Objective To investigate the reasonable perioperative management for elderly patients with esophageal cancer undergon esophagectomy.Methods 92 elderly patients with esophageal neoplasms were treated by esophagectomy.According to the specific pathogenetic condition of the patients,various perioperative managements were provided.After surgery,the operative complications,mortality and 3,5-year survival rate were observed.Results Esophagectomy was carried out for all cases.Cardiovascular and respiratory complications were found in 19,10 respectively.Both of anastomotic stricture and fistulae were found in 4 cases.1 and 2 complicated with chylopleural and disturbance gastric emptying respectively.Mortality was 4.35%,and the 3,5-year survival rate was 80.43%(74/92),34.79%(32/92) respectively.Conclusion Satisfactory perioperative managements are the key to successful esophagectomy.

0.05) in age, sex, disease course and disease activities (SLEDAI). Fever, oral ulcer, Raynaud′s phenomenon and cardiac involvement in infection group were more common than in disease flare group (P

Objective To analyze the clinical features and outcome of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome,and enhance the understanding of it.Methods Fourteen cases of RS3PE syndrome treated in the Department of Rheumatology and Immunology were analyzed retrospec-tively,including the clinical characteristics,laboratory data.Data were presented as -x±s.Results Fourteen patients(nine man,five women) with RS3PE were enrolled.Their age was (68±9) (range:52-78)years.The main clinical features were acute onset symmetrical edema in both hands and feet and polyarthritis.Polyarthritis were involved in hand joints in 14 patients,wrists in 13 patients,knees in 10 patients,ankles in 9 patients,and shoulders in 8.In laboratory examinations,the average value of erythrocyte sedimentation rate was (68±26) mm/l h and C-reactive protein was (49±41) mg/L.Mild anemia of normocytic-normochromic type and mild low level of serum albumin were frequent findings.Antinuclear antibody was present only in one patient at low titer (1∶20).Rheumatoid factor and other auto antibodies were all negative in patients.Before corticosteroid treatment,the MRI test was performed in 8 patients and revealed prominent synovitis and articular effusion.Two cases had bone erosions on MRI; five patients were fuond to have malignant tumors,three of them initially presented with RS3PE.Polyarthritis and edema were relieved after treated with low dose corticosteroids and DMARDs drugs.But those patients with cancer were easily to recurr.Conclusion RS3PE syndrome is relatively uncommon.It occurs predominantly in elderly men and is characterized by rapid-onset symmetrical polyarthritis,presence of pitting edema of both hands and feet.Erosive changes can be seen on MRI.Patients usually have dramatic response to low dose corticosteroids and DMARDs drugs.Patients should be closely followed as RS3PE is closely related to cancer.

Objective:To observe the clinical features of primary Sjgren syndrome(pSS) in young people(≤34 years).Methods: The data of 232 patients with pSS who were in hospital from 2004 to 2008 were analysed in a prospective study.Results: A total of 23.7%(55/232)patients' symptoms came on in youth(≤34 years),who were all females,mean age was(27.6?6.2) years.The other 177 patients' symptoms came on when they were more than 34 years old.In young group,32.73%(18/55) patients' first symptoms were xerostomia and/or keratoconjunctivitis sicca,the other 67.27%(37/55)came on without xerostomia and keratoconjunctivitis sicca,while in the middle-aged and aged group,59.32%(105/177)patients' first symptoms were xerostomia and/or keratoconjunctivitis sicca,40.67%(72/177)without xerostomia and keratoconjunctivitis sicca.There was significant difference(P=0.001).The duration from first symptom to first diagnosis of pSS in the young group was(93?107) months,which was significantly longer than those of the middle-aged and aged group [(45?59) months,P=0.001].The systemic damage of the young group was 61.8%(34/55),which was significantly greater than 41.24%(73/177)in the middle-aged and aged group(P=0.026).Conclusion: Primary Sjgren syndrome in young people is not rare,and about 2/3 of them come on without xerostomia and/or keratoconjunctivitis sicca.Not only the duration from first symptom to first diagnosis of pSS in the young group is longer,but also the systemic damage of the young group is greater than those of the middle-aged and aged group.These findings should alert the clinician to make the possible diagnosis of pSS in young patients.

Objective To comprehensively analyze the academic impacts of papers published by the Chinese Journal of Rheumatology based on the Chinese biological medical journal citations database(CMCI) 1997-2011 data developed by PLA medical library.Methods Based on the Chinese biological medical journal citations database (CMCI),method of bibliometrics for 1997-2011 was adopted for the analysis.The citation rate,the authors distribution,and the research direction of the citated papers were all included for the evaluation.Results During 1997 to 2010,1700 papers were included into the CMCI by the law of the journal of rbeumatology,8323 times were cited by domestic science and technology journal with the average citation of 4.90 times.The authors of 675 cited papers distributed in 28 provinces and autonomous regions and municipalities.During 1997-2011,the law of the journal of rheumatology cited 170l papers,the rank of the first three topics was the systemic lupus erythematosus (sle),in which 453 articles were cited,rheumatoid arthritis in which 404 article were cited,and relevant ankylosing spondylitis in which 106 articles were cited,Articles with these three topics accounted for 56.61％ of overall citations.Conclusion The papers published by the journal have shown certain depth theoretically and some breakthr-oughs.The articles and papers published have focused on the hot topics and critical research area and topics of rheumatology,therefore,have guided the development of Chinese rheumatology.The journal has important influences on clinical practice and research of Chinese rheumatology.The papers published could be used as valuable resources.The influence and the academic status of this journal is gradually expanding and the quality of the publications is persistently improving.It is one of the major scientific journals in medical research in China.

Objective To investigate clinical characteristic of primary Sjogren's syndrome(pSS) with initial manifestations in the extra-gland organs. Methods Clinical data, including symptoms, laboratory parameters and complications of 85 pSS patients with initial manifestations of extra-gland organs hospitalized at the People's Hospital of Peking University during 2003 to 2006 were collected and analyzed retrospectively, as compared to those of pSS with xerophthalmia or xerostomia as initial ones. Results Mean time interval from onset to diagnosis in these patients with initial manifestations involved in the extra-gland organs was 94.5 months, higher than that in those with xerophthalmia or xerostomia as initial ones. Arthritis was manifested initially in 38 of the 85 patients (44.7 percent), peripheral leukopenia in 16 (18.8 percent), thrombocytopenia in nine (10.6 percent) and abnormal liver function in 13 (15.3 percent), respectively. Percentage of serum positive autoantibedies was higher in the patients with initial manifestation of the extra-gland organs than that in those with xerophthalmia or xerostomia as initial ones. Conclusions Initial manifestation of primary Sjogren's syndrome varies, and some patients can be initially involved in their extra-gland organs, with more proportion of arthritis than of other symptoms, and xerophthalmia or xerestomia could appear in them during the course of disease. And, xerophthalmia or xerostomia would not appear even as pSS was diagnosed in some other pSS patients. More attention should be paid to these clinical characteristics mentioned above in practice to avoid misdiagnosis.

Objective:To explore the role of Foxp3 expressing regulatory T cells in the initiation and development of rheumatoid arthritis(RA) and its correlation with clinical features of the disease.Methods:Total RNA isolated from PB in 25 RA treated patients, 25 RA untreated patients and 30 health volunteers was reversely transcribed into cDNA. The real-time-fluorescence quantitative PCR method was used to analyze the expression level of Foxp3 mRNA. The level of Anti-CCP antibody, CRP, ESR and RF of the patients were detected at the same time.Results:The level of Foxp3 mRNA from RA group was significantly lower than that of controls(P

Objective:To study the inhibition of collagen-induced arthritis by an altered CⅡ263-272 peptide(sub268-270) with three consecutive substitutions of TCR-contacting residues.Methods:Arthritis was induced by bovine collagen type Ⅱ. The altered peptide sub268-270 was given intravenously with a dose of 90 ?g once a week. Peptide control and blank control were treated with similar approaches. The therapeutic effect of the altered peptide was evaluated by arthritis score index, radiological score and pathological score.Results:The arthritis score of rats treated with altered peptide, control peptide and blank control were 5.60?1.24, 11.20?1.21 and 11.80?1.22 respectively(P

Objective To immunize BALB/c mice with type 3 musearinic acetylcholine receptor polypeptide (M3RP) and to evaluate the role of M3RP in SS. Methods Four-week-old BALB/e mice were immunized with M3R polypeptide 213-228 (M3RP) on days 0, 14, 35, 56, and were re-immuniged on days 65, 84, 105, and one mouse was killed every 2 to 3 weeks. The mice of the control group were immunized with submaxillary gland homogenate, GST, and PBS. The animals were analyzed for the presence of anti-SSA,anti-SSB, RF, ANA, anti-a-fodrin and anti-M3RP in sera by immunofluorescenee or ELISA. The cytokines of IFN-γ IL-2 and IL-10 were measured with ELISA. Salivary glands were examined by H＆E staining and immunohistochemical analysis. Volume of water drinking by each groups were calculated. Results BALB/e mice immunized with M3RP and submaxillary gland homogenate developed an immune response directed against M3RP, α-fodrin and ANA, but no antibodies against SSA, SSB and RF were found. Furthermore, lym-phocytic infiltrates in the salivary glands of immunized animals were observed 50 days after first immunization of M3RP and submaxillary gland homogenate. The serum IFN-α in mice of M3RP, submaxillary gland ho-mogenate, GST and PBS was (62±6), (89±5), (30±5) and (19±6) pg/ml respectively, and IL-2 was (12.6±1.6), (19.8±0.4), (3.9±0.9), and (4.9±1.1) pg/ml respectively (P<0.05). No difference was found in the level of serum IL-10 among the four group. Expression of α-fodrin was found only in submaxillary gland in M3RP and submaxillary gland homogenate groups of mice, but not in PBS and GST controls when studied by immunohistochemical analysis. Conclusion These results suggest that BALB/c mice immunized with M3RP are reminiscent of human SS, and M3RP as an autoantigen participates the development of SS.

Objective:To evaluate the significance of the combination of rheumatoid factor (RF) and anti-filaggrin antibodies (AFAs) in the diagnosis of rheumatoid arthritis (RA). Methods:Sera from 266 RA patients and 186 controls were studied. RF and some kinds of AFAs (including antikeratin antibodies, anti-perinuclear factor and anticyclic citrullinated peptide antibodies) were detected using immunofluorescence and ELISA respectively. The distributions of these antibodies were compared to determine the significance of the combination of RF and AFAs. Results:The sensitivity and secificity of RF for the diagnosis of RA were 65.8% and 81.8% respectively, as compared with those of anti-CCP or RF positive were 86.5% and 80.6% respectively. Only a slight change was found in the secificity and negative predictive value between them. RF could not be detected in 91 patients while 64.8% of them could be found to have at least one kind of AFAs. Conclusion:AFAs, particular anticyclic citrullinated peptide antibodies, could be helpful for the diagnosis of RA especially in RF-negative patients.