Objective To design and manufacture an external fixator for close reduction of fibu la and tibial fractures.Methods The all-ring reduction and fixation system made of duroplasts comprises three main parts:two reduction rings with gears and worms,two modulation frames to correct lateral or anteroposterior re-placement,and four connecting rods.By cranking the handle,the gears wi ll be driven,which may in turn shift t he modulation frame,then the needle co nnecting the bone with the frame can s hift the fracture ends in three dimen sions and six freedom degrees.After reduction,the fracture is fixed by the cro ssed needles linked to several groups of half-ring fixation arms,which can b e shifted and locked onto the linking rod properly.Results The apparatus was used in 32patients.All cases got anatomic reduction,and the curativ e ratio was 100%.Conclusion The external fixator for close reductio n of tibial and fibula fractures has g ood reduction and fixation effect,a nd the design provides a very good clinical therap eutic method for close reduction of t ibial and fibula fractures.[

Objective:To explore the expression of GITR/GITRL in rheumatoid arthritis(RA)and its correlation with clinical features of the disease.Methods:Fifty three RA patients,35 osteoarthritis(OA)patients and 35 healthy volunteers were included in the study.The real-time-fluorescence quantitative PCR method was used to analyze the expression level of GITR/GITRL mRNA.Using fluorescence-activated cell sorting(FACS),the expression of GITR on CD4+CD25+ T cells in peripheral blood monouuclear cells(PBMC)was detected.The levels of Anti-CCP antibody,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and rheumatoid factor(RF)of the RA patients were measured at the same time.Results:It was shown that the level of GITR/GITRL mRNA and the percentage of GITR+ T cells in the CD4+CD25+ T cell subpopulation[12.38?5.72/16.41?10.16,(28.12?16.85)%] were significantly higher than those of the OA group [9.59?5.87/12.09?7.53,(21.01?14.42)%,P

Objective To investigate the expression of C-erbB-2 and anti-nuclear antigen Ki-67 in thyroid tumor, and its significance in pathologic diagnosis and prognosis the patient. Methods SP immunohistochemical technique was used to detect the expression of C-erbB-2 and Ki-67 in thyroid tissue of 90 cases of thyroid carcinoma and 20 cases of thyroid adenoma. Results High expression of both C-erbB-2 and Ki-67 in thyroid carcinoma, and their expression was weak in thyroid adenoma. The positive rate of C-erbB-2 expression in thyroid carcinoma was statistically higher than that in thyroid adenoma (48.9% vs 20.0%, P

Objective To investigate the clinical and serologic features of patients with Sj(?)gren′s syndrome (SS) associated with systemic lupus erythematosus (SLE), and to compare with patients of primary Sjgren′s syndrome (pSS) and systemic lupus erythematosus. Methods Two hundred and eighteen unselected SLE patients were evaluated for the presence of SS. The SLE patients with SS (SLE-SS) were compared with SLE patients without SS on clinical and laboratory parameters. Results SS was identified in 22 SLE patients (10.1%). The SS preceded the development of SLE in 8 (36%), the SS secondary to SLE in 7 (32%), and in 7 (32%) patients, the SS and SLE occurred at the same time. Compared with the SLE patients without SS group, patients with SLE-SS were older, with a higher frequency of Raynaud′s phenomenon, pulmonary involvement, anti-SSA, anti-SSB, and rheumatoid factor, but with a significantly lower frequency of renal involvement. Compared with the pSS patients group, SLE-SS patients were younger, with a higher frequency of Raynaud′s phenomenon, arthritis, mucocutaneous involvement and anti-SSA. Conclusions SLE-SS patients have distinct clinical and laboratory features that differ from SLE or pSS patients.

Objective To determine the prognostic factors in systemic sclerosis.Methods Clinical data of definite systemic sclerosis patients were collected,including disease onset age,sex,disease course,Raynaud's phenomenon,skin involvement,gastroesophageal reflux,interstitial pneumonia,cardiac lesions,kidney lesions and scleroderma renal crisis.serum antibodies to scl-70.RNP and anti-centromere antibody were detected.Pulmonary artery pressure was measured by ultrasound cardiography.Cox hazard ratio model was employed to assess the mortality risk of systemic sclerosis patients.Results No difference in Raynaud's phenomenon,gastroesophageal reflux,anti-nuclear antybody,anti-sol-70 antibody,anti-centromere antibody,interstitial pneumonia,diffusion capacity (DLco),coronary artery disease,and peripheral artery atherosclerotic disease could be found between the dead and alive systemic sclerosis patients(P>0.05).Dead systemic sclerosis patients had later disease,onset(older than 60 years old)(P=0.002).Male gender(P=0.023),more diffuse skin involvement(P=0.000),more positive anti-RNP antibody(P=0.014),more pulmonary artery hypertension(P=0.000).more cardiac lesions(P=0.000),more cerebral infarets (P=0.035),more kidney lesions(P=0.000),and more scleroderma renal crisis(P=0.000) could be found jn dead sclerosis patients.Cox regression analysis showed that,onset later than 60 years old(OR=5.441.95% CI 2.126～13.926,P=0.000),male sex (OR=5.531,95%CI 2.014～15.190,P=0.001),anti-RNP antibedy positivity (OR=2.664,95%CI 1.016～6.592,P=0.034),diffuse skin involvement(OR=3.432,95%CI 1.400～8.411,P=0.007),pulmonary artery hypertension (OR=25.718,95% CI 5.954～111.085,P=0.000),cardiac lesions (OR=4.141.95%CI 1.685～10.159,P=0.002),kidney lesions(OR=4.214,95%CI 1.654～10.737,P=0.003) and scleroderma renal crisis (OR=20.677,95% CI 4.161～102.764.P=0.000)were risk factors for mortality in systemic sclerosis.Severe pulmonary hypertension was the most strong predictive factor for mortality in systemic sclerosis (OR=55.809,95% CI 12.879～241.832.P=0.000).Conclusion Aggressive therapy should be given to those systemic sclerosis patients with onset later than 60 years old,male sex,diffuse skin involvement,anti-RNP antibody positivity,cardiac involvement,kidney lesions,scleroderma renal crisis and pulmonary artery hypertension,especially seevere pulmonary hypertension.

Objective Antibodies against citrulline-containing peptides such as anti-perinuclear factor (APF), anti-keratin antibodies (AKA), anti-filaggrin antibodies (AFA) and anti-cyclic citruilinated peptide (CCP) antibodies are very specific in RA. In recent years, detection of APF, AKA and anti-CCP antibodies have been widely used in clinical practice. Studies on the combined detection of these ACPA in diagnosing RA are limited in number. The aim of this study is to detect combined examination of APF, AKA, and anti-CCP antibodies and compare their values in the diagnosis of rheumatoid arthritis. The significance of combined detection of these ACPAs in rheumatoid arthritis is also investigated. Methods Five hunndred and fifly-one patients who suffered from arthritic problems during the recent two years were selected from the Department of Rheumatology and Immunology of Peking University People's Hospital. 304 of the patients were RA and 247 were diagnosed to have other rheumatic diseases based on the corresponding classification criteria. AKA and APF were tested by indirect immunofluorescence assay. Anti-CCP antibodies were tested antibodies, AKA and APF tests for RA were 76.2%, 43.6%, and 34.5%, respectively, and the specificities were highest specificity (100%), but it had a rather low sensitivity (28.3%). When two of the three ACPA were positive, the sensitivity and specificity for the diagnosis of RA was 48.4% and 99.2%, respectively. When either anti-CCP antibodies, AKA, or APF was treated as an individual parameter, the sensitivity was slightly increased (77.3%). However, the specificity decreased to 94.7%. Conclusion Anti-CCP antibodies are the most helpful makers for the diagnosis of rheumatoid arthritis among the three ACPAs which are used in clinical practice. The combined detection of anti-CCP antibodies, AKA, and APF cannot increase the diagnostic sensitivity and specificity of rheumaotid arthritis.

Objective To investigate and analyze the behavior and therapeutic status of rheumatoid arthritis (RA) patients. Methods Out patients diagnosed with rheumatoid arthritis in our hospital from May to August 2007 were enrolled. The data including sex, age of onset, site of first hospitalization and medication status were collected and analyzed. Results In this 181 RA patients, the mean age of onset was (53±11) year-old, mean history duration was (10±8) years, the ratio of male to female was 1:4.2. The orthopedics department was the most common site of first hospital visit (32.0%, 58/181) and rheumatology department was the most common site to clarify the diagnosis (62.4% ,113/181). The diagnosis delay caused by patients themselves was (5.9±17.2) months and the delay caused by doctors was (9.0±22.0) months. More than half of the patients were not treated appropriately before they came to our hospital. Methotrexate was the most commonly used DMARDs (67.3%), followed by leflunomide (46.4%), sulfasalazine (37.5%) and hydroxyehloroquine (19.6%). Conclusion In this cohort, the proportion of patients who come to rheumatology department immediately after disease onset is low. There is delay between symptoms and final diagnosis. More than half of the patients are not treated appropriately.

Objective To investigate prevalence of associated diseases in patients with gout as well as their diagnoses and treatment. Methods Two hundreds out-patients diagnosed with gout from April to October 2008 were investigated at Peking University People's Hospital, and information collected included their general characteristics, associated diseases, diagnoses and treatment, as well as blood lipid profiles, serum creatinine, uric acid, results of routine urine tests and glomerular filtration rate estimated by MDRD formula in the past three months. Results Among patients with gout, prevalence of associated hypertension, obesity, renal calculi, coronary heart disease, cerebral infarction and diabetes were 54.5% (109/200), 23.2% (42/181), 20.0% (40/200), 12.0% (24/200), 8.0% (16/200) and 7.0% (14/200), respectively, and 53.7% (101/188) of them associated with hypertriglyceridemia, 63.7% (114/179) with impaired renal function and 15.1% (27/179) with chronic kidney disease. In acute attack of gout, 124 (62.0%) of them were treated with non-steroidal anti-inflammatory drug (NASID), 72 (36.0%) with colchicines, 12 (6.0%) with corticosteroid and 30 (15.0%) with urate-lowering drugs, respectively, and during its intermittent period, 69. 8% (81/116) of them received urate-lowering therapy with indications generally accepted internationally, but serum level of uric acid could be maintained below 0.06 g/L in only 8.6% (10/116) of them. And 73.8% (48/65) of the patients with no therapy indications also were treated with urate-lowering drugs. Conclusions The most commonly associated diseases in gout patients are hypertension, hyperlipidemia and obesity, followed by renal calculi, chronic kidney disease and coronary heart disease, and so on. At present, oral NSAID is the first choice of drugs for its acute attack. Indications for urate-lowering therapy in this hospital usually are not consistent with those by generally international acceptance, with lower therapeutic effectiveness achieved.

Objective To analyze the clinical features,therapy and outcome of systemic lupus erythematosus (SLE) combined with lupus myelopathy (LM).Methods Ten SLE patients combined with LM treated in Department of Rheumatology and Immunology,People' s Hospital from 1990 to 2011 were retrospectively analyzed and 43 cases of SLE combined with LM reported home and abroad were reviewed.Results All the ten patients were women with age of 23-53 (36.9 ± 3.4) years old and duration of 1-18 years.MRI of spinal cord revealed long T2 signal in one case,and normal in two cases.Seven patients received methylprednisolone pulse plus cyclophosphamide (CTX),two were given glucocorticoid pulse only,and one was given moderate dosage of glucocorticoid,CTX and plasma exchange (PE).The results revealed that four patients received complete recovery,four received partial recovery,and two received no improvement.Conclusions LM is a rare but severe complication of SLE with poor prognosis,which usually occurs in early phase of young SLE patients.Pulse methylprednisolone and CTX may be effective.Early and active treatment may improve the outcome.

Objective To better understand the clinical features and the diagnosis of monoclonal gammopathy of undetermined significance (MGUS) associated with systemic lupus erythematosus (SLE).Methods A case of MGUS with SLE were described including clinical manifestations and pathologic data.Literatures were also reviewed.Results The patient was admitted because of proteinuria.Laboratory findings showed monoclonal gammopathy.However,both bone marrow exam and iconography showed no signs of multiple myeloma.Lupus nephritis Ⅳ + Ⅴ was proved by kidney biopsy.Prednisone and tacrolimus were used with significant clinical improvement.Conclusion MGUS associated with SLE is not rare.MGUS criteria based on 2003 international MM working group should be used to differentiate MGUS from MM.Monoclonal protein level,plasma cell in bone marrow and free light chain are risk factors for MM progression.Treatment is based on lupus disease activity and organ damage severity.