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.

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 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.

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 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 explore the effect of the JAK/STAT signal pathway on the apoptosis-related gene in the synovial tissue of rat rheumatoid arthritis (RA).Methods Fifty rat models of collagen-induced arthritis,whose arthritis index was more than 2,were divided into the model group,the low dose of AG490 group,the medium dose of AG490 group and the high dose of AG490 group.In addition,6 rats were treated intraperitoneal injection.Then,the arthritis index and the change of apoptosis-related genes were compared.Multiple-sample average was analyzed by single-factor x2 test and LSD-t or Tamhane's T 2 test were used for two-two comparison.Results The arthritis index of the model group increased evidently,and the apoptosis inhibitor Bcl-2,Bcl-xl gene and protein expression was up-regulated,which was significantly different when compared with that of the control group(0.931±0.035 vs 0.351±0.024,0.920±0.037 vs 0.271±0.029,0.322±0.047 vs 0.230±0.031 ).The expression of apoptosis promoting factor Bax wasslightly up-regulated.The blockage of JAK/STAT pathway cotld down-regulate the expression levels of the gene and protein of survivins Bcl-2 and Bcl-xl,and up-regulate the gene and protein expressions of Bax.Conclusion In the process of RA development,apoptosis inhibitor Bcl-2,Bcl-xl gene and protein expression is up-regulated.JAK/STAT signal transduction pathway regulates the apoptosis process.

Objective To review the experience in the management of gastric cancer with liver cirrhosis and portal hypertension.Method A retrospective analysis was made in 35 gastric cancer cases with liver cirrhosis and portal hypertension admitted into our hospital from January 2000 through June 2009.Result There were no intraoperative death in this group.Postoperative ascites occurred in 19 patients,anastomotic leakage in one case,anastomotic bleeding in 2 cases,wound bleeding in 2 cases,intraabdominal infection in 17 cases (of which combined fungal infection in 4 patients),incision infection in one patient and chylous leakage in one case.The morbidity rate was 71%.Four patients died during hospitalization including multiple organ dysfunction syndrome in 2 cases,with mortality rate of 11%. Conclusion In order to reduce the incidence of mortality and complications,we should complete preoperative evaluation,correct perioperative management,guide surgery with damage control concept,follow individualized principles and emphasize on preventive devascularization.

Objective To analysis the efficacy and safety of endovascular graft exclusion for patients with Stanford type B aortic dissection.Methods The clinical data of 46 patients with Stanford type B aortic dissection who received endovascular graft exclusion were analyzed retrospectively.The stents were inserted from the femoral artery to exclude the tear of dissection,and all operation were peformed under digital subtraction angiography (DSA).The operative technique,outcome and complications were observed.Results The stents were successfully performed in all patients.The length of stay in hospital time after operation was 5-20 (12.9 ± 3.4) d.Endo-leak occurred in 2 patients and relieved after re-expanding.Followed up for 2 d to 5.1 years,average 36 months,1 patient got lacunar infarction and 1 patient died after leaving hospital 2 d.The others were free from the serious complications such as aortic dissection and paraplegia.Conclusion Endovascular graft exclusion is safe and effective for the treatment of Stanford type B aortic dissection in hospital and mid-term,and can significantly improve the survival rate and quality of life.