Rheumatoid arthritis ( RA ) and systemic lupus erythematosus ( SLE ) are the most important and typical autoimmune diseases,however their exact mechanisms has not yet been clear. Autohpagy,a highly conserved process,depends on catabolism of lysosomal degradation of macromolecules or organelles within the cell itself. Autophagy exists widely in various tissues and is involved in maintaining survival and differentiation of cell or the stablility of internal environment. Recently,autophagy has gained wider attention and been one of the hot points of relative reserches. In this review we′ll sum up the development of autophagy in RA and SLE.

Characterized by chronic arthritis, juvenile idiopathic arthritis (JIA) refers to a group of rheumatic diseases in children with unknown causes and strong clinical heterogeneity.Most patients have good prognosis, while some may be involved with important extra-articular organs and tissues, including cardiac system damage, pulmonary or pleural lesions, renal amyloid degeneration, uveitis, and so on.Delay in diagnosis and treatment may lead to short-term and/or long-term involvement in vital systems, thus resulting in the aggravation of the disease or poor prognosis, which may decrease their life quality and even threaten their life.Understanding the extra-articular manifestations of JIA is very important to manage disease.

Objective To evaluate our experience of minimal access parathyroidectomy for primary hy-perparathyroidism (PHPT) caused by parathyroid adenoma. Methods From Jan 2000 to Jan 2009, clinical data of 28 cases of PHPT treated by minimal access surgery were analyzed retrospectively. Results All patients except 3 had severe clinical manifestations, serum calcium and parathyroid hormonal (PTH) of all the cases were elevat-ed. The rate of accuracy of preoperation localization by the sestamibi scan combined with ultrasound was 100%.The pathological diagnoses of all the 28 cases were uni-gland parathyroid adenoma. Within the follow-up of 6 months, no case suffered complication and recurrence, the levels of serum calcium were normal or decreased slightly, and the levels of PTH were normal or elevated slightly but no higher than 2 times of normal PTH level. Conclusions Preoperative localization is very helpful by using combination of sestamibi and ultrasound scan. Minimally invasive parathyroidectomy is a kind of improving procedure for the localized parathyroid adenoma.

Objective To investigate the correlation of traditional Chinese medicine (TCM) syndrome types of chronic gastritis with Helicobacter pylori (Hp) eradication rate after anti-Hp treatment. Methods A total of 180 chronic gastritis patients with Hp infection were differentiated into spleen-stomach insufficiency syndrome, spleen-stomach dampness-heat syndrome, and liver depression and qi stagnation syndrome, and each syndrome group had 60 cases. Patients in each group were evenly divided into two subtypes, and were treated with triple therapy or quadruple therapy for 10 days respectively. After treatment, the Hp eradication rate in each group was compared. Results (1) The overall Hp eradication rate was 78.3%. No matter after triple therapy or quadruple therapy, patients with spleen-stomach insufficiency syndrome had the lowest Hp eradication rate (61.7%), which was lower than that of the patients with spleen-stomach damp-heat syndrome (88.3%) and the patients with liver depression and qi stagnation syndrome (85.0%), the difference being statistical significance (P < 0.05 or P < 0.01). However, the difference of Hp eradication rate between spleen-stomach damp-heat group and liver depression and qi stagnation group was not statistically significant (P>0.05). (2) A total of 10 cases had adverse reaction such as nausea and vomiting, stomachache, and gastric distention, 8 cases from spleen-stomach insufficiency group, one from spleen-stomach dampness-heat group, and one from liver depression and qi stagnation group. Spleen-stomach insufficiency group had higher incidence of adverse reaction than the other two groups (P < 0.05). Conclusion The Hp eradication rate after anti-Hp treatment varied in chronic gastritis patients with different TCM syndrome types, and the rate in patients with spleen-stomach insufficiency syndrome was lower than that of the patients with spleen-stomach damp-heat syndrome and the patients with liver depression and qi stagnation syndrome no matter after triple therapy or quadruple therapy.

Objective To observe the nursing efficacy of cluster-based care for bronchial asthma.Methods 100 cases with bronchial asthma were randomly divided into the study group and the control group with 50 patients in each group.The control group received usual care,and the study group received cluster-based care model.Curative effect,the total of the cases received inhalation therapy correctly,compliance of inhalation therapy,degree of satisfaction to nursing services in the two groups were compared.Results The curative effect in the study group were better significantly than the control group (86％ vs 58％).The cases received inhalation therapy correctly in the study group were more than the control group (92％ vs 72％).The compliance of inhalation therapy in the study group was significantly higher than the control group(90％ vs 80％).The degree of satisfaction to nursing services in the study group were significantly higher than the control group (98％ vs 86％).Conclusions Cluster-based care had good effect on patients with bronchial asthma.

Objective To evaluate the therapeutic effect of health education pathway on type 2 diabetic patients by using the Meta-analysis.Methods The domestic main databases were searched,the quality of included studies which screened by certain standards was evaluated.The Review Manager 5.0software was taken for analysis.Results Totally 12 studies were included,containing 2115 cases of type 2 diabetic patients.The Meta-analysis showed there were significant differences between the health education pathway group and the control group in hospitalization days and hospitalization expenses,rate of patients' satisfaction and rate of mastering knowledge of diabetes mellitus,fasting blood glucose and 2h postprandial blood glucose.Conclusions Health education pathway for type 2 diabetic patients can shorten hospitalization days,decrease hospitalization expenses,increase rate of patients' satisfaction and rate of mastering knowledge as well as lower fasting blood glucose and 2h postprandial blood glucose.

Objective: To compare the difference in somatic gene mutation of PTC subtypes between 114 patients with papillary thyroid carcinoma (PTC) and The Cancer Genome Atlas (TCGA) database. Methods: Totally 114 PTC patients admitted to The First Affiliated Hospital of Nanjing Medical University were recruited. The 18 hotspot genes associated with thyroid cancer were detected in thyroidectomy specimens were using next generation sequencing. PTC data were downloaded from the TCGA database in the cBioPortal website, and the difference in the somatic gene mutation was compared between 114 PTC patients and the TCGA database Results: The 114 PTC patients included 73 women (64.04%) and had a mean age of (39.23±13.18) years. The prevalence of BRAF V600E (66.67% vs. 48.68%), TERTp (3.51% vs. 0.41%), PDGFRA (1.75% vs. 0%), PTEN (3.51% vs. 0.41%) and TP53 gene mutations (4.39% vs. 0.61%) was significantly higher among the 114 PCT patients than in the TCGA database (P<0.05). The prevalence of BRAF V600E (80.88% vs. 54.99%), TP53 (7.35% vs. 0.57%) and TSHR gene mutations (2.94% vs. 0%) was significantly higher in classical PTC(CPTC) patients than in the TCGA database, and the prevalence of BRAF V600E (36.84% vs.13.86%) and TERTp gene mutations (10.53% vs. 0%) was significantly higher in follicular variant PTC (FVPTC) patients than in the TCGA database. According to the American Thyroid Association Risk Stratification of Thyroid Cancer Recurrence, the prevalence of BRAF V600E and TP53 gene mutations was 77.14% and 8.57% among moderate-risk CPTC patients, the prevalence of BRAF V600E gene mutation was 27.27% among low-risk FVPTC patients, and the prevalence of TERTp gene mutation was 33.33% among moderate-risk FVPTC patients, which were all higher than in the TCGA database (55.10%, 0%, 3.28%, and 0%, respectively; P<0.05). Conclusion There are significant differences in the type and rate of somatic gene mutations between 114 PTC patients and the TCGA database.

A total of 55 cases of advanced schistosomiasis patients combined with Ⅲ-grade hepatic fibrosis and ascites were randomized into a splenectomy group and non-splenectomy group. The peripheral vein blood phlebotomized from these patients were detected for leucocytes, hematids, thrombocytes, acidophils, glutamic-pyruvic transaminase,alkaline phosphatase,albumin, total bilirubin,three-type precollagen, fore-type collagen, hyaluronic acid, IgG, IgA, C_3, C_4 and the sub-group of lymphocytes such as CD3、CD4、 CD8 、CD56 + 16. There were no significant difference on hepatic function and the level of hepatic fibrosis between the groups above metioned. It could be found that leucocytes, thrombocytes, IgG, IgA, CD56 + 16 increased while CD3, CD4, and albumin decreased in the splenectomy group. In conclusion, leucocytes and thrombocytes increase after splenectomy, cytoimmunity declines and humoral immunity enhances.

Objective In China primary hyperparathyroidism is not a kind of common disease as in the wesyrn countries.This article reports the current status in the diagnosis and treatment of primary hyperparathyroidism in the mainland of China. Methods We collected 730 cages of primary hyperparathyroidism diagnosed and treated in 7 top hospitals for endocrine surgery from 1965 to 2005.Results In this study.652(89.3%)cases were clinically symptomatic while 78(10.7%)cases were asymptomatic:442 cases were positive on 99mTc-MIBI scanning.Bilateral explorations were undertaken in 377 patients and unilateral or uni-gland exploration through the conventional incision in 204 cases.Minimally invasive parathyroidectomy in 143 cases.Endoscopically assisted 2 cm incision was taken in 6 cases for unilateral gland exploration.Pathologically 632(86.6%)cases were identified as adenoma,58(8.3%)cases were of hyperplasia and 40(5.5%)cases were of carcinoma.There were no major postoperative complications.While 20 patients suffering from recurrence or persistent postoperative hyperparathyroidism,the others are of normal or depressed serum level of calcium. Conclusions Preoperative localization is very helpful: Unilateral exploration for parathyroid adenoma is feasible; minimally invasive parathyroidectomy throush minimal incision is a kind of improving procedure for the localized parathyroid adenoma.

Objective To explore the safety of total thyroidectomy surgery on patients with thyroid carcinoma. Methods From Jan 1986 to Dee 2006, clinical data of patients who underwent total thyroidectomy (total thyroidectomy group) and sub-total or near-total thyroidectomy surgery (control group) for thyroid carcinoma were retrospectively analyzed to identify the incidences of complications, recurrent laryngeal nerve paralysis (RNLP) and secondary hypoparathyroidism in the two groups. Results In the control group there were 433 thyroid carcinoma patients who underwent sub-total or near-total thyroidectomy. Transient unilateral RLNP(13 eases), permanent unilateral RLNP(5 eases), transient hypoparathyroidism (11 cases) was diagnosed. There was no permanent hypoparathyroidism in this group. In the 70 cases of thyroid carcinoma patients receiving total thyroidectomy, there were 4 eases suffering from transient unilateral RLNP, one case from permanent unilateral RLNP (P > 0.05), and there were 7 eases from transient hopyparathyroidim (P < 0.01), 2 eases from permanent hypoparathyroidism (P < 0.05). Conclusion The incidence of RLNP after total thyroidectomy was not higher than that after subtotal or near-total thyroideetomy. Postoperative hypocalcaemia was the most common postoperative complication of total thyroidectomy. It is our belief that total thyroidectomy should be performed in selected patients.