ofies. Comparing with that of pre-therapy, AI was improved after therapy [(2.4±0.9) vs (1.7±0.8), P<0.05]. However, CI indicated no difference. Adverse events including major infection occurred in four patients. The adverse events happened at the 12 th week after treatment. Conclusion The efficacy of LEF plus corticoster-oids as induction and maintenance therapy for class Ⅴ lupus nephritis is remarkable and the tolerance of patients is good.

Trephine arthrodesis of subtalar joints: operative technique and clinical effect / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To review the operative technique of trephine arthrodesis of subtalar joints and evaluate its clinical effect.</p><p><b>METHODS</b>From June 1998 to October 2006, we performed subtalar arthrodesis on 38 feet of 34 patients for a variety of painful disorders of hindfoot with trephine technique. Clinical and radiologic follow-up evaluations were performed for 45 months on average (range, 21 to 110 months) after arthrodesis.</p><p><b>RESULTS</b>No severe complications were found in this study except one patient with dropfoot and two with skin necrosis. The average ankle-hindfoot scores of the American Orthopaedic Foot and Ankle Society (AOFAS) was improved from 48.3 preoperatively to 79.2 postoperatively (P<0.05). The pain scores of visual analogue scales (VAS) decreased from 7.2 (range, 3 to 10) preoperatively to 2.6 (range, 1 to 6) postoperatively (P<0.05). Subjectively, the patients experienced improvements in pain, function, cosmesis, and shoewearing. Overall, 30 patients were satisfied and all patients would have this procedure again under similar circumstances. Postoperative radiology showed that complete union was found in 35 feet 6 months after operation, with the successful union rate of 92.1%. There was an increase in arthritic scores for 5 ankles, 4 talonavicular joints, 4 calcaneocuboid joints, and 4 midfoot joints. Nonunion occurred in 3 subtalar joints with anterolateral approach, which required revision arthrodesis.</p><p><b>CONCLUSION</b>Isolated subtalar arthrodesis with trephine method is an effective procedure for painful malalignment of hindfoot.</p>

Effects of Xingding injection on the expression MCP-1 in the kidney of diabetic rats / 中国医师杂志

Objective To study the protective effects of Ginkgo biloba injection on the renal in diabetic nephropathy rats. Methods The models of diabetic rats were induced by streptozotecin. SD rats (n=18) were randomly divided into three groups, including control group, diabetic group and treated group. After 6 weeks, blood glucose, serum cholesterol and urinary protein were measured respectively. The expression of MCP-1 in the glomerulus was determined by immunohistechemical staining. Results Xingding injection did not influence blood glucose and serum cholesterol, but significantly inhibited expression of MCP-1 and lowered urinary protein excretion. Conclusion Xingding injection has some protective effect, which may be through down-regulating MCP-1 expression.

The clinical characteristics of posterior reversible encephalopathy syndrome in patients with systemic lupus erythematosus / 中华风湿病学杂志

Objective Posterior reversible encephalopathy syndrome (PRES) is a rapidly evolving neurologic syndrome with characteristic clinical and radiographic features. To define the clinical characteristics of PRES in patients with eoneomitant systemic lupus erythematosus (SLE) by analyzing their clinical manif-estations and reviewing the literature. Methods The details of 4 cases and a review of the literature relevant to the development of PRES in association with SLE are presented. We described the clinical and imaging characteristics and associated risk factors of posterior roversible PRES in patients with SLE. Results Inclu-ding our cases, we reviewed a total of 48 patients with SLE and PRES. Hypertension was observed in 42 cases (88%), renal failure in 30 cases (63%), 39 recent onset cases were treated with immunosuppressive drugs and/or steroids recently (81%). Headache was observed in 46 cases (96%), Corffusion/coma in 20 cases (42%), seizures in 43 cases (90%), visual disturbances in 28 cases (58%). Neuroimaging demonstrated posterior white matter edema involving the parietal-occipital, temporal, frontal lobes, and cerebellum. The hypertension and other worsening factors should be treated. Conclusion PRES is a central nervous system syndrome that is observed in SLE patients. It is associated mainly to acute hypertension, renal failure, and immunosuppressive drugs. Although reversibility is common, residual neurological damage may be observed. Complete clinical and radiographic recovery oeeurrs with prompt antihypertensive treatment and supportive care.

Effect of fluvastatin on activation of nuclear factor kappa B induced by angiotensin Ⅱ in rat kidney tubular epithelial cells / 中华肾脏病杂志

Objective To investigate the effect of fluvastatin on activation of nuclear factor kappa B (NF-κB)induced by angiotensin Ⅱ (Ang Ⅱ ) in rat kidney tubular epithelial cells (NRK-52E). Methods NRK-52E cells were divided into (1)control group ; (2)Ang Ⅱ groups with different concentration and time; (3)Ang Ⅱ (10-6 mol/L)+SB203580 ( 10 μmol/L)group; (4) Ang Ⅱ (10-6mol/L) +different fluvastatin concentration (10-7, 10-6, 10-5 mol/L)groups;(5)Ang Ⅱ (10-6mol/L) +fluvastatin (10-5 mol/L) +mevalonate (10-4 mol/L)groap. Electrophoretic mobility shift assays (EMSA) was used to detect NF-κB activation. Phosphorylation of cellular p38 mitogen-activated protein kinase (p38MAPK) was determined by Western blot. Monocyte chemoattractant protein (MCP)-1 mRNA was determined by RT-PCR. Results Ang Ⅱ stimulated the DNA-binding activity of NF-κB,phosphorylation of p38MAPK and up-regulated the expression of MCP-1mRNA in cultured NRK-52E cells in a dose-dependent manner (P<0.01). Ang Ⅱ (10-6 mol/L) induced a rapid (5 minutes) elevation of the p38MAPK phosphorylation. NF-κB DNA binding activity was increased at as early as 30 minutes(P<0.01), peaked at 2 hours after AngⅡ treatment (P<0.01). This stimulatory effect of Ang Ⅱ on NF-κB was blocked by SB203580 (a specific inhibitor of p38MAPK) (P<0.01). Incubation of cells with fluvastatin significantly inhibited the Ang Ⅱ-induced NF-κB activation and expression of MCP-1 mRNA in dose-dependent manner (P< 0.05). Exogenous mevalonate (10-4 mol/L) prevented the effect of fluvastatin on NF-κB activation (P <0.05). Conclusions Fluvastatin reduces Ang Ⅱ-induced NF-κB activation via the p38MAPK pathway in NRK-52E cells. Such effect of flurastatin is partly through blocked by mevalonate.

Emergency medial malleolus osteotomy for the treatment of fractures of talar neck combined with dislocation of talar body / 中国骨伤

<p><b>OBJECTIVE</b>To explore therapeutic effects of emergency medial malleolus osteotomy for the treatment of fractures of talar neck and dislocation of talar body.</p><p><b>METHODS</b>From 1995. 6 to 2007. 10, among 24 patients with fractures of talar neck and dislocation of talar body, 18 patients were male and 6 patients were female, ranging in age from 28 to 58 years (mean 35.4 years). The duration from injury to the emergency ward ranged from 0.5 to 12 h. All the patients were treated in 5 hours after hospitalization with emergency medial malleolus osteotomy and internal fixation. Firstly, osteotomy was made above the medial malleolus tip; Secondly, the medial malleolus was turned over downward to uncover the talus; Then, the fracture of talus can be reduced in direct visidn.</p><p><b>RESULTS</b>All the patients were followed up ranged from 6 to 60 months. According to Kenwright evaluation standards, 18 patients obtained an excellent results, 4 good and 2 fair.</p><p><b>CONCLUSION</b>It is easy and clearly to perform medial malleolus osteotomy. The blood circulation of talus is preserved. So it is an effective method to treat the fractures of talar neck and dislocation of talar body.</p>

A case report of infantile myofibromatosis of left mandibular angle / 华西口腔医学杂志

The clinical data of one case of infantile myofibromatosis of left mandibular angle were analyzed, and the clinicopathological characteristics, imaging diagnosis, treatment and prognosis of infantile myofibromatosis were discussed.

The expression of Maspin protein in oral squamous cell carcinoma and its significance / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the role of Maspin protein in the development of oral squamous cell carcinoma (OSCC), with the effort to realize practical diagnosis use of them.</p><p><b>METHODS</b>The expression status of Maspin protein in 45 cases of OSCC, 33 cases of paratumor tissue and 15 cases of normal tissue was examined by immunohistochemical staining.</p><p><b>RESULTS</b>The positive rates of Maspin protein were 86.67% (13/15), 72.73% (24/33) and 37.78% (17/45) in normal tissue, paratumor tissue and OSCC. The expression of Maspin protein increased respectively in OSCC, paratumor tissue and normal tissue. The expression were different between OSCC and normal tissue, OSCC and paratumor tissue, paratumor tissue and normal tissue (P<0.05). The expression of Maspin protein was correlated with lymph node metastasis, histological grade (P<0.05), but not with TNM staging (P>0.05).</p><p><b>CONCLUSION</b>Maspin protein may play an important role in the development of OSCC. The expression level of Maspin protein detected in early time might be a useful prognostic marker for the diagnosis of lymph node metastasis.</p>

Effects of fluvastatin on the expression of transforming growth factor β1 in the kidney of diabetic rats / 中国医师杂志

ObjectiveTo study the protective effects of fluvastatin on the renal lesions in diabetic rat. MethodsThe model of diabetic rats was induced by streptozotocin. SD rats were random divided into four groups: Control group, diabetic rats group, low-dose fluvastatin group 2mg/(kg·d) and high-dose fluvastatin group 4 mg/(kg·d). After treatment for 4 weeks, serum cholesterol, serum creatinine and urinary protein were measured respectively. The expression of TGF β1 in the renal cortex was determined by RT-PCR. ResultsFluvastatin inhibited the expression of TGF-β1 Mrna in a dose-dependent manner, and had no influence on urinary protein, serum cholesterol and serum creatinine. ConclusionsFluvastatin inhibits the overexpression of TGF-β1Mrna, which may be related to independent cholesterol decreasing effect.

Posterior reversible encephalopathy syndrome:report of six cases / 中华全科医师杂志

ObjecfiveTo investigate clinical features and imaging manifestation in patients with posterior reversible eneephalopathy syndrome (PRES) to improve its recognition.MethodsSix patients with PRES were enrolled,four women with history of end-stage renal disease,kidney transplantation,eclampsia,or systemic lupus erythematosus (SLE) and two men with history of chemotherapy or hypertension.All of them underwent multi-serial MR imaging (T1 WI,T2 WI,FLAIR) and post-contrast T1 WI.Three cases also underwent CT scan and gadolinium enhancement. ResultsAll the six cases of PRES had different inducing causes such as acute hypertension,preeclampsia or eclampsia, taking immunosuppressive agents or steroids.and their clinical symptoms were characterized by sudden occurrence of headache,eclampsia or seizure of epilepsy,altered melltal status,visual disturbances.Clinical symptoms were died out in about one week after prompt and appropriate treatments for high blood pressure.or removal of precipitating factors,or treatment for epileptic seizures or status epilepticus.MRI and CT scanning demonstrated multifocal subcortical white lesions in bilateral parieto-occipital lobes (six cases), bilateralfrontal lobes (two cases),bilateral post temporal lobes (two cases) and left cerebellum (one cases).and cortical involvement (two cases).All lesions appeared unenhanced with gadolinium enhancement. FoHow-up by MRI showed decreased abnormal signs and small infarct foci were left in the cortex-subeortex of one case.ConclusionsPRES is a clinico-neuroradiologieal transient condition, usually benign and reversible in nature.Completely clinical and radiographic recovery Can be achieved with prompt antihypertensive treatment or removal of precipitating factors and supportive care,but delayed diagnosis and therapy Can result in cerebral infarct with neurological sequelae.

Effect of p38MAPK signal transduction pathway on montocyte chemoat tractant protein-1 expression in rats with unilateral ureteral obstruction / 中华急诊医学杂志

Objective To continually observe the monocyte chemoattraetant protein-1(MCP-1) expression in rats with anilateral ureteml obstruction, and to explore the relationship between MCP-1 and p38MAPK, and as well as the nuclear transcription faetor-кB (NF-кB). Method Thirty-six rots were randomly assigned to sham op-eration group (contorl group) and unilateral ureteral obstruction group (UUO group). Renal tissues were examined under light microscope 8 h,24 h and 72 h after operation, Immunhistochemistry was used to measure the expression of MCP-1 and NF-кB. RT-PCR and Western bot were employed to determine MCP-1 mRNA and p38MAPK pro-tein,respectively.Serum creatinine and ure nitrogen were examined with biochemistry methods. Results Com-pared with control group, the expression of MCP-1 mRNA in UUO group dramatically increased (control group:0.401±0.039;UUO group 8 h:0.894±0.137;24 h: 1.416±0.135;72 h: 1.894±0.14, P<0.05).The explosion of MCP-1 protein in renal interstitium of UUO group also markedly increased (control group: 50.08±3.210. UUO group 8 h:108.25±4.325;24 h: 179.34±3.237;72 h: 230.12±3.026, P<0.05),and the expressions of NF-кB and p38MAPK in UUO group were also stimulated (p38MAPK: control group: 110.65±9.734. UUO group 8 h:200.15±8.326; 24 h:272.74±7.244;72 h:549.11±9.544, P<0.05). There were positive correlations between MCP-1 and p38MAPK as well as NF-кB(r=0.74,r=0.81,P<0.01).Conclusions Tne increased expression of MCP-1 may participate in the injury mechanisms of renal tubulointesti-tinm in UUO rats. The increased expression of p38MAPK may induce NF-кB expression in the tubules, and then NF-кB promotes the expression of MCP-1.

Analysis on therapeutic effects of different acupuncture times on peripheral facial paralysis / 中国针灸

<p><b>OBJECTIVE</b>To observe clinical therapeutic effects of different acupuncture times on peripheral facial paralysis.</p><p><b>METHODS</b>Forty-nine cases of peripheral facial paralysis were randomly divided into 2 groups, group A and B. The group A received acupuncture, once daily, and the group B twice each week. Their therapeutic effects were assessed after 3 courses.</p><p><b>RESULTS</b>The acupuncture times were not direct proportion to the therapeutic effect (P<0.01), with no significant difference between the two groups in the cured rate (P>0.05).</p><p><b>CONCLUSION</b>Acupuncture treatment can select twice each week for peripheral facial paralysis.</p>

Fffect of p38MAPK signal transduction pathway on RANTES expression after unilateral ureteral obstruction in rats / 中华急诊医学杂志

Objective To investigate the effect of p38MAPK on the RANTES expression after unilateral ureteral obstruction.Methods Twenty-two rats were randomly assigned to shame operation group (normal group) and operation group after unilateral ureteral obstruction.Renal tissues were examined by light microscopy at 8 h、24 h and 72 h after operation,Immunhistochemistry was applied to measure the expression of RANTES,RT-PCR,Western blot was performed to determine mRNA,protein,respectively.Results Compared with shame opeartion group,the mRNA and protein levels of RANTES in renal interstitum of operation group remarkly increased (P＜0.05),and also stimulated the phosphorylation of p38MAPK.Conclusion The overexpression of RANTES in UUO rats by p38MAPK signal transduction pathway.

Albumin stimulates osteopontin mRNA expression in renal tubular epithelial cells through p38MAPK activation / 中国医师杂志

Objective To investigate the roll of p38MAPK on the expression of osteopontin(OPN) mRNA in cultured renal tubular epithelial cells stimulated by albumin.Methods The normal renal tubular epithelial cells(NRK-52E) were incubated in the presence of albumin(30mg/ml) with or without SB203580,an inhibitor of p38MAPK.Reverse transcriptase polymerase chain reaction(RT-PCR) was performed to determine the expression of OPN mRNA and the p38MAPK phosphorylation was evaluated by Western blot analysis.Results Albumin stimulated the phosphorylation of p38MAPK in a timedependent manner,and up-regulated the expression of OPN mRNA.SB203580 could inhibit the expression of OPN mRNA.Conclusion The p38MAPK signal pathway plays an important roll in OPN mRNA expression stimulated by Albumin.

Renoprotective Effects of Benazepril on Rats Kidney After Unilateral Ureteral Obstruction / 中国医师杂志

Objective To investigate the mechanism of renal interstitial fibrosis after unilateral ureteral obstruction and renal protctive effect of angiotensin coverting enzyme inhibitor (ACEI),benazepril on rat kidney.Methods Twenty-four rats were randomly assigned to shame operation group (normal group),operation group, benazepril(10mg?kg -1 ?d -1 ) treatment group after unilateral ureteral obstruction. Renal tissues were examined by light and electronmicroscopy at the 2nd week after operation. Immunohistochemistry was applied to measure the expression of collagen Ⅲ,transforming growth factor ? 1 (TGF-? 1 ) and nuclear factor-kB(NF-kB) in the renal interstitium.Results In comparison with shame operation group, the expression of collagen Ⅲ , TGF-? 1 and NF-kB in the interstitium of operation group markedly increased (P