Objective:To study the clinical effect of etanercept combined with methotrexate in the treatment of rheumatoid arthritis ( RA) . Methods:Totally 62 patients with RA from May 2014 to May 2015 in our hospital were divided into the observation group and the control group with 31 cases in each according to the random number table. The control group was treated with methotrexate (10mg, po, once a week), the observation group was treated with etanercept (25 mg, twice a week) additionally, and the treatment course was 12 weeks. Before and after the treatment, serum TL1A, TNF-a, IL-6 and IL-17, time of morning stiffness, joint swelling, tenderness and pain change scores in the two groups were studied and compared. The clinical efficacy and adverse reactions of the two groups were analyzed as well. Results:After the theatment, compared with before theatment, two groups’ TL1A, TNF-a, IL-6 and IL-17 had de-creased, and observation group was lower than control group(P<0. 05). Two groups’ time of morning stiffness have shortened, and the joint swelling, tenderness and painscores were significantly decreased, and each index in the observation groups were better than control group(P<0. 05). The total effective rate of the observation group was higher than the control group(P<0. 05). There was no significant difference about adverse reaction in the two groups(P>0. 05). Conclusion:Etanercept combined with methotrexate in the treatment of RA can reduce serum levels of TL1A, TNF-a, IL-6 and IL-17, and significantly alleviate joint swelling, tenderness and pain symptoms with high safety.

Objective Definition Chiasm of crus penis and discuss its possible role in penile erection. Methods Penile samples were acquired from 15 formalin preserved corpses.The structure located among crus penises were observed.The information about the structure located in crus penises with the nerve and blood vessel structure were recorded and analyzed. Results There was a structure of muscle fiber of ischiocavernosus among the crus penises.These muscle fiber through muscle bundle and tendon reach albuginea of cavernous body of the penis.There was long muscle fiber in the lateral surface of crus penises.While the muscle bundles were interlaced with each other with opposite side homonymous muscle and were encased with connective tissue when it reach to the back side of cavernous body of the penis.There were nerves and blood vessels observed in and out of the cavernous body of the penis and through the above structure in the crus penises. Conclusions Chiasm of crus penis was named as a structure of muscle fiber coming from two sides of the ischiocavernosus in crus penises.The structure of Chiasm of crus penis may provide an internal connection for the role of controlling the erection of the penis.

Objective: To detect the values of CT texture features in the preoperative prediction of Fuhrman grade of clear cell renal cell carcinoma (ccRCC). Methods: The CT data of 206 patients with ccRCC admitted to the Third Affiliated Hospital of Soochow University from January 2011 to December 2016 were retrospectively analyzed, and the ccRCC cases were graded using Fuhrman grading system, including 38 cases of Grade Ⅰ, 107 cases of Grade Ⅱ, 50 cases of Grade Ⅲ and 11 cases of Grade Ⅳ. All subjects undergone plain and enhancement CT scans. There were two methods used for the extraction of texture features, including histogram (2 features: Kurtosis and Skewness) and gray-level co-occurrence matrix (6 features: Contrast, Correlation, Energy, Entropy, Homogeneity and Variance). Each texture feature during Grade Ⅰ to Ⅳ was compared using a one-way analysis of variance following the log-ratio transformation, and a Newman-Keuls test was performed for all pairwise comparisons. An independent sample t test was used to find the differences of each texture feature between low (Grade Ⅰ+Ⅱ) and high grade (Grade Ⅲ+Ⅳ) ccRCC. A Spearman Rank test was performed to quantify the correlation of each texture feature with Fuhrman grade in ccRCC. Receiver operating characteristic curve (ROC) was employed to compare the diagnostic performance of the texture features to differentiate the low grade from high grade ccRCC. Results: Six texture features, including Contrast, Correlation, Entropy, Homogeneity, Variance and Kurtosis, were different during Grade Ⅰ to Ⅳ (all P<0.05) with the exception of the two features of Energy and Skewness (all P>0.05). Furthermore, five textures, such as Correlation, Entropy, Homogeneity, Variance and Kurtosis, were not significantly different between Grade Ⅲ and Ⅳ ccRCC. There was no clinical application value for the features of Correlation, Energy, Entropy, Variance and Skewness with the absolute coefficients of<0.3, in contrast, the correlation coefficients were -0.54, 0.39 and 0.32 for the features of Contrast, Homogeneity and Kurtosis, respectively (all P<0.05). Compared with that in the low grade ccRCC, the values of Contrast and Variance reduced in the high grade ccRCC (all P<0.05), while the values of Kurtosis, Correlation and Homogeneity increased significantly in the high grade ccRCC (all P<0.05), and no difference was found for the features of Skewness, Energy and Entropy between the low and high grade ccRCC (all P>0.05). When those features were used to differentiate the high from low grade ccRCC, the Contrast exhibited the biggest area under ROC of 0.806 (P<0.05), followed by the Correlation of 0.641, Homogeneity of 0.687, Kurtosis of 0.668 and Variance of 0.659. Conclusion CT texture features can preoperatively predict the Fuhrman grade of ccRCC, and the Contrast will likely be the potential imaging biomarker for the clinical application.