Objective To investigate the clinical features of Remitting Seronegative Symmetrical Synovitis with Pitting Oedema(RS3PE),especially it’s association with malignancy. Methods The clinical data of eight RS3PE patients hospitalized during Jan 2003 and June 2007 in Peking Union Medical College Hospital were reviewed. The clinical characteristics, laboratory tests, response to treatment as well as the outcome were studied. Among the 8 patients, five were male and 3 were female,the mean age of RS3 PE onset was 60.9 (38～79yr). 5 had idiopathic RS3PE without underlying disease, and 3 presented associated neoplasm. Results All patients had symmetrical polyarthritis and pitting edema on the dorsum of hands and/or feet. Extra-articular symptoms were more conspicuous in patients complicated by neoplasm. Serum RF、AKA、APF and anti-CCP antibody were all negative. antinuclear antibodies (ANA) was positive with low titer in five cases. Hand and foot radiographs did not show bone erosion in all cases. After steroid and/or immunosuppressive treatment, 2 cases exhibited persistent remission of articular symptoms and edema, whereas relapses occurred 6, 7 and 36 months respectively after the initial diagnosis in 3 cases who had been pathologically confirmed as having Non-Hodgkin-Lymphoma and thereby received periodical chemotherapy. Conclusion RS3PE is a group of clinical manifestations with prominent heterogeneity, therefore intensive follow-up is necessary, and the presence of systemic symptoms/ signs in RS3PE patients alert the physician for the potential concomitant malignancy.

Objective According to international classification criteria (2002) on Sjogren' s syndrome, labial pathology was still considered as a major criterion for diagnosis. Standard labial biopsy was hard to be carried out in China. This study is to evaluate whether the invasive labial biopsy could be replaced by noninvasive detection of serum anti-SSA antibody. Methods 181 Chinese patients with the initial diagnosis of primary Sjogren's syndrome in Peking Union Medical College Hospital (PUMCH) were enrolled in Sjogren's International Collaborative Clinical Alliance (SICCA). All patients received standard labial biopsies (area of salivary gland tissues≥4 mm~2) and focal score (FS) of focal lymphatic sialadenitis were confirmed by pathologists from school of stomatology,University California of San Francisco (UCSF). Anti-SSA antibodies in sera of all patients were detected by double immunodiffusion (DID), Western blot in PUMCH and by enzyme-linked immunosorbent assay (EIJSA) in central laboratory of SICCA. The correlation between labial pathological findings and serum anti-SSA antibody was studied by X~2 test and the concordance was calculated by unweighted Kappa. Results(1)Bivariate analysis revealed strong associations of FS > 1 with the presence of anti-SSA antibody by DID (83.9% vs 42. 0%, P <0. 0001). The accordance between FS and antibody detection by DID was fine with a kappa value of 0. 432. However, there were 16. 1% false-positive antibody reports and 42.0% false-negative antibody reports. (2)FS > 1 was strongly associated with the presence of anti-SSA antibody by Western blot (83.0% vs 51.7%, P < O. 0001). But the accordance between FS and antibody detection by Western blot was only fair with a kappa value of 0. 316. There were 17.0% false-positive antibody reports and 51.7% false-negative antibody reports. (3)FS > 1 was strongly associated with the presence of anti-SSA antibody by ELISA (81.5% vs 38.6%, P <0. 0001). The accordance between FS and antibody detection by EI,ISA was fine with a kappa value of 0.427. There were 18.5% false-positive antibody reports and 38. 6% false-negative antibody reports. Conclusion In Sjogren's syndrome, labial biopsy with FS > 1 finding is strongly associated with anti-SSA antibody. Positive results of anti-SSA antibodies by DID or ELISA may indicate FS > 1, thus labial biopsy could relatively be avoided, negative results may need further standard labial biopsy procedure to confirm the diagnosis of Sjogren's syndrome.

Objective To compare the safety of laparoscopic live donor nephreetomy(LDN) and open live donor nephrectomy(ODN), evaluate the kidney function and blood pressure of living donors during 1 year follow-up. Methods Thirty cases of LDN and 30 eases of ODN were retrospectively reviewed. The operation time, warm ischemia time, operative blood loss, time to post-operative intake and time to ambulation of the 2 grouups were compared. According to the modified Clavien classifica-tion system procedure-related complications were described and compared. Serum creatinine(SCr) le-vels, blood pressure and 24-h urine protein excretion were measured before nephreetomy and 1 d, 7 d, 3 months, 6 and 12 months after nephrectomy. Glomerular filtration rate (GFR) were measured preo-pratively and at 6 and 12 months postoperatively. These data were statistically analyzed. Results The operation time was (98. 6+13. 6)rain and (96.3+19. 5)rain in the LDN and ODN groups, re- spectively. Warm ischemia time in the LDN group was (90.6±15.1)s, in the ODN group was (86.4±12.3)s. Operative blood loss was (105.2±634.8)ml and (206.3±126.4)ml in the LDN and ODN groups(P<0.01). For the time to post-operative intake and time to ambulation, LDN group was (28.5±2.9)h and (25.8±63.8)h, ODN group was (38.6±63.3)h and (36.5±65.3)h(P<0.01). Perioperative complications rates were 6.6%(2/30) and 23.3%(7/30) for LDN and ODN, respective-ly. SCr was (109.1±7.5), (105.4±69.5), (96.6±10.7), (89.4±11.5), (91.6±69.3)/zmol/L in the LDN group and (107.3±69.6), (103.3±68.4), (95.4±69.1), (90.5±13.6), (90.3±11.7)μmol/L in the ODN group 1 day, 7 days, 3 months, 6 months and 12 months after nephrectomy. The mean GFR of LDN and ODN was 64.7 and 65.8 ml/min at 6 months after nephrectomy, 65.9 and 67.5 ml/min at 12 months postoperatively, which were significantly different comparing with preoperative mean GFR in each group(P<0.05) but no significant difference was found between 6 months and 12 months after nephrectomy and between the 2 groups at the same time point respectively(P>0.05). Mean 24 h protein excretion was elevated after either LDN or ODN during 1 year followup, but was not significantly different either between predonation and 1 year after nephrectomy or between the 2 groups at the same period. Blood pressure increased or decreased slightly with the duration of follow-up,no significant blood presure changes were found before and after nephrectomy or between the two groups at the same period postoperatively. Conclusions LDN has the advantages of minimal trauma, less operative blood loss and quicker convalescence. It is safe and and has no adverse effects regarding kidney function and blood pressure during the first year after living kidney donation comparing to ODN.

Objective The aim of this study was to investigate the possibility of type 2 vesicular monoamine transporter molecular probe,18 F-FP-(+)-DTBZ, in the monitoring of total islet β cell mass in animal models. Methods Two groups of Wistar rats were included in this study. In the type 1 diabetes group ( n = 6 ) , the streptozotocin ( STZ) was intraperitoneally injected at a dose of 65 mg/kg, and the control group ( n= 6 ) was likewisely injected with an equal volume of saline, Micro- positron emission tomography ( PET )/ computed tomography ( CT) imaging was performed at these rats post injection of18 F-FP-(+)-DTBZ at 0. 5, 1, 4, 6, and 12 months after STZ or saline injection, bodyweight and glucose level were also measured. Results The average standardized uptake values ( SUV) in the pancreas in the type 1 diabetes rats were decreased significantly than that of the control group at 0.5, 1, and, 4 months ( P<0.05) , and there was no significant difference at 6th and 12th months ( P>0.05) post injection of STZ and saline. Fasting blood glucose positively correlated with pancreatic SUV in the two groups at 0.5, 1, and 4 months (P<0.05) post injection of STZ and saline. Conclusion 18F-FP-(+)-DTBZ PET imaging is a promising method for dynamic monitoringβcell mass in type 1 diabetic rats.

Objective The aim of this study was to evaluate theβ-cell mass ( BCM) in patients with type 2 diabetes mellitus( T2D) by PET/CT using [ 18 F]-FP-(+)-DTBZ, which is a vesicular monoamine transporter type 2 molecular probe. The feasibility of pancreatic head, body and tail as the target area was investigated for evaluation of the BCM in T2D. Methods 15 subjects ( 8 with T2D, and 7 as control) were involved in this study with 20 min static PET imaging at 40 min post injection of [ 18 F]-FP-(+)-DTBZ. The volume of interest ( VOIs) of pancreatic head, body and tail were drawn and quantitatively assessed. Spleens were collected as reference tissue for SUVR calculation. Results SUVR in the pancreatic head ( SUVR=1.72 ± 0.47) and pancreatic body, tail ( SUVR=1.85 ± 0.41) in T2D group was no significant difference, and no significant difference was observed in the pancreatic head (SUVR=2.54±0.57) and pancreatic body, tail(SUVR=2.73±0.41) in control group as well. In T2D group, a significant decreased SUVR was found in pancreatic head (P=0.0088) and pancreatic body and tail (P=0.0012) compared with controls. Conclusion The VMAT2 molecular probe [ 18 F]-FP-(+)-DTBZ can be used to evaluate BCM in patients with T2D.

Objective:To investigate the correlations between cerebral β-amyloid (Aβ) deposition assessed by 18F-florbetapir (AV45) PET imaging and clinical cognitive symptoms in patients with subtle cognitive decline (SCD) and mild cognitive impairment (MCI). Methods:Data of twenty-four patients (11 males, 13 females, age: (63.2±7.6) years) diagnosed as SCD ( n=15) or MCI ( n=9) from December 2018 to March 2019 in Shanghai Jiao Tong University Affiliated Sixth People′s Hospital were collected prospectively. All patients underwent 18F-AV45 PET imaging, brain MRI T 1 scan and Mini-Mental State Examination (MMSE) within two weeks. 18F-AV45 PET images were analyzed visually (positive, mild positive, negative). After being pretreated according to the MRI, 18F-AV45 PET images were analyzed semi-quantitatively by calculating the standardized uptake value ratio (SUVR) of Aβ deposition in 8 regions of interest (ROIs; frontal lobe, lateral parietal lobe, lateral temporal lobe, medial temporal lobe, occipital lobe, basal ganglia, posterior cingulate and precuneus), with cerebellar gray matter as the reference. Partial correlation coefficients between regional SUVRs and MMSE score were calculated. Results:18F-AV45 PET imaging showed that 16 patients with positive results and 8 patients with mild positive results. MMSE score of 24 patients was 28.2±2.0, and the SUVR was 0.93-1.87. Correlation analysis revealed that Aβ deposition in frontal cortex ( r=-0.432), posterior cingulate lobe ( r=-0.434) and precuneus ( r=-0.418) was negatively correlated with MMSE score (all P<0.05); and no significant correlations between SUVR and MMSE in other brain regions were found ( r values: from -0.412 to -0.110, all P>0.05). Conclusion:18F-AV45 PET imaging can noninvasively detect brain Aβ deposition in patients, and can effectively reflect the clinical cognitive status of patients with SCD and MCI to a certain extent.

Objective:To explore the abnormal brain metabolic pattern and connectivity in temporal lobe epilepsy (TLE) patients.Methods:18F-FDG PET images of 75 patients diagnosed as drug resistant unilateral TLE from January 2014 to December 2016 in Huashan Hospital of Fudan University were collected retrospectively, including 41 (22 males, 19 females, age (28.4±8.7) years) left TLE (LTLE) and 34 (13 males, 21 females, age (28.5±8.8) years) right TLE (RTLE). Forty-four healthy controls (24 males, 20 females, age (31.2±6.2) years) were also enrolled. The cerebral glucose metabolism in TLE patients and the controls were analyzed with statistical parametric mapping (SPM) 12. The brain connectivity based on glucose metabolism were analyzed with bilateral hippocampus and amygdala as seeds. Permutation test with 1 000 permutations was used to analyze data. Results:Compared to control group, in both LTLE and RTLE groups, hypometabolism was found in affected hippocampus, amygdala, insula and temporal gyrus and hypermetabolism was observed in health hippocampus, parahippocampal gyrus, amygdala, lenticular nucleus and thalamus. In addition, hypometabolism was also found in affected superior/middle frontal gyrus and hypermetabolism was also found in bilateral frontal-orbital gyrus, bilateral cerebellum, affected lenticular nucleus and thalamus in LTLE group. In both TLE groups, affected seeds exhibited increased connectivity with affected superior frontal gyrus, lingual gyrus, fusiform gyrus, superior/middle temporal gyrus and temporal pole (all P<0.05); affected seeds exhibited increased connectivity with health superior frontal gyrus ( P=0.005), lingual gyrus ( P=0.018) and transverse temporal gyrus ( P=0.016) in RTLE group in addition. Besides, affected seeds exhibited decreased connectivity with bilateral default mode network (DMN) (all P<0.05), affected caudate nucleus ( P=0.015) and health thalamus ( P=0.008), in a uniform distribution pattern in LTLE group, and with bilateral cerebral cortex in an irregular distribution pattern in RTLE group (all P<0.05). In LTLE group, health seeds exhibited more increased connections with superior ( P=0.005)/middle frontal gyrus ( P=0.042), health hippocampus ( P=0.038), parahippocampal gyrus ( P=0.019), amygdala ( P=0.038), posterior cingulate gyrus ( P=0.004), and bilateral fusiform gyrusand ( P=0.048) compared with RTLE group; while, in RTLE group, health seeds exhibited more decreased connections with health superior ( P=0.047), inferior frontal gyrus ( P<0.001), orbital frontal gyrus ( P<0.001) and rectus gyrus ( P=0.016) compared with LTLE group. Conclusion:Altered brain glucose metabolism and connectivity pattern are found and will elucidate the underlying metabolic pattern of TLE.

Objective To investigate the clinical features of bullous systemic lupus erythematosus (BSLE),so as to improve the physicians' understanding of this condition.Methods The clinical date of 8 BSLE patients who were hospitalized in Peking Union Medical College Hospital from January 2014 to December 2016 were analyzed.Numerical data and categorical data were analyzed using t-test and chi-square test,respectively.Results These 8 subjects accounted for 0.3％ of the 2 965 hospitalized systemic lupus erythematosus (SLE) patients,including 2 males and 6 females with the mean age of (25±10) years old and median duration of 17 (3～43) months.Skin lesions,as the initial symptom at onset were shown in 3 cases.Blisters or bullae occurred on the face in 6 patients (6/8),trunk in 5 patients (5/8),extremities in 5 patients (5/8).All of them arose on normal-appearing skin.BSLE often occurred in active SLE with the average SLE disease activity index (SLEDAI) score of (12±8).Renal damage (8/8) was the most common complication followed by hematological abnormality (6/8),serositis (4/8),arthritis (3/8),neurological involvement (2/8).Compare with SLE patients without BSLE,the incidence of hematuria (6 cases,75％) and hemolytic anemia(4 cases,50％) were statistically higher in BSLE patients.Treated by corticosteroid and immunosuppressants,6 patients achieved clinical improvements,Conchusion The incidence of SLE is relatively rare.It tends to occur in patients with active lupus,especially in lupus nephritis and hematologic involvement.Glucocorticoids combined with immunosuppressants,as well as local treatment,could improve the prognosis.

Objective The aim of this study was to compare the short-term and long-term prognostic significance of dif-ferent systemic inflammatory scores in patients with gastric cancer:neutrophil lymphocyte ratio(NLR) and platelet lymphocyte ratio ( PLR). Methods The clinical data of 240 patients with gastric cancer who underwent radical surgery were retrospectively analyzed. The relationship between NLR,PLR,glasgow prognostic score( GPS) and clinicopathological characteristics and perioperative compli-cations were compared. Survival analysis was performed using Kaplan-Meier survival analysis. The Log-rank methods were used to test the difference significance,and the multivariate analysis was performed using the Cox regression risk model. Results Patients in the high NLR and PLR groups were older,had a high GPS,deep tumor infiltration,more lymph node metastasis,and a late TNM stage (P<0. 05). The rate of positive margin in the high NLR group was higher(P<0. 05). Patients in the high NLR and PLR groups re-quired significantly higher transfusion rates than those in the low NLR and PLR groups(P<0. 05),and the high NLR group had more postoperative complications(P<0. 05). Univariate analysis showed that age,GPS,tumor location,tumor infiltration depth,lymph node metastasis status,TNM stage,vascular tumor thrombus,nerve infiltration,NLR and PLR were associated with postoperative survival of gastric cancer patients(P<0. 05). The overall survival(OS)in high NLR and high PLR groups was lower than that of low NLR and low PLR groups(P=0. 018 and P<0. 001). Cox regression analysis showed GPS and lymph node metastasis were independent prog-nostic factors of OS(P<0. 001 and P=0. 002). Conclusion Preoperative systemic inflammatory scores NLR and PLR are prognos-tic factors affecting the preoperative clinical outcomes of gastric cancer. It is recommended to be used in combination with other prog-nostic indicators for routine use in the prognosis of patients undergoing radical gastrectomy.

Objective: To observe the alteration of brain glucose metabolic network in patients with somatoform disorders (SFD). Methods: ¹⁸F-fluorodeoxyglucose (FDG) PET images of 18 SFD patients (10 males, 8 females; age: (39.5±12.0) years; illness duration: (3.67±3.20) years) and 21 matched healthy controls (13 males, 8 females; age: (43.9±8.4) years) in Huashan Hospital of Fudan University from October 2011 to December 2012 were enrolled to construct the brain glucose metabolic networks for 2 groups (SFD group, control group) respectively. Then the global network properties (normalized clustering coefficient, normalized shortest path length, small-worldness and global efficiency) and local parameters (clustering coefficient and betweenness centrality of the node) were calculated using the graph theory. Differences between 2 groups were compared by permutation test with 1 000 permutations. The top 20% (18/90) were classified as Hub nodes based on the results of clustering coefficient and betweenness centrality of the node. Results: Small-worldness of SFD patients was similar to that of healthy controls (σ>1). There were decreased tendency in normalized clustering coefficient and global efficiency, and increased tendency in normalized shortest path length in SFD patients, but without significant differences (P>0.05). Compared to healthy controls, the betweenness centrality of left pallidum, left amygdala, left precuneus and right angular gyrus increased (permutation test, P<0.05); the betweenness centrality of left middle temporal gyrus, right superior occipital gyrus decreased (permutation test, P<0.05); the clustering coefficients of bilateral pallidum, bilateral thalamus, and left amygdala decreased (permutation test, P<0.05). Most changed Hub nodes (16/24) belonged to limbic system. Conclusion The changes of topological properties of brain glucose metabolic network in SFD patients including the decreased tendency of small-worldness and global efficiency, as well as the altered Hub nodes, may provide valid imaging evidences for brain dysfunction of somatization symptoms.