Objective To study the use of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in patients with cholecystocholedocholithiasis.Methods From July 2006 to June 2010,127 patients with cholecystocholedocholithiasis were treated either by LC+LCBDE (n=78) or LC+endoscopic sphincterotomy (EST,n=49).The treatment success rate,complications,retained bile duct stones rate,recovery of gastrointestinal function and hospital-stay were retrospectively analyzed.Results The LCBDE+ LC group:The operative success rate was 94.87 ％.The incidence of postoperative complications was 5.41 ％.The EST+ LC group:Complete removal of bile duct stones was achieved in 46 of 48 patients (95.92％).The incidence of postoperative complications was 12.77％.There was a significant difference in the incidences of postoperative complications between the EST+ LC group and the LCBDE+ LC group (P＜0.05).The operative time and the cost for hospital stay between the two groups were significantly different (P＜0.05).After a follow-up of 3.2 years (mean,range 1-5 years),there was no significant difference in long-term complications such as bile duct recurrent stones,duodenal papilla stenosis and cholangitis between the two groups (P＜0.05).ConclusionsLCBDE was a safe,efficacious and feasible minimal invasiveness treatment for cholecystocholedocholithiasis.Primary closure of common bile duct in selected cases brought additional benefits to the minimal invasive technique.

To investigate the etiology and differential diagnoses of patients with systemic lupus erythematosus (SLE) and fever of unknown origin (FUO).From January 2012 to December 2014,a total of 928 SLE patients were admitted to Peking Union Medical College Hospital.Only 50 patients were combined with FUO (5.4％).The most common reason of fever was caused by infections (33 cases,66.0％),including bacterial infection in 17 cases with 5 tuberculosis,viral infection in 11 cases,and fungal infection in 5 cases.The second reason offever was due to poor disease control or recurrence in 17 patients (34.0％).No fever was caused by malignant tumor.When clinical data was compared between 17 non-infected patients versus 33 infected patients,C reactive protein and procalcitonin in the infected group were significantly higher than those in the non-infected group.In SLE patients combined with FUO,infection is the most common etiology which is necessary to be paid attention to.

Objective To analyze the clinical characteristics and prognosis of ANCA associated microvasculitis patients with gastrointestinal tract hemorrhage. Methods A retrospective analysis was conducted in 8 ANCA associated microvasculitis patients with gastrointestinal tract hemorrhage admitted to our hospital from May 1987 to May 2007. The statistical treatment is Kaplan-Meier. Results This group contained 4 male and 4 female patients. The average age was (39±20) years. The time from the onset of their disease to gastrointestinal bleeding was (8 ±8) months. Wegener's granulomatosis was the most common disease.Hematochezia(7/8 ) was the most common clinical manifestation and the distal small bowel (5/8) was the most common involved site. After the diagnosis was confirmed, methylprednisolone bolus therapy was used in 2 patients and 1～2 mg·kg-1·d-1 prednisone in 6 patients. Surgical operations were performed for 3 patients.However, 5 patients died. The prognosis was poor with the average survival time of (373±108) days. The mean survival time was (46 ±10) days after bleeding. Conclusion ANCA associated microvasculitis with gastrointestinal tract hemorrhage is rare. Early diagnosis and treatment could improve the prognosis.

Objective To discuss the clinical value of D-dimer(DD) testing in diagnosis of patients with deep vein thrombosis(DVT) of the lower extremity.Methods An analysis retrospectively was made on the changes of DD testing in 106 cases of DVT at different periods after onset and different clinical stages of DVT,and DD testing in 99 patients with primary deep venous insufficiency(PDVI) as control group.(Results) DD was higher in the acute stage of DVT,and gradually decreased with time in chronic DVT,and was negative in the patients with PDVI;the positive rate was up to 85.7% in the distal DVT.Conclusions The DD testing can be used as one of the methods for diagnosis,prediction and prognosis of acute DVT,especially for diagnosis of distal DVT.

Objective To estimate the characteristics of gastroesophageal reflux (GER) and its clinical association with pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) patients.Methods Two hundred and five patients with SSc,who fulfilled the American College of Rheumatology criteria were consecutively recruited.GER was recognized in patients with symptom of heartburn or regurgitation.Demographic,clinical,and laboratory data were analyzed.A six minute walk test,pulmonary function test and modified Rodnan's skin score (mRSS) were also calculated for GER and non-GER groups.x2 test,Fisher's exact test and t-test were used for statistical analysis.Logistic regression test was used for the analysis of risk factors.Results There were 90 patients with GER among 205 patients,the prevalence of GER was 43.9％.The presence of PAH (23.3％ vs 9.6％),Raynaud's phenomenon (98.9％ vs 92.2％ ) and fingertip ulcers (56.7％vs 51.3％) were significantly higher in patients with GER than those without GER.There was no difference in autoantibody profile between GER patients and non-GER patients (P＞0.05).The New York Heart Association (NYHA) functional class of SSc-related GER was worse than patients without GER (P=0.015).Pulmonary function test showed that diffuse capacity (DLCO)％,forced vital capacity (FVC)％,and forced expiratory volume (FEV1)％ were lower and the FVC％/DLCO％ ratio was higher in patients with GER than non-GER (P＜0.05).GER was an independent risk factor of PAH in SSc patients (P=0.047,OR=3.41 ).Conclusion GER frequently occurs in SSc patients,SSc patients presenting with GER should be screened for PAH.Targeting the underlying vascular dysfunction might prevent not only PAH,but also GER in SSc patients.

Objective To investigate the levels, phenotypes and functions of regulatory T cells (Treg) and Th17 cells in systemic sclerosis (SSc) patients and assess the role of imbalance between Treg and Th17 cells in the pathogenesis of SSc. Methods Peripheral blood mononuclear cells (PBMCs) of 31 SSc patients and 33 healthy controls were analyzed for the expression of CD4, CD25, CD45RA, the cytotoxic T-lymphocyte antigen-4 (CTLA-4), FoxP3, and IL-17 using flow cytometry. Treg immunosuppression capacities were measured in co-cultured experiments. The expressions of IL-17A, IL-22, IL-6 and IL-1β were measured by FlowcytoMix. The expression of FoxP3, CTLA-4, IL-17A, and RORC mRNA were measured by real-time polymerase chain reaction (PCR). The independent samples t-test was used to compare data between the groups. Results The frequency of Treg cells was significantly elevated in SSc [(3.6 ±1.1)%] compared with controls [(2.0±0.8)%, t=6.88, P<0.01)] and the expression of CTLA-4 was lower in Treg cells of SSc (P=0.034). The expression of CTLA-4 and FoxP3 mRNA was lower in SSc compared with controls (P<0.05), the immunosuppressive capacity of Treg cells were diminished in SSc (P=0.034). Th17 cells were increased in SSc (P<0.01); the levels of IL-17A, IL-22, IL-6 and IL-1β in the serums of SSc were higher than the controls (P<0.05). In SSc, CD25+FoxP3+IL-17+cells were increased[0.075%±0.032)%vs (0.049±0.027)%, t=3.52, P=0.029], but no difference of CD25+FoxP3+IL-17- was observed when compared with control. The expression of IL-17A and RORC mRNA were increased in SSc (P<0.01, respectively). Conclusion Both Treg and Th17 cells are increased in patients of SSc. Treg increases along with the deficiency of phenotype and function. FoxP3+IL-17+co-express cells are increased, and the balance between Treg and Th17 cells is broken.

ObjectiveTo investigate the clinical and laboratory characteristics of systemic sclerosis (SSc) patients with digital ulcer(DU) in China.MethodThe data of 166 consecutive SSc patients in EUSTAR DATABASE in Peking Union Medical Colloge Hospital from February 2009 to August 2010 were prospectively collected,and patients with DU were compared with those without DU.All patients fulfilled the ACR classification criteria for SSc in 1980.Results① Forty-nine patients (29.5％) had DU in 166 SSc patients.The disease onset age was(36±12) years(8.1-61.7 years) for those patients with DU.All had Raynaud's phenomenon(RP).② Demographic data:there were significant differences between patients with and without DU in sex (F/M 40/9 vs 112/5,P=0.005),age [(40±12) years old vs(46±12) years old,P=0.005],the onset age of RP [(33±12) years vs(39±13) years,P=0.005] and the duration from RP to the first non-RP presentaion[ (18±15) months vs(115±307) months,P=0.002 ].③ Clinical manifestations and laboratory findings:there were more diffuse SSc patients and more esophageal involvement in patients with DU (P＜0.05).ConclusionsDU in SSc patients is common,especially in man and patients with diffuse SSc.SSc patients with DU usually are younger when RP onsets and the non-RP manifestations usually present earlier when compared with those patients without DU.

Objective To detect the expression of scleroderma-related autoantibodies, such as anti-Scl-70, anli-centromere antibody ( ACA)and anti-RNA polymerase Ⅲ ( ARA) , and their relationship with clinical features in Chinese systemic sclerosis (SSc) patients. Methods One hundred and thirty-five Chinese SSc patients from the clinical database of the Scleroderma Trials and Research Group proposed by European League Against Rheumatism's Scheroderma Trial and Research Group( EUSTAR) were consecutively enrolled. The expression of ARA, anti-Scl-70 and ACA were detected through linear immunoblotting, double immunodiffusion and indirect irnmunofluorescence, respectively. The relevance between the existing of autoantibodies and clinical manifestations was analyzed statistically. Results Among the 135 Chinese SSc patients, the prevalence of anti-Scl-70, ACA, ARA were 49. 6% , 13.3 % and 8.9% respectively. Patients with anti-Scl-70 antibody had significantly shorter disease course [(71 ±59) month vs (90 ± 103) month, P = 0.041] , higher proportion of interstitial lung disease ( P = 0. 031) but lower of pulmonary arterial hypertension (P =0.042). Modified Rodnan's skin score (P=0.008) and prevalence of facial and cervical cutaneous sclerosis (P = 0. 002) , distal (to elbow/knee ) cutaneous sclerosis ( P = 0. 004 ) and digital pitting scarring/disappear of digital pad were all significantly higher in anti-Scl-70 positive group. Patients with AC A had longer disease course ( P = 0. 036) , lower IgM level ( P = 0. 045) and were less prevalent of interstitial lung disease ( P =0. 045). Patients with ARA had higher serum creatinine and urea nitrogen level ( P ＜ 0.001) although otherwise features had unremarkable differences. Conclusion Scleroderma-related autoantibodies have relevance with different clinical manifestation and detection of these autoantibodies may be helpful to the diagnosis of SSc, organ involvement evaluation and predicting outcomes. The clinical relevances of autoantibodies in Chinese SSc patients may differ from other areas or races.

Objective To investigate the clinical and laboratory characteristics of SSc patients in China. Method The data of 119 consecutive SSc patients based on EUSTAR DATABASE in Peking Union Medical College Hospital from February 2009 to January 2010 were prospectively collected and analyzed. All patients fulfilled ACR classification criteria in 1980 for SSc. Thex2 test and t-test were used to analyze the data. Results (1) Demographic data. Sex ratio (F/M) was 109/10 and the age rang was (44±12) years. There were 65 diffuse cutaneous SSc (dcSSc) patients and 54 limited cutaneous SSc (1cSSc) patients. 112 patients (94.1%) had Raynaud's phenomenon (RP), and the age of RP occurrence was 36 years (13～76 years), among which it was the initial presentation in 91 patients (81.3%) and the disease duration from RP to other manifestation was 12 months.(2) Clinical manifestations. ① The gastrointestinal manifestations (70.6%), especially esophageal involvement (56.3%), articular involvement (54.6%), pulmonary interstitial fibrosis (PIF) (58.8%) were frequently observed, but renal crisis (2.5%), heart block (0) and reduced LVEF (0) were rarely detected. ② Twenty cases (28.6%) out of 70 PIF patients denied any respiratory symptom and were confirmed by HRCT screening. The disease duration from RP to PIF was 34 months(3～352months); 3 case of 24 pulmonary artery hypertension (PAH) patients had no clinical manifestations. The disease duration from RP to PAH was 25 months (4～343 months). Nineteen patients had PIF and PAH simultaneously. ③Peripheral artery disease: SSc patients had a lower ankle brachial index (ABI) level (0.91± 0.19 vs 1.09±0.08, P<0.00l). (3) Laboratory finding. All patients had positive ANA. The positive rate of anti-Scl-70 antibody and ACA was 56.0% and 14.7% respectively. There was no serum sample positive for anti-Scl-70 antibody and ACA. The positive rate of anti-RNA polymerase Ⅲ antibody was 13%. (4) Compared the clinical characteristics and laboratory findings between dcSSc and lcSSc patients, we found that there were significant differences between dcSSc and lcSSc patients in finger ulcer (40.0% vs 20.4%), ACA positive rates (7.7% vs 23.3% , P<0.05). Conclusion The system involvements besides skin in SSc is common, especially PIF and gastrointestinal involvement. According to our data, there are fewer cases with renal crisis and heart block. Because part of patients with PIF have almost no clinical manifestations, so early screening for PIF/PAH is important for early diagnosis and intervention.

Objective To investigate the clinical characteristics of Takayasu's arteritis (TA) with pulmonary hypertension (PAH) in order to improve the diagnosis and treatment earlier. Methods Twelve out of 191 patients with TA registered in Peking Union Medical College Hospital from 1987 to 2007 were diagnosed as PAH, the clinical data of 12 patients were analyzed. Results Ten patients were females. The range of age were from 14 to 47 years old, the average age was (27±10) years old. Eleven patients had the clinical manifestations or/and signs of pulmonary artery involvement. Seven patients presented with short breath after exercise or hemoptysis as the first manifestation, four patients with fatigue, four patients with intermittent claudication or pain or numbness of extremities, three patients with dizziness. Seven patients belonged to type Ⅰ+Ⅳ, one patient to type Ⅱ+Ⅳ, three patients to type Ⅲ+Ⅳ, one patient to type Ⅴ. Elevated ESR/CRP was found in ten patients. All patients took the glucocorticoid and DMARDs, stent implantation in pulmonary artery was done in one patient, Bentall was operated in another patient.The symptoms of all patients improved except one patient died for low cardiac output after operation. Conclusion PAH is one of the severe complications in late stage of TA, and other arteries are usually involved too. Because it is difficult to observe PAH in TA patients in early stage, CTA or pulmonary angiography and UCG should be taken in early stage. The stent implantation or dilating the artery should be considered aa a treatment, but at on the same time, glucocorticoid and DMARDs should be taken to avoid the relapse.