Objective To assess the clinical features and risk factors of coronary heart disease(CHD)in patients with systemic lupus erythematosus (SLE).Methods The clinical data of 32 lupus patients with CHD and 64 age and sex-matched lupus patients without CHD from a total of 1792 in-patients with lupus from January 1994 to December 2008 were collected and retrospectively analyzed.The traditional risk factors of atherosclemsis as well as their association with the characteristics of lupus were evaluated and compared between the two group of patients.Results The average age of CHD group was(51±12)years with an average disease duration of((8±6) years、.The most common coronary events were acute myocardial infaretio(53%)and non-stable,angina[34%).Among the 12 patients who accepted coronary angiography or computed tomography scan of coronary artery,11 patients had significant atheroselerosis lesions and 1 had thrombosis in coronary arteries.Their atheroselerosis lesions were severe,which manifested as diffuse stenosis and severe calcification.Compared to the control group,the CHD group patients had more traditional risk factors[(3.9±1.8)vs(2.0±1.6),P<0.01 j as well as higher prevalence of hypertension,hyperlipidemia,postmenopausal and smoking(P<0.05).Meanwhile,the CHD group patients had longer SLE duration[12.0(6.3~19.8)vs 2.0[O.8～9.0)years,P<0.01)J,higher C3 level[(750±364)vs(598±267)mg/L,P<0.05]and higher totalprednisone dose[28.8(0~49.8)vs 24.0(0~24.6)g,P<0.05]compared to patients without CHD.No significant differences were found in auto-antibodies,SLE disease activity,organ damage,average Drednisone dose and cyclophosI,hamide usage between the two groups of patients.Multi-variate analysls showed more traditional risk factors(OR:1.62)and longer SLE duration(OR=1.09)Were independent predictors of CHD.Condusion Atherosclerosis is a common pathological change of coronary in lupus patients with CHD.Traditional risk flactors of atherosclerosis and lupus duration are identified to be the independent risk factors of CHD in SLE patients.Early interventions for traditional risk factors and appropriate control of lupus arerecommended.

Objective To evaluate the correlation between pathological findings and clinical characteristics of patients with Sj(o)gren's syndrome (SS). Methods Eighty-four patients diagnosed with SS from 119 suspected ones at Peking University First Hospital were recruited. According to the pathological changes of lip biopsy, 64 patients were focus score (FS)( + ) and 20 patients were FS (-). In the FS( + ) group, 20 patients had germinal center (GC)( + ) and 44 patients had no GC. x2 test and t test were used for statistical analysis. Results The duration of symptoms of dry eyes or dry mouth in the FS (+) group was longer than that in the FS (-) group (P＜0.05). In the FS ( + ) patients, those with GC (+) had significantly longer duration of xerothalmia or xerostomia, higher serum IgG levels, greater FS score, and higher incidence of system involvement than those without GC patients (P＜0.05). In the FS (-) group, lip biopsies showed degenerative changes in 6 (30%) patients. Those with degenerative changes had longer duration of dry eyes and dry mouth and higher incidence of system involvement. Conclusion GC (+) in FS (+) patients and degenerative changes in FS (-) patients from lip biopsy are associated with severer clinical manifestations in patients with SS, suggesting that more clinical attention should be paid to this subgroup of patients.

Objective To compare the contrast-enhanced ultrasonography (CEUS) manifestations of pNENs with the pathological changes and to explore the clinical value of CEUS in diagnosis of pNENs. Methods The CEUS of sixteen pathologically diagnosed pNENsfrom April,2012 to February,2014 were retrospectively observed.The CEUS of thirty pathologically diagnosed pancreatic carcinomas during the same period were taken as the control group.The enhancement extent and enhancement patterns of CEUS in pancreatic tumors were analyzed. The specimens of pNENs were stained with HE and CD34 immunochemistry.The grading of interstitial content and Ki-67 index were obtained on HE-stained slices and microvascular density(MVD) were obtained on CD34 immunochemistry stained slices.Spearman rank test analysis was employed to analyze the correlation.Results Among the 16 cases of pNENs,12 cases (75.0%) demonstrated hyper-or iso-enhancement,which included 6 cases (37.5%) showing homogeneous enhancement and 6 cases (37.5%) showing inhomogeneousen hancement,and the other 4 cases demonstrated hypo-enhancement. Among 30 cases of pancreatic carcinomas,25 cases (83.3%) demonstrated hypo-enhancement and 5 cases (16.7%) hyper- or iso-enhancement,and 21 cases (70.0%) demonstrated homogenous enhancement,and 9 cases(30.0%)inhomogeneous enhancement.Taking hyper-or iso-enhancement on CEUS as the diagnostic criteria,its diagnostic sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were 75.0%,83.3%,70.6%,86.2%,80.4%respectively.Negative and positive correlation of the enhancement extent of pNENs with the interstitial content(r =-0.880,P < 0.001) and MVD (r =0.658,P =0.003) were observed,respectively.Six tumors with inhomogeneous enhancement contained cystic degradation or necrosis under microscope. Conclusions CEUS is an effective and non-invasive diagnostic approach for pNENs and can reflect the pathological changes.Hyper-or iso-enhancement of CEUS is typical appearance of pNENs.

Objective To explore the manifestation of pancreatic metastases (PM)using contrast‐enhanced ultrasound (CEUS). Methods Eleven patients with PM confirmed by pathology or CT/MRI combined with clinical data were analyzed retrospectively. The manifestation on conventional ultrasound and the enhancement appearance on CEUS were analyzed. Results The primary malignant tumors included lung cancer(n=6), breast cancer(n=1), renal clear cell carcinoma(n=1), gastric cancer(n=1), rectal cancer(n=1)and leiomyosarcoma of uterus(n=1). Eight patients had one lesion and three were multiple. The maximum lesion diameter was 2. 0-5. 0cm. Eight of the 11 patients showed hypoechoic on conventional US. Three patients were diagnosed as probably PM, one probably malignant and 7 undetermined by US. In the early stage of CEUS, two patients showed hyper‐enhancement, six showed iso‐enhancement and 3 showed hypo‐enhancement I.n the late stage of CEUS, nine patients (9/11) showed hypo‐enhancement. Seven patients showed homogeneous enhancement S.ix patients were diagnosed as PM, three malignant, one neuroendocrine tumor and one undetermined by CEUS. Conclusions PM showed certain characteristics on CEUS. The hyper‐or iso‐enhancement at the early stage of CEUS and history of primary cancer is helpful for diagnosis of PM.

Objective To investigate the pathologic mechanism of radiofrequency ablation ( RFA ) combined with intravenous infusion of thermosensitive liposome encapsulated vinorelbine (TL-Vin) in treating liver tumors, and to analyze the effect of combination therapy on the long-term survival rate. Methods H22 liver adenocarcinoma tissue was subcutaneously implanted into ICR mice to establish the animal models. At the first experimental period, 40 mice were randomly and equally divided into 5 groups to receive different therapeutic scheme (using different TL-Vin concentrations). Twenty-four hours after the treatment the tumor specimens were collected, the necrotic areas were measured separately, and the optimal TL-Vin concentration was determined. At the second experimental period, 13 mice were randomly selected to receive treatment. Half an hour after the treatment the tumor tissues were collected and the TL-Vin concentration within the tumor was determined. At the third experimental period, 32 mice were randomly and equally divided into 4 groups, and 90 days after treatment the tumor growth curve was drawn. The survival rate was compared between each other of the groups. Results Compared with pure RFA group, TL-Vin + RFA significantly increased tumor coagulation extent (P<0.01). But free-VIN+RFA had similar tumor necrotic extent as that produced by RFA alone (P>0.05). Tumor coagulation area in TL-Vin + RFA group was bigger than that in free-VIN + RFA group at the concentration of 10 mg/kg [(341.8 ± 65.4)mm2 vs (225.3 ± 25.4)mm2, P < 0.01]. In TL-Vin group the coagulation margin was clear. The mean intratumoral Vinorelbine accumulation in TL-Vin + RFA group was 10 folds of that in free-Vin group [(1 156.5 ± 158.3)ng/ml vs (194.5 ± 52.3)ng/ml, P = 0.005]. TL-Vin +RFA had better survival result than that of RFA alone (37.6 ± 20.1 days vs. 23.4 ± 5.0 days, P=0.015), as well as than that of free-Vin + RFA [(37.6 ± 20.1)days vs (23.3 ± 1.2)days, P = 0.016]. Conclusion Thermosensitive liposomal chemotherapies (Vinorelbine) can be selectively delivered at the edge of RFA coagulation area and thus effectively increase RFA-induced tumor coagulation and prolong the end-point survival in experimental mice.

Objective To discuss the clinical application of contrast enhanced ultrasonography (CEUS) in radiofrequency ablation (RFA) treatment for residual and recurrent hepatic neoplasms. Methods A total of 517 cases of primary hepatocellular carcinoma (HCC) or hepatic metastases with residual or recurrent hepatic neoplasms after different kinds of treatment were treated with RFA. A total of 619 lesions were used as study subjects. The average size of the 290 lesions detected in 281 patients with recurrent HCC was (3.4 ± 1.5) cm. CEUS-guided RFA group included 150 cases (154 lesions in total), while conventional US-guided RFA group included 131 cases (136 lesions in total). A total of 329 lesions were detected in 236 cases with recurrent hepatic metastases, and the mean size of the lesions was (3.1 ± 1.3) cm, of which CEUS-guided RFA group included 152 cases (198 lesions in total) and conventional US-guided RFA group included 84 cases (131 lesions in total). Results In recurrent HCC, the one-month tumor necrosis rate of CEUS group and conventional US group was 96.1% and 89.7% respectively (P = 0.032), and the local recurrence rate was 9.7% and 17.6% respectively (P = 0.049). The differences between the two groups were statistically significant. In recurrent hepatic metastases , the one-month tumor necrosis rate of CEUS group and conventional US group was 88.4% and 87.0% respectively (P = 0.712), and the local recurrence rate was 16.7% and 23.7%respectively (P = 0.117). No significant differences existed between the two groups. Conclusion For the treatment of recurrent HCC, CEUS-guided radiofrequency ablation can effectively improve the early necrosis rate and decrease local recurrence rate.

Objective To evaluate the prevalence of subclinical atherosclerosis in rheumatoid arthritis (RA) and the related risk factors.Methods Fifty RA patients without overt atherosclerotic disease and 121 control subjects matched for age and sex were recruited.Duplex carotid sonography was used to measure intima-media thickness (IMT) and plaque formation assessment.Differences between RA and the control group were compared, and the risk factors were explored.RA patients then were divided into two subgroups according to IMT and the comparison between the two subgroups were completed.T test, Mann-Whitney U test, chi-square test, Pearson's correlation and Logistic regression analysis were used for statistical analysis.Results Although RA patients had lower level of serum lipids and body mass index than the control group, the mean IMT value was significantly higher in the RA group than that in the control group [(0.78±0.18) mm vs (0.62±0.14) mm, t=5.853, P=0.000], and plaque formation was more prevalent [56.0％(28/50) vs 36.4％ (44/121),x2=5.596, P=0.018].The difference was especially significant in the younger groups (＜50 years old group and 50-60 years old group).Logistic regression showed that the presence of RA [OR=7.34, 95％CI (2.53, 21.25)], male [OR=2.0, 95％CI (91.25, 3.17)] and old age [OR=1.1, 95％CI (1.04, 21.15)] were the independent risk factors for abnormal IMT (thickened or the presence of carotid plaques).The RA patients were divided into two subgroups according to IMT.Compared with patients with normal IMT, patients with abnormal IMT were older and more common in postmenopausal, and had longer RA duration and higher cholesterol level.In treatment, less patients with abnormal IMT had been taking methotrexate (MTX) for more than 3 months compared with patients with normal IMT.Among these parameters, old age [OR=1.13, 95％CI (1.03, 1.23)] was shown to be the independent risk factor for abnormal IMT in RA patients, and more than 3 months of MTX treatment [OR=0.12, 95％CI (0.02, 0.71)] was the protective factor.Conclusion Atherosclerosis occurs frequently and prematurely in patients with RA and the presence of RA is an independent risk factor for atherosclerosis.Early primary prevention for atherosclerosis should be recommended.MTX probably has a positive effect on preventing atherosclerosis for RA patients, which needs to be confirmed by further study.

Objective To explore the diagnostic value of contrast enhanced ultrasound (CEUS) by comparison with enhanced MRI.Methods Thirty-two cases with pancreatic cystic lesions confirmed by surgery or biopsy were enrolled.Ultrasound,CEUS and MRI were applied respectively for the diagnosis of 32 cases.The diagnostic ability of different imaging methods were compared according to pathological results as the gold standard.Results The 32 cases include 8 cases of serous cystadenoma,6 cases of mucinous cystic neoplasm,3 cases of intraductal papillary mucinous neoplasm,4 cases of solid pseudopapillary tumor,3 cases of neuroendocrine tumor,6 cases of pancreatic carcinoma,1 case of cyst and 1 case of inflammatory myofibroblastic tumor.The diagnostic accuracies of ultrasound,CEUS and MRI were 46.88％ (15/32),75.00％ (24/32) and 78.13％ (25/32) respectively.There was no significant difference between the diagnostic accuracies of CEUS and MRI (P =0.768).The diagnostic accuracies of CEUS and MRI were higher than that of ultrasound (P ＜0.05).Conclusions CEUS has obvious superiority over ultrasound in the diagnostic accuracy of pancreatic cystic lesions.The diagnostic ability of CEUS is similar to that of MRI.

Objective To investigate the outcomes of patients with rheumatoid arthritis (RA) treated by different combination of synthetic disease modifying antirheumatic drugs (DMARDs) under the guidance of treat-to-target strategy.Methods Forty-two RA patients with high disease activity were enrolled into this randomized,open-label and prospective study.It was comprised of a maximal 36-week induction phase and then followed by a maintenance phase up to 84 weeks.Combination of synthetic DMARDs was initiated in the induction phase,with or without low dose glucocorticoids (GCs) during the first 12 weeks.Patients who achieved low disease activity (LDA) were randomized into two maintenance groups.An increase of DAS28 by 0.6 was defined as relapse.The patients achieved LDA in the induction phase,relapsed during maintenance phase and possible relevant risk factors were analyzed.Results Twenty-seven (64％) patients achieved LDA during the induction phase.More non-smoking patients achieved LDA than those smoked [85％ (11/13) vs 55％(16/29),P＜0.05].During the maintenance phase,14 (61％) out of 27 patients relapsed.Patients taking GCs during the first 12 weeks had a significantly higher relapse rate compared to those without GC (83％ vs 36％,P=0.021).Patients who entered maintenance phase at week 12 had a significantly higher tendency to relapse compared to those who entered the maintenance phase at week 24 [75％(9/12) vs 33％(3/9),P=0.026].Conclusion Smoking seems to be a risk factor for RA patients who fail to reach LDA.Low dose GCs as a bridge therapy may require a longer duration.High relapse rates in both the maintenance groups indicat that a longer tight induction phase may be appropriate before downstairs therapy.

Objective To observe the effects of fluorosis on the levels of endogenous cystathionine beta-synthase (CBS) and hydrogen sulfide (H2S) in rats.Methods According to body weight,forty-eight Sprague-Dawley rats (body weight 105-180 g) were divided into three groups by a random number table(16 rats in each group,half male).Fluorine contents of the feed in control group,low-fluoride group and high-fluoride group were 9.80,15.40 and 23.80 mg/kg.After 6 months of fluorine exposure,the fluorine contents of urine and bone were determined by the method of fluorine ion-selective electrode ; H2S levels in serum and brain and the activity of CBS in brain were detected by methylene blue; and protein expression of CBS was detected by Western blotting.Results Compared with control group,dental fluorosis was found in rats of low-fluoride and high-fluoride groups.The differences of fluorine contents of urine and femur were statistically significant between groups(F =65.16,67.93,all P ＜ 0.05).The urinary and femoral fluorine in low-fluoride groups [(5.25 ± 0.45)mg/L,(1 196.54 ± 72.78)mg/kg] and high-fluoride groups[(13.17 ± 0.98)mg/L,(2 656.61 ± 170.12)mg/kg] were higher than those of control groups [(3.64 ± 0.20)mg/L,(870.71 ± 71.51)mg/kg,all P ＜ 0.05],and the increases were in a dose-dependent fashion(all P ＜ 0.01).The differences of H2S contents in serum and brain were statistically significant(F =4.83,1 456.13,all P ＜ 0.05).The H2S content in serum was higher in high-fluoride group [(17.64 ± 2.38) μ mol/L] than that of the control group [(10.29 ± 0.74) μ mol/L,P ＜ 0.01].The H2S contents in brain were higher in the low-fluoride [(364.74 ± 2.06)μmol/L] and high-fluoride groups [(513.43 ± 4.18) μmol/L] than those of the control group[(314.94 ± 0.72)μmol/L,all P ＜ 0.01],and the increase was in a dose-dependent fashion (P ＜ 0.01).The difference of CBS activity was statistically significant between groups (F =760.63,P ＜ 0.01).The CBS activities were lower in low-fluoride [(438.90 ± 2.83) mmol· kg-1· min-1] and high-fluoride groups [(529.83 ± 2.37)mmol· kg-1· min-1] than those of the control group [(596.33 ± 2.75) mmol · kg-1· min-1,all P ＜ 0.01],whereas the protein expression of CBS in brain in high-fluoride group (1.49 ± 0.08) was higher than that of the control group (1.19 ± 0.06,P ＜ 0.05).Conclusion Chronic fluorosis can affect the levels of endogenous CBS and H2,S,and the increases are in a dose-dependent fashion in addition to CBS activity.