Objective To investigate the reasonable perioperative management for elderly patients with esophageal cancer undergon esophagectomy.Methods 92 elderly patients with esophageal neoplasms were treated by esophagectomy.According to the specific pathogenetic condition of the patients,various perioperative managements were provided.After surgery,the operative complications,mortality and 3,5-year survival rate were observed.Results Esophagectomy was carried out for all cases.Cardiovascular and respiratory complications were found in 19,10 respectively.Both of anastomotic stricture and fistulae were found in 4 cases.1 and 2 complicated with chylopleural and disturbance gastric emptying respectively.Mortality was 4.35%,and the 3,5-year survival rate was 80.43%(74/92),34.79%(32/92) respectively.Conclusion Satisfactory perioperative managements are the key to successful esophagectomy.

Objective To analyze the clinical features and outcome of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome,and enhance the understanding of it.Methods Fourteen cases of RS3PE syndrome treated in the Department of Rheumatology and Immunology were analyzed retrospec-tively,including the clinical characteristics,laboratory data.Data were presented as -x±s.Results Fourteen patients(nine man,five women) with RS3PE were enrolled.Their age was (68±9) (range:52-78)years.The main clinical features were acute onset symmetrical edema in both hands and feet and polyarthritis.Polyarthritis were involved in hand joints in 14 patients,wrists in 13 patients,knees in 10 patients,ankles in 9 patients,and shoulders in 8.In laboratory examinations,the average value of erythrocyte sedimentation rate was (68±26) mm/l h and C-reactive protein was (49±41) mg/L.Mild anemia of normocytic-normochromic type and mild low level of serum albumin were frequent findings.Antinuclear antibody was present only in one patient at low titer (1∶20).Rheumatoid factor and other auto antibodies were all negative in patients.Before corticosteroid treatment,the MRI test was performed in 8 patients and revealed prominent synovitis and articular effusion.Two cases had bone erosions on MRI; five patients were fuond to have malignant tumors,three of them initially presented with RS3PE.Polyarthritis and edema were relieved after treated with low dose corticosteroids and DMARDs drugs.But those patients with cancer were easily to recurr.Conclusion RS3PE syndrome is relatively uncommon.It occurs predominantly in elderly men and is characterized by rapid-onset symmetrical polyarthritis,presence of pitting edema of both hands and feet.Erosive changes can be seen on MRI.Patients usually have dramatic response to low dose corticosteroids and DMARDs drugs.Patients should be closely followed as RS3PE is closely related to cancer.

0.05) in age, sex, disease course and disease activities (SLEDAI). Fever, oral ulcer, Raynaud′s phenomenon and cardiac involvement in infection group were more common than in disease flare group (P

Objective To comprehensively analyze the academic impacts of papers published by the Chinese Journal of Rheumatology based on the Chinese biological medical journal citations database(CMCI) 1997-2011 data developed by PLA medical library.Methods Based on the Chinese biological medical journal citations database (CMCI),method of bibliometrics for 1997-2011 was adopted for the analysis.The citation rate,the authors distribution,and the research direction of the citated papers were all included for the evaluation.Results During 1997 to 2010,1700 papers were included into the CMCI by the law of the journal of rbeumatology,8323 times were cited by domestic science and technology journal with the average citation of 4.90 times.The authors of 675 cited papers distributed in 28 provinces and autonomous regions and municipalities.During 1997-2011,the law of the journal of rheumatology cited 170l papers,the rank of the first three topics was the systemic lupus erythematosus (sle),in which 453 articles were cited,rheumatoid arthritis in which 404 article were cited,and relevant ankylosing spondylitis in which 106 articles were cited,Articles with these three topics accounted for 56.61％ of overall citations.Conclusion The papers published by the journal have shown certain depth theoretically and some breakthr-oughs.The articles and papers published have focused on the hot topics and critical research area and topics of rheumatology,therefore,have guided the development of Chinese rheumatology.The journal has important influences on clinical practice and research of Chinese rheumatology.The papers published could be used as valuable resources.The influence and the academic status of this journal is gradually expanding and the quality of the publications is persistently improving.It is one of the major scientific journals in medical research in China.

Objective To investigate clinical characteristic of primary Sjogren's syndrome(pSS) with initial manifestations in the extra-gland organs. Methods Clinical data, including symptoms, laboratory parameters and complications of 85 pSS patients with initial manifestations of extra-gland organs hospitalized at the People's Hospital of Peking University during 2003 to 2006 were collected and analyzed retrospectively, as compared to those of pSS with xerophthalmia or xerostomia as initial ones. Results Mean time interval from onset to diagnosis in these patients with initial manifestations involved in the extra-gland organs was 94.5 months, higher than that in those with xerophthalmia or xerostomia as initial ones. Arthritis was manifested initially in 38 of the 85 patients (44.7 percent), peripheral leukopenia in 16 (18.8 percent), thrombocytopenia in nine (10.6 percent) and abnormal liver function in 13 (15.3 percent), respectively. Percentage of serum positive autoantibedies was higher in the patients with initial manifestation of the extra-gland organs than that in those with xerophthalmia or xerostomia as initial ones. Conclusions Initial manifestation of primary Sjogren's syndrome varies, and some patients can be initially involved in their extra-gland organs, with more proportion of arthritis than of other symptoms, and xerophthalmia or xerestomia could appear in them during the course of disease. And, xerophthalmia or xerostomia would not appear even as pSS was diagnosed in some other pSS patients. More attention should be paid to these clinical characteristics mentioned above in practice to avoid misdiagnosis.

Objective:To observe the clinical features of primary Sjgren syndrome(pSS) in young people(≤34 years).Methods: The data of 232 patients with pSS who were in hospital from 2004 to 2008 were analysed in a prospective study.Results: A total of 23.7%(55/232)patients' symptoms came on in youth(≤34 years),who were all females,mean age was(27.6?6.2) years.The other 177 patients' symptoms came on when they were more than 34 years old.In young group,32.73%(18/55) patients' first symptoms were xerostomia and/or keratoconjunctivitis sicca,the other 67.27%(37/55)came on without xerostomia and keratoconjunctivitis sicca,while in the middle-aged and aged group,59.32%(105/177)patients' first symptoms were xerostomia and/or keratoconjunctivitis sicca,40.67%(72/177)without xerostomia and keratoconjunctivitis sicca.There was significant difference(P=0.001).The duration from first symptom to first diagnosis of pSS in the young group was(93?107) months,which was significantly longer than those of the middle-aged and aged group [(45?59) months,P=0.001].The systemic damage of the young group was 61.8%(34/55),which was significantly greater than 41.24%(73/177)in the middle-aged and aged group(P=0.026).Conclusion: Primary Sjgren syndrome in young people is not rare,and about 2/3 of them come on without xerostomia and/or keratoconjunctivitis sicca.Not only the duration from first symptom to first diagnosis of pSS in the young group is longer,but also the systemic damage of the young group is greater than those of the middle-aged and aged group.These findings should alert the clinician to make the possible diagnosis of pSS in young patients.

Objective:To explore the role of Foxp3 expressing regulatory T cells in the initiation and development of rheumatoid arthritis(RA) and its correlation with clinical features of the disease.Methods:Total RNA isolated from PB in 25 RA treated patients, 25 RA untreated patients and 30 health volunteers was reversely transcribed into cDNA. The real-time-fluorescence quantitative PCR method was used to analyze the expression level of Foxp3 mRNA. The level of Anti-CCP antibody, CRP, ESR and RF of the patients were detected at the same time.Results:The level of Foxp3 mRNA from RA group was significantly lower than that of controls(P

Objective:To study the inhibition of collagen-induced arthritis by an altered CⅡ263-272 peptide(sub268-270) with three consecutive substitutions of TCR-contacting residues.Methods:Arthritis was induced by bovine collagen type Ⅱ. The altered peptide sub268-270 was given intravenously with a dose of 90 ?g once a week. Peptide control and blank control were treated with similar approaches. The therapeutic effect of the altered peptide was evaluated by arthritis score index, radiological score and pathological score.Results:The arthritis score of rats treated with altered peptide, control peptide and blank control were 5.60?1.24, 11.20?1.21 and 11.80?1.22 respectively(P

Objective To investigate clinical significance of positive antineutrophil cytoplasmic antibodies (ANCA) in diagnosis for vasculitis or other diseases. Methods From January 2005 to December 2008, 104 patients with positive ANCA detected by enzyme-linked immunosorbent assay (ELISA) in People's Hospital of Peking University were randomly selected and their clinical features and diagnoses were analyzed retrospectively. Results Among 104 ANCA-positive patients, 22 were diagnosed as vasculitis and 13 as ANCA-associated vasculitis, and 82 (78. 8% )were diagnosed as non-vasculitis including 40 of connective diseases such as systematic lupus erythematosus (SLE) and rheumatoid arthritis (RA) and 42 of non-connective diseases with the most common of ulcerative colitis. According to the results of ANCA tests by ELISA, ANCA-positive patients could be divided into those with proteinase 3 (PR3)-positive and myeloperoxideaso (MPO)-positive. More organs were involved in MPO-positive patients (n =48 ) than that in PR3-positive ones ( n = 49), and more frequent involvement of the kidneys and less frequent involvement of the gastrointestinal tract in MPO-positive than those in PR3-positive ones (P < 0. 01 ). As compared to those with non-vasculitis, more organs (2. 28 organs vs. 3.55 organs in average) were involved in patients with vasculitis (P <0. 01 ) and more frequent involvement of the upper or lower respiratory tracts and the kidneys in vasculitis patients ( P <0. 01 or <0. 05, respectively). Elevated leukocyte count and accelerated erythrocyte sedimentation rate (ESR) were also more common in vasculitis patients than those in non-vasculitis ones (P <0. 01 and P <0. 05, respectively). Positive ANCA combined with number of organs involved, clinical manifestations and other laboratory findings, its positive predictive value (PPV) in diagnosis for vasculitis can be improved. Conclusions Spectrum of disease in patients with positive ANCA was varied. Diagnostic value of positive ANCA in diagnosis for vasculitis can be improved if combined with comprehensive analysis of their clinical features and laboratory examinations.

Objective To assess the outcomes of chronic hepatitis B (CHB) infection following immunosuppressant and corticosteroid treatment in patients with rheumatic disuses.Methods The medical records of patients with positive HBsAg and rheumatic diseases from 1 Jan 2004 to 31 Dec 2007 were retros pectively reviewed and analyzed for the types of rheumatic diseases,hepatitis B seroiogies,name and dosage of immunosuppressive agents used,anti-viral therapies and outcomes of CHB infection.Results Twenty one patients were included.There were 14 female and 7 male patients.The mean age of all patients was (45±16)years.All patients were positive for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (HbcAb),and had alanine aminotransferase (ALT) less than 60 U/L except one patient with dermatomyositis.Twelve(57%) patients treated with immunosuppressant only.Among them,rheumatoid arthritis (75%) was the most commonly diagnosed rheumatic diseases.These patients were treated with methotrexate (no more than 10 mg per week) or leflunomide ( 10 mg/d),combined with suffasalazine or hydroxychloroquine.Three patients received antivirus drugs because of the elevation of HBV-DNA.During the follow-up period (7 to 47 months with a median of 25 months),four (33%) developed ALT elevation,but none had developed HBV reactivation.Nine (43%) patients were treated with prednisolone and /or immunosuppressants.Among them,5 (56%)patients were diagnosed as systemic lupus erythematosus,others were adult onset of Still's disease and dermatomyositis,and 3 patients had elevation of HBV-DNA copies.These patients were treated with predni-soione (0.8～1.2 mg·kg-1·d-1) only or combined with immunosuppressants (methotrexate or cyclophosphamide),and all patients received antivirus drugs.During the follow-up period (3 to 50 months with a median of 13 months),two developed ALT elevation,but none had developed HBV reactivation.Conclusion In patients with rheumatic disease complicated with chronic HBV infection,methotrexate (no more than 10 mg per week) and leflunomide (10 rag/d) may be safe for patients with negative HBV-DNA.Prednisolone and immunosuppressants (methotrexate or cyclophosphamide) may be used safely with prophylactic antivims drugs.