Objective　To better understand the clinical characters of juvenile onset spondyloarthropa-thies (JSpA).Methods　The clinical and laboratory data of 190 in-patients with JSpA were analyzed and the diagnosis,classification and differentiation of juvenile onset arthritis were discussed.Results　Among these 190 patients,163 were male,with a male to female ratio 6∶1.Of them 92.1% had the disease after the age of 8.Peak of age at onset was 12 to 15 years;157(82.6%) patients had peripheral arthritis and only 23(12.1%) patients felt low back pain at onset.During the disease course, peripheral arthritis was found in 187(98.4%) patients and the history of low back pain or buttock pain was recorded in 123(64.7%).The interval between peripheral arthritis and low back pain was from 0 to 20 years,with an average of (3.2±4.5)years.Extra-articular features including enthesitis in 67(35.3%)patients,dactylitis in 20(10.5%),iritis in 9(4.7%) were observed.HLA-B27 was positive in 87.9%(160/182) patients.Sacroiliitis on X-ray was observed in 76.0%(136/179) patients,and 106(55.8%) patients were diagnosed juvenile ankylosing spondylitis (JAS) according to 1984 New York modified criteria.The average disease course in JAS was (6.3±6.2) years,longer than that in JSpA (P＜0.01).Conclusion　The concept of JSpA is helpful to early diagnosis and treatment of juvenile onset arthritis.The JSpA are characterized by asymmetric lower limb predominant oligoarthritis,a wide spectrum of extra-articular features,presence of HLA-B27 and familial history of SpA or psoriasis.It will take an average of 6.3 years for JSpA patients to fulfill the diagnostic criteria of adult AS.

Objective To analyze the clinical characters of psoriatic arthritis (PA) which antedates psoriasis.Method The clinical characters,laboratory tests and radiographic findings of fifteen PA patients whose arthritis antedated psoriasis were analyzed.Results The male to female ratio was 2 75∶1,the age of onset was 11 to 47 years.The course was 2 month to 30 years.HLA B27 was positive in 86 7%(13/15) of patients and sacroiliitis on X ray was noted in 10 patients.Conclusion There are more sacroiliitis in PA patients whose arthritis antedates psoriasis and they are associated with HLA B27.

Objective To study the characteristics of IgA nephropathy (IgAN) secondary to ankylosing spondylitis (AS) compared with primary IgAN.Methods Clinical and pathologic data were collected in patients who were diagnosed with IgAN by renal biopsy and admitted to our hospital from Jan 2007 to Sep 2015.Patients with IgAN secondary to AS were recruited by the ratio 1 ∶ 5 of patients with primary IgAN as control group at the same period.Results There were 15 patients in AS group,proportionately 75 patients in the control group.Compared with those in control group,patients in AS group had shorter disease course [(10.1 ± 8.3) months vs (20.2 ± 27.9) months] and lower proportions of renal insufficiency and hypertension[1/15 vs 52.0％ (39/75);1/15 vs 46.7％ (35/75)].In laboratory tests,quantitative 24 hour urinary protein and serum ereatinine were significantly lower in group AS than those in the control group [(1.42±0.67)g vs (2.88 ±1.35)g;(79.0±18.2)mmol/L vs (145.3 ±77.6) mmol/L].The Lee grading of IgAN in two groups was comparable.The treatment in both groups was similar including steroids,immunosuppression agents,angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.After follow-up from 1 to 6 years,3/11 patients in AS group and 22.8％ (13/57) (13/75) in control group developed deterioration of renal function.Conclusion Patients with IgAN secondary to AS have shorter disease course and milder condition compared with patients with primary IgAN.Clinical outcome of renal function in both groups is similar according to comparable treatment.

Objective To investigate the efficacy and safety of mycophenolate mofetil (MMF) for refractory autoimmune 1iver disease:Methods Six patients with autoimmune liver disease who had failed MMF treatment and variation of biochemical indexes.adverse effects of the MMF treatment were recorded.Results After MMF treatment.the serum 1evels of alanine aminotransferase (ALT) were decreased to nOrmal level in three of four patients with higher ALT.The serum levels of alkaline phosphatase (ALP) were decreased to more than fifty percent of normal level in four of five patients with higher ALP.The serum levels of γ-glutamyhransferase (GGT) were decreased to more than fifty percent of normal level in all five patients with higher GGT.The serum levels of immunoglobulin G (IgG) and γ-globulin were decreased to normal level in all two patients who had elevated IgG and r-globulin levels.The serum levels of total bilirublin and total bile acid.the count of white blood cell and platelet had no change.There were no adverse effects in a11 six patients.Conclusion MMF treatment for early refactory autoimmune liver disease is effective with few sideeffects.

Objective To enhance the understanding of the clinical features,diagnosis,treatment and prognosis of reflex sympathetic dystrophy (RSD).Method Three patients with RSD in PLA General Hospital were analyzed.Results In the three patients the symptoms appeared following an injury,they had severe pain,swelling,limited range of motion,vasomotor instability,skin changes,patchy bone demineralization,and increased scintigraphic uptake in the peripheral joints of involved extremities.Two of them had shouder hand syndrome and one had obvious skin thickening.The patients showed better responses after the treatrment of physiotherapy,nonsteroidal antiinflammatory drugs,corticosteroids and tricyclic antidepressants.Conclusion Early diagnosis is very important and appropriate treatment must be initiated as early as possible for RSD patients.

Objective To study the characteristics of the deficits of switching function in video game addicts .Methods A total of 21 game addicts and 21 normal participants were performed a classic task switch task ,then the switching cost between two groups was compared .Results The results showed that the switching cost was significant greater for game addicts (372 ms) than that for health participants(180 ms) ,t=3 .63 ,P<0 .05 .Conclusion The present study suggested that the switching function was impaired to a certain extent for video game addicts ,and it might be one of the cognitive mechanisms for causing the game addicts .

Objective To improve the understanding of progressive pseudorheumatoid dysplasia (PPD). Methods The clinical and roentgeno graphic features of two patients with PPD diagnosed in our department were analysed, and the related literature was reviewed. Results The patients first experienced the osseous swelling in phalangeal joints of both hands in childhood, and progressively almost all joints were involved. The spine was also involved. By analyzing the clinical information of 53 cases, it was found that PPD involved both male and female similarly. The ages at onset of first symptoms, were from 1 to 10 years, and in seventy seven percent of patients the ages were 3 years to 5 years. Clinical features included progressive involvement of the major joints, including small joints of the hands, hips, knees, ankles, wrists and shoulders. Premature osteoarthritis developed in early adult life, and it was the major reason of disability. 38% of patients were short in stature. The roentgenographic features consisted of generalized platyspondyla with irregular delineation of the endplates of the vertebral bodies, varying degrees of epiphyseal involvement with enlargement of the large joints, metacarpal heads and phalanges, secondary degenerative arthritis with periarticular osteoporosis. The symptoms of PPD were similar to those of rheumatoid arthritis (RA), but differed from it by the Absence of synovitis and other inflammatory changes, and radiographically by the Absence of destructive changes and the presence of dysplastic bone changes. There was no specific treatment for cure. Conclusion PPD is a rare autosomal recessive skeletal disorder associated with WISP3 gene mutations. Its clinical features and typical roentgenographic features are helpful to the diagnosis.

Objective To explore the sleep problem and its related factors,and to provide evidence for improving sleep quality of patients with ankylosing spondylitis (AS). Methods Pittsburgh sleeping quality index (PSQI),self-rating depression scale (SDS),self-rating anxiety scale (SAS) and a self-designed questionnaire were applied to survey 318 patients with AS.Data were analyzed by the SPSS 17.0 software.The relationship between the various relevant factors were revealed by t-test,x2 test,Wilcoxon rank-sum test and Pearson correlation analysis.Results The mean total score of PSQI was 6.6±3.6, and 35.4％ of AS outpatients showed poor sleep quality.The difference of PSQI scores and detection rate of poor sleep quality between male and female were not statistically significant.There were significant difference of early morning stiffness(Z=-3.077,P=0.002),BASFI(Z=-4.766,P=0.000),BASDAI(Z=-6.880,P=0.000),nocturnal pain VAS(VAS)(Z=-6.502,P=0.000),total back pain VAS(Z=-6.675,P=0.000),ESR(Z=-2.370,P=0.018),CRP(Z=-2.063,P=0.039) between the poor sleep and the good sleep patients (P＜0.05).The PSQI score was positively correlated with age (r=0.165,P=0.003) but not gender and disease duration (r=0.078,P=0.165; r=0.094,P=0.097).PSQI score difference were also observed between patients with negative mood and patients without negative mood (t=-7.613,P=0.000; t=-7.287,P=0.000).Conclusion High incidence of sleep disorder exists among AS outpatients,and it is closely related with age,anxiety,depression and activity of AS.Attention should be paid to AS patients with sleep problems.

Objective To discuss the value of CT prognosis on the Masaoka staging system of thymic epithelial tumors(TET) before surgical resection.Methods The CT images of 102 patients with TET proved by surgery and pathology were reviewed retrospectively.The TET were reclassified according to Masaoka stage system.The size,homogeneity,sharp,contour,infiltration of surrounding tissue,and metastasis on CT were analyzed with Logistic analysis.The diagnostic value was also evaluated with a ROC curve.Results Masaoka pathologic stages were stage Ⅰ for 36 (35.3 ％),stage Ⅱ for 27 (26.5 ％),stage Ⅲ for 30 (29.4 ％),and stage Ⅳ for 9 (8.8 ％).A multivariable Logistic regression model showed that TET with larger size of tumor (20/35,P =0.0371,OR =4.539),irregular or lobulated tumor contour (26/42,P =0.0230,OR =4.870),heterogeneous (21/33,P =0.0154,OR =6.020),infiltration of surrounding fat (25/32,P =0.0019,OR =14.005),and pleural seeding (11/11,P =0.0032,OR =36.153)were more likely to have stage Ⅲ or Ⅳ disease.The area under ROC curve was 0.940.Conclusions The tumor CT imaging features can differentiate between stage Ⅰ,Ⅱ and stage Ⅲ,Ⅳ disease.This helps identified patients more likely to benefit from neoadjuvant therapy.

0.05).The jitter(q=27.885),shimmer(q=35.839),NNE(q=5.817),and harmonic noise ratio(HNR,q=6.383)decreased significantly at 1 month after the operation(P