Objective To investigate the current situation of clinical and imaging remission in patients with axial spondyloarthritis(axSpA) and analyze relevant impacted factors.Methods According to past treatment programs,ankylosing spondylitis disease activity scores based on C-reactive protein(CRP)(ASDAScrp)and Spondyloarthritis Research Consortium of Canada(SPARCC) scores,233 patientswith axSpA were divided into different groups respectively.Clinical data of each group were compared.Risk factors for clinical and imaging remission were analyzed by multivariate logistic regression analysis.Results Rate of clinical remission was 25.3% in patients with axSpA.Rate of imaging nonremission in clinical standard group(32.2%) was lower than that in clinical nonstandard group(56.3%,P<0.05).CRP in clinical standard group was lower than that in clinical nonstandard group,and ratio of patients receiving anti-tumor necrosis factor（TNF）-α treatment was higher than that in clinical non-standard group(P<0.05).ASDAScrp in imaging remission group was lower than that in imaging non-remission group,and ratio of patients receiving anti-TNF-α treatment was higher than that in imaging non-remission group(P<0.05).Rate of clinical standard and imaging remission in non-standard treatment group were lower than those in anti-TNF-α treatment group(P<0.05).Results of multivariate logistic regression analysis showed that CRP rise was risk factor for clinical non-remission in axSpA(P<0.001),while ASDAScrp rise was risk factor for imaging non-remission(P<0.05).Anti-TNF-α treatment was protective factor for both clinical and imaging remission(P<0.05).Conclusion Rate of clinical remission in axSpA is still low.CRP and ASDAScrp rise are risk factors for clinical and imaging non-remission in axSpA respectively,while anti-TNF-α treatment can promote clinical and imaging remission.

Objective To analyze the value of inflammatory factors combined with Ranson scores in predicting the severity of acute pancreatitis(AP) and guiding clinical treatment.Methods According to the 2012 Atlanta standard,150 AP patients were divided into mild group (n=50),moderate group(n=50) and severe group(n=50).Serum inflammatory factors [interleukin(IL)-6,procalcitonin (PCT),C-reactive protein(CRP),IL-8,IL-10] levels,Ranson scores in 3 groups were compared and the mortality rate of each group was counted.Draw the receiver operating characteristics (ROC) curve.The area under the ROC(AUC) of each index was calculated and and the value of each index to assess organ failure and mortality rate was compared.Results PCT,IL-6 and CRP increased gradually at 12h,24h,48h in the three groups,and PCT,IL-6 and CRP increased gradually with the severity of the disease(P<0.05).The IL-10 levels in the three groups were higher at 24h than those at 12h,but the IL-10 levels were lower at 48h than those at 24h(P<0.05).The Ranson scores of the light,moderate and severe groups showed an increasing trend with the increase of the severity of the disease(P<0.05).The mortality rate of severe group was higher than that of mild group(0) and moderate group(2.0%，P<0.05).Among the serum inflammatory factors,the AUCs of IL-6 to evaluate organ failure and mortality rate were larger than that of PCT and CRP.The AUC of CRP to evalute pancreatic necrosis was larger than that of PCT and IL-6.The AUCs of Ranson scores to evaluate organ failure and fatality rate were larger than that of PCT,IL-6 and CRP.The AUCs of PCT+IL-6+CRP+Ranson scores to evaluate organ failure,pancreatic necrosis and fatality rate were larger than those of Ranson score and any serum inflammatory factor.Conclusion IL-6 has higher predictive value for organ failure and mortality rate in AP patients,and CRP has higher predicitvie value for pancreatic necrosis.The combination of PCT,IL-6,CRP and Ranson scores can further improve the predictive ability of organ failure,pancreatic necrosis and mortality rate,which provides a reference for the selection of clinical treatment strategies.

Objective To explore the short-term variation and related factors of serum calcium and phosphorus after parathyroidectomy(PTX) in patients with secondary hyperparathyroidism (SHPT).Methods A total of 18 patients treated with PTX for intractable SHPT in our hospital were analyzed retrospectively.Baseline data and serum intact parathyroid hormone(iPTH),serum alkaline phosphatase(ALP),serum calcium and phosphorus of all patients on the first，the third and the seventh day after PTX were collected and compared.The calcium requirements in a week after PTX were collected.Pearson and Spearman correlation analysis were used to analyze the correlation among preoperative serum iPTH,serum calcium,serum phosphorus,serum ALP and calcium requirements in a week after the operation.Results Serum iPTH and phosphorus of all patients on the first，the third and the seventh day after PTX were significantly decreased than those before PTX(P＜0.05).Serum ALP on the first day after PTX was significantly decreased than that before PTX(P＜0.05).Serum calcium on the seventh day after PTX was significantly decreased than that before PTX(P＜0.05).Serum iPTH level before PTX was positively correlated with serum ALP level before PTX(r=0.773,P＜0.001).Calcium requirements in a week after PTX were positively correlated with serum iPTH level(r=0.855,P＜0.001) and ALP level(r=0.925,P＜0.001)before PTX.Conclusion PTX is a safe and effective treatment for intractable SHPT，which can quickly correct the metabolic disorder of serum calcium and phosphorus in short time.

Objective To explore the correlation between level of nine vitamins and metastasis of lung adenocarcinoma.Methods Clinical data of 201 patients with lung adenocarcinoma in our hospital from January 2016 to August 2018 were analyzed retrospectively.They were divided into metastasis group(132 cases) and non-metastasis group(69 cases) according to tumor metastasis or not.The 132 patients in metastasis group were divided into oligo-metastasis group(73 cases) and multiple-metastatic group(59 cases) according to number of tumor metastatic organs and metastatic lesions.Levels of serum nine vitamins were measured and compared between each group.Results There were no significant differences of age and composition ratio of sex,smoking history,family history,regular exercise,daily sunshine time,fruit intake and diet balance between non-metastasis group and metastasis group(P>0.05).Levels of serum vitamins in patients of non-metastasis group and metastasis group were mainly deficient,such as vitamin A,vitamin B₂,vitamin C and vitamin D deficiency.Overdose of serum vitamins were relatively rare.There were no significant differences of levels of serum vitamin A,B₁,B₂,B₆,B₉,B₁₂,C,D and E between non-metastasis group and metastasis group(P>0.05).Level of serum vitamin D in multiple metastasis group was lower than that in oligo-metastasis group(P＜0.05).While there were no significant differences of levels of serum vitamin A,B₁,B₂,B₆,B₉,B₁₂,C and E between multiple-metastasis group and oligo-metastasis group(P>0.05).Conclusion Vitamin D may play a role in inhibition of metastasis of lung adenocarcinoma.   

Objective To explore predictive value of serum microRNA(miR)-20a and autophagy related gene 7(ATG7) on major adverse cardiovascular event(MACE) in patients with acute ST-segment elevation myocardial infarction(STEMI) after percutaneous coronary intervention(PCI).Methods According to in-hospital prognosis,233 patients with newly diagnosed acute STEMI undergoing PCI were divided into MACE group(64 cases) and non-MACE group(169 cases).Serum amino terminal pro-brain natriuretic peptide(NT-proBNP),type Ⅲ procollagen amino terminal peptide(PⅢNP),ATG7 and miR-20a levels were compared and to analyze their correlation.Results Age,NT-proBNP,PⅢNP,ATG7 levels and ratio of patients with Killip cardiac function grade Ⅳ in MACE group were higher than those in non-MACE group,while serum miR-20a level was lower than that in non-MACE group(P<0.05).Multivariate logistic regression analysis showed that elevated age,Killip cardiac function grade Ⅳ,NT-proBNP,PⅢNP and ATG7 levels were independent risk factors for in-hospital MACE after PCI in patients with acute STEMI,and elevated serum miR-20a level was an independent protective factor for it（P<0.05).Pearson correlation analysis showed that serum miR-20a was negatively correlated with ATG7,NT-proBNP and PⅢNP(P<0.05)，while serum ATG7 was positively correlated with NT-proBNP and PⅢNP（P<0.05).Receiver operating characteristic(ROC) curve analysis showed that value of serum miR-20a combined with ATG7 predicted in-hospital MACE in patients with acute STEMI after PCI was higher than serum miR-20a and ATG7.Conclusion Serum miR-20a and ATG7 are closely related with NT-proBNP and PⅢNP and are independent predictive factors of in-hospital MACE in patients with acute STEMI after PCI.

Objective To observe the efficacy and safety of different doses of recombinant tissue plasminogen activator(rt-PA) intravenous thrombolysis in the treatment of senile acute cerebral infarction(≥80 years old).Methods Seventy-eight patients with acute cerebral infarction were treated with intravenous thrombolysis using rt-PA，and were divided into low-dose group(0.6mg/kg，40 cases) and standard group(0.9mg/kg，38 cases) according to the drug dose.There were 39 cases in the non-thrombolytic group.Clinical efficacy,National Institutes of Health Stroke scale (NIHSS),modified Rankin Scale(mRS),incidence of intracranial hemorrhageand mortality of the three groups were compared.Results There was no significant difference in total effective rate between low-dose group and standard dose group (P>0.05),and were both higher than that in the non-thrombolytic group(P<0.05).There was no significant difference in NIHSS scores between low-dose group and standard dose group on 1d,7d,15d and 30d after treatment (P>0.05),and were significantly lower than those of the non-thrombolytic group (P<0.05).There was no significant difference in mRS scores between low-dose group and standard dose group(P>0.05),and were significantly lower than that of non-thrombolytic group(P<0.05).The intracranial hemorrhage rate in low-dose group was significantly lower than that in standard dose group(P<0.05).The intracranial hemorrhage rates in low-dose group and standard dose group were higher than that in non-thrombolytic group(P<0.05).There was no significant difference in the mortality between low-dose group and standard dose group(P>0.05)，and were significantly lower than that in non-thrombolytic group(P<0.05).Conclusion Venous thrombolysis is safe and effective in the treatment of senile acute cerebral infarction.Small dose of rt-PA can reduce the risk of bleeding and reduce the neurological deficit.

Objective To observe the therapeutic effect of β-glucan on immunoglobulin A(IgA) nephritis rat model and its effect on Th1/Th2 drift.Methods Forty-two rats were selected to establish IgA nephritis model,which were divided into model group,low dose group,medium dose group and high dose group,and 12 unmodeled rats were set as control group.The urinary erythrocyte count and 24 hour urinary protein content were compared.The histopathological changes of kidney were observed.IgA immunofluorescence precipitation in kidney tissues,Th1/Th2 in rat spleen,the levels of gamma interferon (IFN-γ) and interleukin-4 (IL-4) in serum and kidney tissues of rats were detected.IFN-γ/IL-4 were calculated and compared.Results (1)Comparisons of urinary erythrocyte count and 24 hour urinary protein levels of rats in 5 groups showed that model group>low dose group>medium dose group>high dose group>control group (P<0.05).(2)In model group,glomerular enlargement,cystic wall adhesion,mesangial matrix proliferation and vacuole like changes of renal tubular epithelial cells were observed.The above structures were normal in control group and alleviated in each dose group with doseindependence.(3)There was no IgA immunofluorescence precipitation in the glomerular mesangial area of the control group,but there was strong IgA green fluorescence precipitation in the model group,which was weakened in each dose group with dose independence.(4)Comparison of Th1/Th2 in spleen tissue of rats in 5 groups showed that model groupP<0.05).(5)Comparison of the levels of IL-4 in serum and kidney tissues of rats in 5 groups showed that,model group>low dose group>medium dose group>high dose group>control group（P＜0.05）.Comparison of serum IFN-γ levels and IFN-γ/IL-4 showed that,model groupP＜0.05）.Conclusion β-glucan can significantly improve the condition of hematuria,urinary protein and IgA precipitation in rats with IgA nephritis,and alleviate renal injury,which may be related to regulating the shift of Th1/Th2 balance to Th1.