Objective To compare and analyze the different clinical features between male and female patients with rheumatoid arthritis (RA), by detecting the gender difference to make clinical decisions. Method The clinical features of 95 male RA patients(MRA) were analyzed and compared with those of 248 female RA patients (FRA) by retrospective analysis method. Results The mean onset age of MRA [18-79 (51.40±15.55) years old] was older than that of FRA[18-75(43.54 ±15.46) years old](P=0.0002). The morning stiffness time of MRA [(1.58 ±1.34) h] was shorter than that of FRA [(2.10 ±1.51) h](P = 0.0357). There was statistical difference in the first involved joint between MRA and FRA (P=0.0170), the prevalence of knee,metatarsonphalangeal joint,shoulder and ankle of MRA was higher than those of FRA, ' but conversely the wrist prevalence of FRA was higher than that of MRA.The prevalence of secondary Sj(o)gren syndrome of MRA(13.68%, 13/95) was rather lower than that of FRA(35.08%, 87/248)(P = 0.0007). MRA had lower positive rate of ANA (2.11% ,2/95) and lower value of IgM [(1.42 ±0.75) g/L] than FRA [(10.48% ,26/248), (1.69 ±0.86) g/L] (P < 0.05). There was no statistical difference between MRA and FRA in articular radiographic changes, most extraarticular manifestations and lab results (P >0.05). Conclusions MRA patients have older onset age and milder articular symptom than FRA patients. The disease severity of MRA is similar to that of FRA. Weighted joints are more involved in MRA. FRA is more inclined to have secondary Sj(o)gren syndrome.

Objective To evaluate the safety of laparoscopic cholecystectomy (LC) for patients with hepatic cirrhosis. Methods We retrospectively analyzed the clinical data of 72 patients with hepatic cirrhosis (Child-Pugh’s grads A or B). The patients received LC between July 2002 and March 2007. Under general anesthesia, the operation was preformed with four trocars and an intra-abdominal pressure of 8 to 12 mm Hg. Results LC was completed in 71 of the patients (antegrade in 67 and retrograde in 4), 6 of them received subtotal cholecystectomy. One patient was converted to open procedure because of dense adhesion at the Calot triangle. The operation time was 35 to 105 minutes (mean, 51 minutes); blood loss ranged from 5 to 60 ml with a mean of 12 ml. The patients were discharged 3 to 11 days (mean, 5.6 days) after the operation and were followed up for 3 to 18 months (mean, 12 months). After the operation, 7 patients developed ascites, and 1 had hemorrhage at the puncture site. During the follow-up, all patients were free of biliary symptoms, no residual or recurrent liver stone was found. Conclusions LC is safe for patients with liver cirrhosis, and should be the first choice for Child-Pugh’s grads A or B patients. Proper preoperative preparation and intra-and postoperative treatments are critical for the surgical outcomes.

Based on the high-dimension chaos characteristics of electroencephalogram(EEG) and the analysis by the multi-variable state space reconstruction,better estimation of the correlative dimension can be obtained by dividing the brain into two parts and using eight EEG channels as the reconstruction samples.Lorenz system was firstly tested by request of the amount of data to test the feasibility of the algorithms.After Comparing the high-dimension data of the EEG of epileptic patients with the results of control subjects,it is indicated that the multi-variable state space reconstruction is applicable in short time noise-containing time sequences to obtain reliable results and can free the researchers from the hard choice of delay time and embedding dimension.

Objective To discuss the role of p38MAPK signal pathway in the process of TWEAK inducing rheumatoid arthritis(RA) fibroblast-like synoviocyte(FLS) to synthesize MMP-9 and look for a new target for RA treatment. Methods RA FLS were primarily cultured and stimulated with TWEAK. Western blot was used to detect the expression of p-p38MAPK and p65 in RA FLS. FLS were pretreated by SB203580 or not. ELISA was used to detect the concentration of MMP-9 in cell-cultured fluid. The mRNA expression of MMP-9 was measured by RT-PCR. Results TWEAK( 100 ng/ml) can make p38MAPK phosphorylated and increased the expression of p65 protein in the cell nucleus. SB203580 can partially inhibit the expression of MMP-9 and MMP-9 mRNA produced by RA FLS which is induced by TWEAK. Conclusion TWEAK induced RA FLS to synthesize MMP-9, in that process, the p38MAPK signal trausduction pathway was in active state, and induced the expression of NF-κB.

Echinococcosis is a zoonotic parasitic disease caused by infection of Echinococcus granulosus and Echinococcus multilocularis in the human body,which may endanger the health and life of patients.Surgical treatment is presently the main method for the treatment of echinococcosis,with drug therapy as a subsidiary measure.The paper summarizes the advances in the treatment of echinococcosis.

BACKGROUND: The existing technique takes articular process and lateral mass as a reference mark. Due to differences of subjective judgment in operation and the impact of articular hyperplasia, some errors of screw entry point selection and serious complications such as vertebral artery or cervical spinal cord injury easily occurred, which limit the clinical application of the technique. At present, it is very important to select a constant reference mark of cervical pedicle screw entry point.OBJECTIVE: Three-dimensional reconstruction CT images were made to measure the relationship between the lower cervical pedicle screw entry point and the lateral concave between articular process.METHODS: Three-dimensional reconstruction of CT scan was performed in 30 patients with cervical deformity, and the occurrence rate and morphological characteristics of the lateral concave between articular process were observed. The following parameters were determined on specific reconstructed CT image of C3-C7: (1) the distance between pedicle axis projection point in the posterior surface and the outer edge of lateral mass in transversal section through bilateral pedicle axis and (2) the distance between the point and the lateral concave between articular process in oblique sagittal section through homolateral pedicle axis. Mean value and standard deviation were counted and statistics difference was compared.RESULTS AND CONCLUSION: (1) The lateral concave between articular process in lower cervical vertebrae was a obvious and less constant proliferative anatomical landmark and its occurrence rate was 100%. (2) Using CT technology of 3D reconstruction, C3-C7 lower cervical transversal section through bilateral pedicle axis and oblique sagittal section through homolateral pedicle axis were successfully obtained. (3) In transversal section, the left and right distances between C3-C7 pedicle axis projection point in the posterior surface and the outer edge of lateral mass were (4.1±0.9)mm and (4.3±0.9) mm, and the difference was not statistically significant (P=0.609). Except for C3 and C7, C4 and C7,there was no significant difference in the measured values of the same side (P > 0.05). (4) In oblique sagittal section, the left and right distances between C3-C7 point and the lateral concave between articular process were (-0.3±1.7) mm and (-0.3±1.6) mm, and the difference was not statistically significant (P=0.916). Except for C3 and C4, there was significant difference in the measured values of the same side (P < 0.05). (5) The above results suggest that the lower cervical pedicle entry point and the lateral concave between articular process have a relatively constant orientation relationship in transversal section and a large variation in the sagittal section.

Objective To investigate the relationship between sonic hedgehog(SHH)signaling pathway and chronic pancreatitis.Methods Thirty Wistar rats were randomly divided into the model group,experimental control group and blank control group,and there were 10 rats in each group.Trinitrobenzene sulfonic acid was infused into the pancreatic duct of the rats to induce pancreatitis in the model group.The pancreatic duct of the rats in the experimental control group were infused with 0.9％ sodium chloride solution.No treatment was performed on rats in the blank control group.The serum levels of bilirubin and amylase of the 3 groups were determined,and the histopathological alterations were studied.Expressions of patched-1(PTCH-1),smoothened (SMO)and SHH were detected by immunohistochemistry.All data were analyzed using the analysis of variance or Student's t test.Results The levels of total bilirubin(TBil)in the model group,experimental control group and blank control group from day 1 to day 35 were(3.17 ±0.21)μmol/L-(9.28 ±2.15)μmol/L,(3.44 ±0.54)μmol/L-(3.76 ± 0.15)μmol/L,(2.45 ± 0.32)μmol/L-(3.27 ± 1.43)μmol/L,respectively.The levels of amylase in the model group,experimental control group and blank control group were(1124 ± 143)U/L-(1522 ± 169)U/L,(1123 ± 104)U/L-(1007 ± 141)U/L,(1014 ± 115)U/L-(1013 ± 142)U/L,respectively.Compared with the experimental group and the blank control group,the serum levels of TBil and amylase in the model group were increased significantly from day 7 to day 35(F =14.81,16.27,18.13,11.49,17.91;11.54,10.24,12.64,21.11,15.38,P ＜ 0.05),and fibrotic proliferation of pancreatic tissues were found at day 35;the expressions of PTCH-1,SMO and SHH in the pancreatic tissue was increased significantly in the model group.Conclusion SHH signaling pathway is activated in the tissue of pancreatitis in rats,it might play an important role in the genesis of pancreatitis.

OBJECTIVE To study the effect of the intervention of monitoring-training-planning(MTP) on use of antibacterials and injections for pediatric acute upper respiratory infection.METHODS In accordance with selected drug use indicators(SDUIS),the pediatric outpatient prescription of acute upper respiratory infection was selected in our hospital from Jun to Aug 2006 as the baseline,and intervented by MTP,then the investigation of post-interfervention was carried out after a month,and then re-intervention research was made,so the cycle continued.RESULTS The percentage ratio of antibacterials,and injection usage,and the average drug fee in pediatric outpatient prescription for acute upper respiratory infection in our hospital was decreased from 75.00%,61.67%,40.33% and 54.29 yuan to 7.00%,5.00%,3.00% and 39.16 yuan,respectively after four rounds of MTP(all P

Objective To summarize the successful experience of radiodiagnosis specialist nursing model in our hospital.Methods Retrospectively analyze the course of establishment and development of radiodiagnosis specialist nursing model in our hospital.Many aspects including setting of the nursing unit,post,quota and salary,development of post responsibilities,systems,standards and procedures,establishment of quality control and performance evaluation system,standardization of the conventional specialist technology,study and application of the new specialist technology were expounded.Results Radiodiagnosis specialist nursing model had been established and improved after five years' exploration.Quality index of care,service and safety showed a steady upward trend.Specialist new technologies had prominent features.Teaching and research achieved initial success.Conclusions Establishment of radiodiagnosis specialist nursing model makes radiology nursing connotation more comprehensive.More importantly,it is of significance in guiding the development of radiodiagnosis specialist nursing.

Objective To evaluate the clinical characteristics of epithelioid trophoblastic tumor (ETT).Methods Six cases of ETT treated in Women's Hospital,School of Medicine,Zhejiang University from 2005 to 2007 were retrospectively analyzed,together with a literature review.Results Six cases of ETT were diagnosed pathologically after surgery.The age of patients ranged from 27 to 46 years.The most common presentation was abnormal vaginal bleeding(5/6).The preceding gestational events were hydatidiform mole in 1 case,abortion in 2 cases,and term delivery in 3 cases.The interval between the preceding gestation and the diagnosis of ETT ranged from 15-48 months.The serum human chorionic gonadotropin(hCG)level was 46-121 147 IU/L.Four cases presented with metastasis,including lung metastasis in all of the 4 cases,liver metastasis in 1 case,and pancreas metastasis in another 1 case.The main therapies were surgery combined with chemotherapy.All of the 6 cases received total abdominal hysterectomy.and 1 case also had lung lobectomy.One ease had a recurrence but refused any treatment again,and was lost to follow up;the therapy of 1 case unfinished;another 4 cases were without evidence of disease 9 to 19 months after surgery.Condusions The confirmation of ETF diagnosis is difficult before surgery.Surgical management is mostly recommended in ETT. The role of chemotherapy in ETT is not clear yet.