Safety and efficacy of remote ischemic conditioning for spontaneous intracerebral hemorrhage (SERIC-ICH): A multicenter, randomized, parallel-controlled clinical trial study design and protocol.

BACKGROUND: Previous studies have revealed that remote ischemic conditioning (RIC) may have a neuroprotective function. However, the potential benefit of RIC for patients with ICH remain unclear. OBJECTIVE: The primary aim of this study is to assess the safety and efficacy of RIC for patients with ICH. METHODS: The Safety and Efficacy of RIC for Spontaneous ICH (SERIC-ICH) is an ongoing prospective, randomized, multicenter, parallel-controlled, and blinded-endpoint clinical trial. The study will enroll an estimated 2000 patients aged ⩾18 years within 24 h after ICH onset, with National Institutes of Health Stroke Scale ⩾6 and Glasgow Coma Scale ⩾8 upon presentation. The patients will be randomly assigned to the RIC or control groups (1:1) and will be treated with cuffs inflated to a pressure of 200 or 60 mmHg, respectively, twice daily for 7 days. Each RIC treatment will consist of four cycles of arm ischemia for 5 min, followed by reperfusion for another 5 min, for a total procedure time of 35 min. The primary efficacy outcome measure is the proportion of patients with good functional outcomes (modified Rankin scale 0-2) at 180 days. The safety outcome measures will include all adverse events and severe adverse events occurring in the course of the study. DISCUSSION: RIC is an inexpensive intervention and might be a strategy to improve outcomes in patients with ICH. The SERIC-ICH trial will investigate whether RIC treatment can be applied as an adjuvant treatment in the acute phase of ICH and identify safety issues.

Sustained Release Microneedles: Materials and Applications in Facial Rejuvenation.

Wrinkled and loose skin resulting from collagen degradation along with fibers decreasing reflects the youth diminishing. Microneedles (MNs) have opened up new avenues for the development of painless and noninvasive transdermal drug delivery systems for facial rejuvenation. Encapsulated drugs or molecules are transmitted to targeted tissues via percutaneous microchannels, which eliminate potential gastric stimulation or first-pass metabolic effects, as well as boost patient compliance. Although MNs are considered effective and feasible therapeutic alternatives to metals, silicon, and polymers, traditional procedures with reduction processes continue to encounter methodological limitations. In recent years, promising additive manufacturing processes such as three-dimensional printing and two-photon polymerization manufacturing have been developed with the aim of overcoming the limitations by traditional processes to facilitate an efficient and economic production mode. This review summarizes the design, material selection, and manufacturing method for recently advanced MN systems. Furthermore, we also highlight specific polymeric or natural microneedle products, like hyaluronan, plant derivates, and vitamins, for esthetic applications in this review. Impact Statement In this review, the materials and manufactural routes of microneedles (MNs) are detailed. Moreover, similar to the diagnostic or therapeutic MNs, the feature of dispensation with training and ready-to-use is perfect for beautification and anti-aging, which necessitate repeated and long-term usage. Furthermore, the specific polymeric or natural products for esthetic applications of MNs are highlighted in this review.

Both indirect maternal and direct fetal genetic effects reflect the observational relationship between higher birth weight and lower adult bone mass.

BACKGROUND: Birth weight is considered not only to undermine future growth, but also to induce lifelong diseases; the aim of this study is to explore the relationship between birth weight and adult bone mass. METHODS: We performed multivariable regression analyses to assess the association of birth weight with bone parameters measured by dual-energy X-ray absorptiometry (DXA) and by quantitative ultrasound (QUS), independently. We also implemented a systemic Mendelian randomization (MR) analysis to explore the causal association between them with both fetal-specific and maternal-specific instrumental variables. RESULTS: In the observational analyses, we found that higher birth weight could increase the adult bone area (lumbar spine, ß-coefficient= 0.17, P < 2.00 × 10-16; lateral spine, ß-coefficient = 0.02, P = 0.04), decrease bone mineral content-adjusted bone area (BMCadjArea) (lumbar spine, ß-coefficient= - 0.01, P = 2.27 × 10-14; lateral spine, ß-coefficient = - 0.05, P = 0.001), and decrease adult bone mineral density (BMD) (lumbar spine, ß-coefficient = - 0.04, P = 0.007; lateral spine; ß-coefficient = - 0.03, P = 0.02; heel, ß-coefficient = - 0.06, P < 2.00 × 10-16), and we observed that the effect of birth weight on bone size was larger than that on BMC. In MR analyses, the higher fetal-specific genetically determined birth weight was identified to be associated with higher bone area (lumbar spine; ß-coefficient = 0.15, P = 1.26 × 10-6, total hip, ß-coefficient = 0.15, P = 0.005; intertrochanteric area, ß-coefficient = 0.13, P = 0.0009; trochanter area, ß-coefficient = 0.11, P = 0.03) but lower BMD (lumbar spine, ß-coefficient = - 0.10, P = 0.01; lateral spine, ß-coefficient = - 0.12, P = 0.0003, and heel ß-coefficient = - 0.11, P = 3.33 × 10-13). In addition, we found that the higher maternal-specific genetically determined offspring birth weight was associated with lower offspring adult heel BMD (ß-coefficient = - 0.001, P = 0.04). CONCLUSIONS: The observational analyses suggested that higher birth weight was associated with the increased adult bone area but decreased BMD. By leveraging the genetic instrumental variables with maternal- and fetal-specific effects on birth weight, the observed relationship could be reflected by both the direct fetal and indirect maternal genetic effects.

General and abdominal obesity operate differently as influencing factors of fracture risk in old adults.

To infer the causality between obesity and fracture and the difference between general and abdominal obesity, a prospective study was performed in 456,921 participants, and 10,142 participants developed an incident fracture with follow-up period of 7.96 years. A U-shape relationship was observed between BMI and fracture, with the lowest risk of fracture in overweight participants. The obesity individuals had higher fracture risk when BMD was adjusted, and the protective effect of moderate-high BMI on fracture was mostly mediated by bone mineral density (BMD). However, for abdominal obesity, the higher WCadjBMI (linear) and HCadjBMI (J-shape) were found to be related to higher fracture risk, and less than 30% of the effect was mediated by BMD. By leveraging genetic instrumental variables, it provided additional evidences to support the aforementioned findings. In conclusion, keeping moderate-high BMI might be of benefit to old people in terms of fracture risk, whereas abdominal adiposity might increase risk of fracture.

[Cross-scale spatiotemporal characteristics of landscape ecological conditions index in coastal zone of Jiangsu Province, China during 1990-2020.] / 1990­2020年江苏省海岸带景观生态状况指数跨尺度时空特征.

Coastal zone ecosystems in Jiangsu have produced different degrees of spatial response and degradation characteristics under complex external disturbances, especially significant spatiotemporal evolution of landscape pattern in recent decades. It is urgent to carry out comprehensive assessment on landscape ecology covering landscape composition, configuration, and function at multiple scales. We analyzed the spatial and temporal variations of landscape ecological condition index (LECI) in large-scale coastal zone of Jiangsu Province from 1990 to 2020, assessed landscape ecological conditions of 14 county-level districts, and selected evaluation units with side lengths of 100, 200,…, 1000 m to understand the spatial scale effects of LECI. The results showed that the indicators of landscape composition, configuration and function could sensitively reflect the changes of LECI, which could comprehensively evaluate landscape ecological condition of Jiangsu coastal zone during the study period, with 300 m evaluation unit being the best spatial scale. The LECI value in the study area fluctuated. Landscape ecological condition was the best in 1990 and the worst in 2020. Landscape composition and configuration had a greater impacts on the changes of landscape ecological condition. The fluctuation of LECI in different counties and cities was closely related to intense human activities. Human activities, such as industrial development and urban expansion, had damaged landscape ecological status. The establishment of nature reserves had restored landscape ecological status to a certain extent. LECI could effectively indicate the changes of landscape ecological status of large-scale coastal zone, and provide multi-perspective suggestions for space utilization and protection.

[Treatment of open fracture of lower limb in high altitude area].

OBJECTIVE: To explore the treatment methods and experience of open fracture of lower limb in high altitude area. METHODS: From January 2016 to January 2021, 62 patients with open fractures of lower limbs were treated by staged surgery with the concept of injury control orthopedics, emphasizing wound treatment and combining various fracture fixation methods. There were 51 males and 11 females, ranging in age from 14 to 59 years old, with a mean of (37.2±12.3) years old; and the course of disease ranged from 7 to 59 days, with a mean of (23.7±15.5) days. According to Gustilo Anderson classification, there were 14 cases of typeⅠ, 24 cases of typeⅡ, 14 cases of typeⅢA, 8 cases of typeⅢB and 2 cases of typeⅢC. The fracture repair and wound healing were observed, and the clinical efficacy was evaluated by Johner-Wruhs evaluation standard. RESULTS: Fifty-five patients were followed up, and the duration ranged from 4 to 36 months, with a mean of (14.7±8.5) months, and 7 cases were lost to follow-up. According to Johner-Wruhs evaluation criteria, 33 cases got an excellent result, 16 good, 4 poor and 2 bad. The wound healing was poor in 2 cases, partial necrosis of Achilles tendon in 1 case, nonunion of fracture in 1 case and delayed healing of fracture in 2 cases. CONCLUSION: It is an effective method to treat the open fracture of lower extremity in high altitude area to pay attention to the management of soft tissue injury, the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end. Paying attention to the treatment of soft tissue injury and the management of wound moisturizing, staged operation of fracture and full protection of blood supply at the fracture end are effective methods for the treatment of open fracture of lower limbs in high altitude areas.

LncRNA ANRIL affects the sensitivity of ovarian cancer to cisplatin via regulation of let-7a/HMGA2 axis.

This paper tried to explore ANRIL expression in ovarian cancer and how it affects cisplatin-sensitivity of ovarian cancer cells via regulation of let-7a/high-mobility group protein A2 (HMGA2) axis. qRT-PCR was used to detect ANRIL and let-7a levels in ovarian cancer tissues and cell lines (SKOV3 and SKOV3/DDP). Then cells were randomly assigned into Blank, negative control siRNA, ANRIL siRNA, let-7a inhibitor, and ANRIL siRNA+let-7a-inhibitor groups. CCK-8 assay was applied for assessing cell viability of cells treated with different concentrations of cisplatin. Flow cytometry was employed to test cell apoptosis rate. qRT-PCR and Western blot were performed for related molecules detection. Nude mice transplanted with SKOV3/DDP cells were used to confirm the effects of ANRIL siRNA on the cisplatin-sensitivity. Ovarian cancer tissues and cisplatin-resistant cells had increased ANRIL expression and decreased let-7a expression, and those patients with higher clinical stage and pathological grade showed higher ANRIL and lower let-7a. Dual-luciferase reporter-gene assay confirmed the targeting relationship between ANRIL and let-7a, and between let-7a and HMGA2. The cell viability and cisplatin IC50 were decreased in ANRIL siRNA group exposed to different concentrations of cisplatin, with enhanced apoptosis, as well as elevated let-7a and declined HMGA2, which would be reversed by let-7a inhibitor. Meanwhile, ANRIL down-regulation enhanced the inhibitory effect of cisplatin on tumor growth of nude mice and reduced tumor weight. Silencing ANRIL expression reduced HMGA2 expression to promote the apoptosis and improve cisplatin-sensitivity of ovarian cancer cells via up-regulating let-7a expression.

Effects of Mydrin eye-drops on central corneal thickness values in adult patients with myopia.

OBJECTIVE: This study aimed to evaluate the effect of Mydrin eye-drops on central corneal thickness values and investigate the duration of the effect. METHODS: In this prospective randomised self-controlled study, we enrolled 60 myopic patients (120 eyes) undergoing corneal laser refractive surgery. The central corneal thickness was measured before and one and four hours after administration of Mydrin eye-drops (major components are tropicamide and phenylephrine hydrochloride) using the Orbscan II anterior segment analysis system and a SP-2000P non-contact specular microscope, respectively. RESULTS: Using the Orbscan II system, the baseline central corneal thickness (545 ± 27 µm) was significantly lower than that at one hour after Mydrin eye-drop application (559 ± 31 µm; p < 0.001); it was comparable to that at four hours post-Mydrin eye-drop administration (544 ± 26 µm; p < 0.74). Measured by non-contact specular microscopy, the baseline central corneal thickness (508 ± 26 µm) was significantly lower than that at one hour after Mydrin eye-drop application (521 ± 29 µm; p < 0.001); it was comparable to that at four hours after Mydrin eye-drop administration (506 ± 24 µm; p = 0.62). A significant difference was observed in the central corneal thickness at one and four hours after Mydrin eye-drop application by both methods (p < 0.001). Bland-Altman plots showed agreement between the measurements by the two methods at different times. CONCLUSION: Central corneal thickness increases one hour after topical application of Mydrin eye-drops and is normalised at four hours following the administration of the drops. For patients scheduled to undergo excimer laser corneal refractive surgery, the central corneal thickness should be measured before or four hours after administration of Mydrin eye-drops.

Rare case of primary pleural lymphoma presenting with pleural effusion.

Primary pleural lymphoma is rare and has been described in association with human immunodeficiency virus (HIV) infection or pyothorax. We report a rare case of primary pleural lymphoma in a 73-year-old man who presented with chest pain and no history of HIV infection or pyothorax. Chest imaging showed pleural thickening and pleural effusion. Thoracoscopic pleural biopsy was performed. Histopathological and immunohistochemical examinations conformed to that of a diffuse large B-cell lymphoma. Physicians should be aware of this rare location of primary lymphoma and implement thoracoscopy as soon as possible.

Continuous Curvilinear Capsulorhexis in Cataract Surgery Using a Modified 3-Bend Cystotome.

We modified a 2-bend cystotome for continuous curvilinear capsulorhexis (CCC) in manual or phacoemulsification cataract surgery to improve the safety and ease of performance. A 26G needle was converted into a cystotome with 3 bends. In this retrospective study, the performance of modified 3-bend cystotome was compared with conventional 2-bend cystotome. During cataract surgery, in the 3-bend cystotome group, mean completion time of CCC was shorter, mean times of viscoelastic agent supplement were less, and CCC success rate was higher than that in 2-bend group. Complication incidence, such as postoperative transient corneal edema and irreparable V-shaped tear, was also lower in 3-bend group. No posterior capsular rupture or no other complication was observed in either group. A polymethyl methacrylate intraocular lens or a hydrogel intraocular lens was implanted in the capsular bag in all eyes. We conclude that it is safe and efficient to accomplish a CCC using the 3-bend cystotome due to its ability to sustain the anterior chamber depth (ACD) and keep the posterior lip intact. Using the 3-bend cystotome also allowed for an adequate view into the anterior chamber from lack of wound deformation.

Application of cold patch in relieving pain after transepithelial photorefractive keratectomy.

BACKGROUND: A return toward toward photorefractive keratectomy has occurred due to better corneal stability and fewer corneal flap complications; however, pain remains a major drawback of the procedure. Currently, clinical pain control measures focus on the administration of pain medications, which may delay corneal epithelial healing and has, occasionally, led to serious corneal toxicity. OBJECTIVES: To investigate the safety and efficacy of a cold patch on postoperative pain and other relevant consequences of transepithelial photorefractive keratectomy. METHODS: A prospective, randomized controlled study was conducted. Forty patients (80 eyes) scheduled to undergo transepithelial photorefractive keratectomy for myopia or myopic astigmatism were randomly and equally assigned to be treated with ice-cold balanced salt solution during surgery (wash group) or to wear a postoperative cold patch on the eye for 24 h. The main outcomes were pain score on a visual analogue scale, postoperative eyelid edema, conjunctival hyperemia, epithelial healing time, haze and postoperative best-corrected visual acuity. RESULTS: All patients completed the final tests. Demographic characteristics and pain scores during surgery were similar between the two groups. The mean postoperative pain scores of patients in the cold patch group at 8 h, 16 h and 24 h were significantly lower than those of patients in the wash group. Scores for postoperative eyelid edema and conjunctival hyperemia in the cold patch group were also lower than in the wash group. Patients in the cold patch group used fewer painkillers. Epithelial healing time, haze and early recovery of visual acuity were similar between the two groups. No eyelid frostbite was observed. CONCLUSION: Wearing a cold patch on the eye after transepithelial photorefractive keratectomy effectively relieved pain and inflammation, and reduced the use of painkillers without any side effects.

MicroRNA-9 promotes tumorigenesis and mediates sensitivity to cisplatin in primary epithelial ovarian cancer cells.

MicroRNAs play critical roles in regulating tumor occurrence and drug sensitivity in ovarian cancers. This study aimed to investigate the key members of MicroRNAs (miRNAs) involved in modulating tumor initiation and drug resistance in primary ovarian cancer cells. An in vitro assay based on tumor clonal formation was established to evaluate tumorigenicity and cisplatin sensitivity. By performing real-time polymerase chain reaction, we examined the expression of nine microRNAs associated with the pathology of ovarian cancers in primary ovarian tumor cells, which were surgically resected from 46 patients with distinct sensitivity to platinum-based chemotherapy. MiR-9, miR-145, and miR-429 were expressed significantly higher in drug-sensitive patients (n = 26) than in drug-resistant ones (n = 20), while higher miR-26a expression was found in resistant patients (p < 0.05). In addition, tumor cells from drug sensitive patients were more tumorigenic than those of drug resistance (p = 0.0013). Cisplatin treatment led to a sharp decrease of clonal formation of drug-sensitive cells but showed slight effects on drug resistant cells. Specific anti-miRs were then employed to downregulate the expression of microRNAs in primary tumor cells. Inhibition of miR-9 resulted in decreased clonal formation and sensitivity to cisplatin, while the knockdown of other three microRNAs did not show any influence in tumorigenesis and drug sensitivity. In conclusion, this study showed that in primary ovarian tumor cells, high expression of miR-9 was associated with enhanced tumorigenesis and increased sensitivity of the tumor cells to cisplatin treatment.

[Sintering behavior of tooth-like yttria-stabilized tetragonal zirconia polycrystal by adding rare-earth oxide].

PURPOSE: To investigate the influence on the sintering densification, microstructure and transformation behavior of tooth-like yttria-stabilized tetragonal zirconia polycrystal by adding rare-earth oxide as colorants. METHODS: Six kinds(S1,S2,S3,S4,S5,S6) of tooth-like yttria stabilized tetragonal zirconia polycrystal(Y-TZP)were made by introducing internal colorating technology, the relative density of sintered specimens was determined by the Archimedes method. Scanning electron microscope (SEM) was used to examine the surface morphology and determine the grain size. The phase identification of sintered samples was carried out by X-ray diffractometer. RESULTS: The relative density of the six kinds of tooth-like yttria stabilized tetragonal zirconia polycrystal were over 98%, through SEM images of the cross-sectional surfaces, the grain size of the six kinds of sintered composites were observed in a wide range from 100 nm to 300 nm, a second phase was not detected in the grain boundaries. The diffraction peaks of the main phase were observed as tetragonal phase. CONCLUSIONS: Tooth-like yttria-stabilized tetragonal zirconia polycrystal was acquired with better mechanical property by adding rare-earth oxide as colorants, and was available for clinical application.

Inter-rater reliability of three most commonly used pressure ulcer risk assessment scales in clinical practice.

The objective of this study was to evaluate inter-rater reliability of Braden Scale, Norton Scale and Waterlow Scale for pressure ulcer risk assessment in clinical practice. The design of the study was cross-sectional. A total of 23 patients at pressure ulcer risk were included in the study, and 6 best registered nurses conducted three subsequent risk assessments for all included patients. They assessed alone and independently from each other. An intra-class correlation coefficient (ICC) was used to determine the inter-rater reliability. For the Braden Scale, the ICC values ranged between 0·603 (95% CI: 0·435-0·770) for the item 'moisture' and a maximum of 0·964 (95% CI: 0·936-0·982) for the item 'activity'; for the Norton Scale, the ICC values ranged between 0·595 (95% CI: 0·426-0·764) for the item 'physical condition' and a maximum of 0·975 (95% CI: 0·955-0·988) for the item 'activity'; and for the Waterlow Scale, the ICC values ranged between 0·592 (95% CI: 0·422-0·762) for the item 'skin type' and a maximum of 0·990 (95% CI: 0·982-0·995) for the item 'activity'. The ICC values of total score for three scales of were 0·955 (95% CI: 0·922-0·978), 0·967 (95% CI: 0·943-0·984), and 0·915 (95% CI: 0·855-0·958) for Braden, Norton, and Waterlow scales, respectively. Although the inter-rater reliability of Braden Scale, Norton Scale and Waterlow Scale total scores were all substantial, the reliability of some items was not so good. The items of 'moisture', 'physical condition' and 'skin type' should be paid more attention. However, some studies are needed to find out high reliable quantitative items to replace these ambiguous items in new designed scales.

2,3,7,8-Tetrachlorodibenzo-p-dioxin Delays Palatal Shelf Elevation and Suppresses Wnt5a and Lymphoid Enhancing-Binding Factor 1 Signaling in Developing Palate.

OBJECTIVE: 2,3,7,8-Tetrachlorodibenzo-p-dioxin contributes to cleft palate, but the cellular and molecular mechanisms responsible for the deleterious effect on the developing palate are unclear. Because Wnt signaling is associated with 2,3,7,8-tetrachlorodibenzo-p-dioxin in organ development, we wondered whether the malformation of the palate also results from altered Wnt signaling. RESULTS: The 2,3,7,8-tetrachlorodibenzo-p-dioxin administration affected cell proliferation of the anteroposterior axis of the palatal shelf and delayed shelf elevation in mice. The activity of Wnt5a and lymphoid enhancing-binding factor 1 was inhibited by 2,3,7,8-tetrachlorodibenzo-p-dioxin in the developing palate. CONCLUSIONS: Downregulated Wnt5a and lymphoid enhancing-binding factor 1 are associated with 2,3,7,8-tetrachlorodibenzo-p-dioxin-induced cleft palate. Moreover, delayed shelf elevation by 2,3,7,8-tetrachlorodibenzo-p-dioxin is the crucial mechanism contributing to the high incidence of cleft palate. Our findings may help in elucidating the mechanisms of 2,3,7,8-tetrachlorodibenzo-p-dioxin-induced cleft palate.

Co-circulation of Hantaan, Kenkeme, and Khabarovsk Hantaviruses in Bolshoy Ussuriysky Island, China.

Hemorrhagic fever with renal syndrome (HFRS) was first recognized in far eastern Asia in the 1930s, and has been highly prevalent in this region ever since. To reveal the molecular epidemiology of hantaviruses in this region, a total of 374 small mammals (eight species of rodents and one species of shrew) were captured in the Chinese part of the Bolshoy Ussuriysky Island (Heilongjiang Province). Hantavirus sequences were recovered from three striped field mice (Apodemus agrarius), 11 Maximowicz's voles (Microtus maximowiczii), and one flat-skulled shrew (Sorex roboratus). Genetic and phylogenetic analysis revealed the presence of three viruses: Hantaan virus (HTNV), Khabarovsk virus (KHAV), and Kenkeme virus (KKMV). HTNV sequences recovered from A. agrarius were closely related to those identified in Apodemus mice from the surrounding areas, while a new lineage of KHAV was present in M. maximowiczii. Additionally, while the viral sequences recovered from one flat-skulled shrew were most closely related to KKMV, their divergence to the prototype strain suggests that they represent a new viral subtype. Overall, these results suggest that Bolshoy Ussuriysky Island harbors considerable hantavirus diversity.

[Etanercept combined with Tripterygium wilfordii polyglycoside for treatment of rheumatoid arthritis in the elderly: a clinical study].

OBJECTIVE: To evaluate the efficacy and safety of etanercept plus Tripterygium wilfordii polyglycoside (TWP) in elderly patients with active rheumatoid arthritis (RA). METHODS: Totally 46 elderly patients with active RA were randomly assigned to the treatment group (22 cases) and the control group (24 cases). All patients received subcutaneous injection of etanercept, 25 mg each time, twice per week. The dosage was reduced to once per week 3 months later. Patients in the treatment group took TWP Tablet (10 mg each time, three times per day), while those in the control group took methotrexate (MTX), 10 mg each time, once per week. The whole course lasted for 24 weeks. Patients' rest pain, tender joint number, swollen joint number, health assessment questionnaire (HAQ), patients' global assessment, physicians' global assessment, erythrocyte sediment rate (ESR), C reactive protein (CRP), rheumatic factor were assessed at week 0, 4, 8, 12, and 24. The curative effect was statistically evaluated by the United States Institute of Rheumatology ACR20, ACR50, and ACR70 improvement criteria. Meanwhile, any adverse event was recorded and evaluated. RESULTS: Totally 41 completed the trial, and 5 dropped off (3 in the treatment group and 2 in the control group). Compared with the control group, there was no statistical difference in ACR20, ACR50, or ACR70 in the treatment group (P > 0.05). Compared with before treatment in the same group, there was some improvement in tender joint number, swollen joint number, visual analogue scale (VAS) for patients' global assessment, VAS for physicians' global assessment, ESR, CRP, and HAQ between the two groups, showing statistical difference (P < 0.05). Compared with the control group in the same phase, there was no statistical difference in the treatment group (P > 0.05). There was no statistical difference in the occurrence of adverse events between the two groups. CONCLUSIONS: Etanercept plus TWP could achieve equivalent therapeutic effect to that of Etanercept plus MTX. The two regimens could improve clinical signs, symptoms, and QOL related to RA. They were well tolerated in the treatment of elderly patients with active RA.

Changes in water and sediment exchange between the Changjiang River and Poyang Lake under natural and anthropogenic conditions, China.

To study the fluvial interaction between Changjiang River and Poyang Lake, we analyze the observed changes of riverine flux of the mid-upstream of Changjiang River catchment, the five river systems of Poyang Lake and Poyang Lake basin. Inter-annual and seasonal variations of the water discharge and sediment exchange processes between Changjiang River and Poyang Lake are systematically explored to determine the influence of climate change as well as human impact (especially the Three Gorges Dam (TGD)). Results indicate that climate variation for the Changjiang catchment and Poyang Lake watershed is the main factor determining the changes of water exchanges between Changjiang River and Poyang Lake. However, human activities (including the emplacement of the TGD) accelerated this rate of change. Relative to previous years (1956-1989), the water discharge outflow from Poyang Lake during the dry season towards the Changjiang catchment increased by 8.98 km(3)y(-1) during 2003-2010. Evidently, the water discharge flowing into Poyang Lake during late April-late May decreased. As a consequence, water storage of Poyang Lake significantly reduced during late April-late May, resulting in frequent spring droughts after 2003. The freshwater flux of Changjiang River towards Poyang Lake is less during the flood season as well, significantly lowering the magnitude and frequency of the backflow of the Changjiang River during 2003-2010. Human activities, especially the emplacement and operation of the TGD and sand mining at Poyang Lake impose a major impact on the variation of sediment exchange between Changjiang main river and Poyang Lake. On average, sediments from Changjiang River deposited in Poyang Lake before 2000. After 2000, Changjiang River no longer supplied sediment to Poyang Lake. As a consequence, the sediment load of Changjiang River entering the sea increasingly exists of sediments from Lake Poyang during 2003-2010. As a result, Poyang Lake converted from a depositional to an erosional system, with a gross sediment loss of 120.19 Mty(-1) during 2001-2010, including sand mining.

A novel nucleus extraction technique using a vectis in sutureless, manual, small-incision cataract surgery.

INTRODUCTION: In manual, tunnel-incision cataract surgery, nucleus extraction has remained a crucial issue and a challenge. It is also the period when serious complications easily occur, especially for beginners and when the nucleus is large and dense. OBJECTIVES: To report a modified vectis technique for nucleus extraction in sutureless, manual, small-incision cataract surgery (MSICS) to improve the safety and ease of performance. MATERIALS AND METHODS: A novel nucleus extraction technique using a vectis in MSICS is presented. After capsulorhexis and hydrodissection, the nucleus is moved into the anterior chamber and extracted by pulling with a Sinskey hook and pressuring on the scleral bed near the posterior wound margin with an irrigating vectis. MAIN OUTCOME MEASURES: The operating time for the whole surgery and nucleus extraction, best corrected visual acuity postoperatively and complications during and after operation were recorded. RESULTS: In a series of 1,180 eyes, the operating time for the whole surgery and nucleus extraction were 8±3.4 minutes and 5.1±4.6 seconds respectively. Among all the eyes, 88.98 % achieved a best-corrected visual acuity of 5/10 or better two months postoperatively. The complications were posterior capsule rupture (4 eyes, 0.34 %) and transient corneal edema (12 eyes, 1.02 %). Neither vitreous loss nor dislocation of the nucleus into the vitreous was noted in the whole series of the surgery. CONCLUSIONS: We found that the "scleral bed" vectis technique for nucleus extraction improved the ease of performance, safety of MSICS, and did not require expensive instrumentation.