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To investigate the clinical manifestations and imaging characteristics of patients with different types of infectious sacroiliitis. Clinical data of 40 patients diagnosed with infectious sacroiliitis were retrospectively analyzed. Among the 40 patients, 16 patients were diagnosed as non-brucellar and non-tuberculous infectious sacroiliitis (ISI), 13 with tuberculous infectious sacroiliitis (TSI), and 11 with brucellar sacroiliitis (BSI). In the ISI and TSI group, female patients accounted for 11/16, 12/13, while the proportion of unilateral involvement was 15/16 and 12/13, respectively. Compared with ISI and TSI group, BSI patients were mainly male (8/11) and presented more bilateral involvement (6/11) ( P<0.05). Bone erosion was more common in ISI and TSI groups than in BSI group (6/15, 7/11 and 2/10), as well as abscess formation (3/15, 4/11 and 1/10, respectively). Symptoms in all patients relieved 1-2 weeks after administration of antibiotics or anti-tuberculosis treatment, but the resolution of the magnetic resonance imaging findings delayed about 6 (3-9) months. ISI and TSI patients with infectious sacroiliitis should be differentiated from spondyloarthritis, with a characteristic of more female patients, unilateral sacroiliitis, bone erosion, soft tissue involvement and abscess formation. However, BSI patients are mainly male, more bilateral involvement and less bone destruction and abscess formation. Antibiotic therapy demonstrates significant therapeutic effects, but resolution of the magnetic resonance imaging findings responses late.
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Objective:By analyzing the clinical characteristics of anti-Ku antibody associated disease, this paper aims to improve the diagnosis and treatment level of it.Methods:The clinical symptoms, laboratory tests and prognosis of 40 anti-Ku-antibody positive patients from the First Affiliated Hospital of Zhengzhou University from September 2017 to September 2019 were retrospectively collected, and then hierarchical clustering analyzed.Results:The average age of 40 anti-Ku positive patients was 48±18 years, and the male to female ratio was 1∶4. The average follow-up was (11±7) months, of which 2 cases were accompanied by malignant tumors and 3 cases died. Interstitial lung disease was most common and was found in 24 cases (60%). The most common disease was inflammatory myopathy (11 cases, 28%), followed by systemic lupus erythematosus (SLE) (9 cases, 22%). According to hierarchical cluster analysis, the anti-Ku-antibodies positive patients were divided into 3 groups. Among them, group A had the highest incidence of pulmonary interstitial fibrosis (84%, P<0.01), and the lowest incidence of renal involvement (0, P<0.01), cytopenia (0, P<0.01), serositis (0, P<0.01). Although the incidence of anti-Jo-1 antibody positivity in group A was the highest (16%, P=0.44) but without statistically significant difference. The characters of group A were in line with inflammatory myopathy. Group C had the highest incidence of renal involvement (57%), lupus rash (71%), cytopenia (57%), low complement (71%) and lupus-related antibodies positivity ( P value were all<0.05), which was in line with SLE. These two groups had their own significant biological characteristics, and were rarely overlapped. Conclusion:Anti-Ku antibody appears in a wide spectrum of autoimmune diseases, among which inflammatory myopathy is the most common, followed by SLE. Patients with anti-Ku antibody rarely have SLE and myositis overlapped, and the overall prognosis is good, but it is necessary to be alert to complications, such as tumors.
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Objective:To investigate the alterations of cerebellar and cerebral functional connectivity (FC) in patients with relapsing-remitting multiple sclerosis (RRMS) and associations with clinical parameters.Methods:Eighteen acute RRMS patients, 25 remitting RRMS patients and 20 healthy controls (HC) who underwent 3.0 T brain MRI using resting-state functional protocols were collected retrospectively from September 2012 to June 2019 at the First Hospital of Nanchang University. After data preprocessing, the functional connectivity coefficients were calculated between each seed of the cerebellum and every other voxel in the cerebrum for comparison of the inter-groups difference and correlation analysis with clinical variables.Results:Compared with HC, the acute RRMS patients showed significant decreased FC of left cerebellar lobule Ⅵ, the right cerebellar lobule Ⅵ and the left vermis ( P<0.001, Gaussian Random Field theory correction at cluster level P<0.05), the remitting RRMS patients showed the decreased FC of the right cerebellar Crus I, the left cerebellar Crus Ⅰ, the left cerebellar lobule Ⅴ and right cerebellar lobule Ⅴ ( P<0.001, Gaussian Random Field theory correction at cluster level P<0.05). In the acute RRMS patients, FC between the left cerebellar lobule Ⅵ and the right precentral/postcentral gyrus was negatively correlated with illness duration ( r=-0.492, P=0.038). FC between the right cerebellar lobule Ⅵ and the right postcentral gyrus/right superior parietal gyrus was negatively correlated with the expanded disability status scale scores ( r=-0.611, P=0.007). FC between the left vermis and the left calcarine gyrus was negatively correlated with illness duration ( r=-0.534, P=0.02). In the remitting RRMS patients, FC between the right Crus Ⅰ and the left anterior insula was negatively correlated with normalized total white matter lesion load ( r=-0.453, P=0.023). FC between the right Crus Ⅰ and the right anterior insula was negatively correlated with modified fatigue impact scale ( r=-0.450, P=0.024). Conclusions:The cerebello-cerebral connection of cognitive related networks is decreased in both acute attack and remission stages of RRMS patients. In addition, the cerebello-cerebral connection in sensorimotor network can also be significantly impacted in acute attack stage, while the cerebello-cerebral connection of emotional network may be decreased in remission stage.
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Antibiotics are widely used and prevalently distributed in the environment. The issue of antibiotic resistance genes has posed a huge threat to the global public health. Soil is an important sink of antibiotics in the environment. Antibiotic exposure may introduce adverse effects on soil organisms, and bring indirect but potential risks to human health. Therefore, it is urgent to take actions to remediate antibiotics-contaminated soil. This review summarized effects of antibiotics on phenotype growth of plants, physiological characteristics and community structure of animals, composition and structure of microbial communities, and transmission of antibiotic resistance genes among organisms in soil. Additionally, the potential and prospects of employing antibiotic-resistant soil plants, animals, microorganisms, and their combinations to treat antibiotics-contaminated soil were illustrated. Last but not least, the unaddressed issues in this area were proposed, which may provide insights into relevant research directions in the future.
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Animals , Humans , Anti-Bacterial Agents/pharmacology , Biodegradation, Environmental , Drug Resistance, Microbial/genetics , Soil , Soil Microbiology , Soil PollutantsABSTRACT
BACKGROUND: Pedicle screw internal fixation has been widely used in the lumbar spine, and fixed application in thoracic vertebra has gradually been accepted. Considering the narrow thoracic pedicle, especially at T3-T9, pedicle screw always punctures the cortex and important adjacent structures. To avoid serious complications, researchers developed the external pedicle approach from the costal transverse process joint and the costal vertebra joint to the vertebral body, and then others designed a similar screw entry method, which can provide enough safe paths as long as the ribs are not penetrated. At present, the existing studies mainly focus on the upper and middle thoracic vertebrae in adults. OBJECTIVE: To measure the anatomical parameters of pedicle-rib unit screw fixation in thoracic vertebrae of preschoolers, and to explore their developmental regularity and morphological characteristics at different age groups and sexes, so as to provide theoretical basis for clinical practice. METHODS: Sixty-seven preschoolers aged 7-12 years old without bone destruction, tumor, deformity, degeneration or fractures at the spine and no history of spine related surgery were selected. Three-dimensional reconstruction was conducted after spiral CT scanning. The morphological structure of pedicle-rib unit was observed. The transverse diameter, length, inclination angle and safety angle range of pedicle-rib unit screw were measured and analyzed statistically to investigate the feasibility of screw on anatomy. All guardians of the children signed the informed consents, and the study was approved by the hospital ethical committee. RESULTS AND CONCLUSION: (1) The transverse diameter of the thoracic pedicle-rib unit was increased with age, and decreased first and then increased with the increase of vertebral sequence. The transverse diameter in males was larger than in females at the same age. (2) The length of pedicle-rib screw channel was significantly different in different age groups (P < 0.05), which showed a significant increase with age and a trend of first increase and then decrease with the increase of vertebral sequence. (3) Pedicle-rib unit screw placement showed that safety angle range was 18°-25°, including maximum safety scope in T1, followed by T|0, minimum in T4 and T5. (4) Thus, security angle range of pedicle-rib unit screw in children is narrower than that in adults. Compliance with the adult standards in screw placement may cause severe nerve damage to the nerves and blood vessels, so preoperative individualized screw placement should be carried out according to the CT results.
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Objective@#To investigate the effects of miRNA on the expression of paraoxonase 1 (PON1) and its clinical application in the patients with nonalcoholic steatohepatitis (NASH). @*Methods@#Bioinformatics methods were used to analyze and predict PON1 related regulation on miRNA. PON1 luciferase reporter gene vectors were constructed and the activity of dual luciferase was analyzed. The up/down-regulated levels of miRNA in HepG2 cells of different groups were detected by real-time fluorescence quantitative PCR (qRT-PCR), and the levels of PON1 protein in HepG2 cells were detected by western blot. The levels of miR140-5p in the serum of healthy people and NASH patients were also analyzed by qRT-PCR. @*Results@#According to the prediction of TargetScan database, miR140-5p may bind complementarily to the end of PON13′-UTR. The analysis for the activity of dual luciferase reporter gene showed that miR-140-5p mimic significantly downregulated the fluorescence of wild type PON1 vector (P＜0.01). The results of qRT-PCR demonstrated that miR-140-5p mimic group showed high overexpression (P＜0.01) compared with the normal cell control group and the negative mimic control group, while miR-140-5p inhibitor group appeared corresponding low expression (P＜0.05). western blot results suggested that the transfection of miR140-5p mimic significantly down-regulated the expression of PON1 (P＜0.01) while miR140-5p inhibitor up-regulated this expression (P＜0.01). Compared with the healthy control group, the level of miR140-5p was decreased in the serum of NASH patients, and the difference was statistically significant (P＜0.01). @*Conclusion@#miR140-5p may be involved in the progression of nonalcoholic steatohepatitis through regulation for the posttranscriptional gene expression of PON1.
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Objective To investigate the clinical features of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) associated hypertrophic pachymeningitis (HP).Methods Clinical data of 4 casesdiagnosed with MPO-ANCA vasculitis complicated with HP in our hospital were analyzed retrospectively and the related literaturewere reviewed.Results Four male patients with an age range from 44 to 66 years were diagnosed with ANCA-associated HP.The main clinical manifestations included headache and withvarious degree ofmultiple cranial paralysis.During active phase of the disease,all patients showed perinuclear(p)-ANCA positive,elevated levels of inflammatory biomarkers and titers of MPO-ANCA,whereas renal function,cytoplasmic (c)-ANCA and protease 3 (PR3)-ANCA were negative.Contrast-enhanced cranial magnetic resonance imaging (MRI) scan showed obviously thickened dura mater and sinusitis or mass in paranasal sinus.Four patients were sensitive to glucocorticoid.Three patients had a relapse during glucocorticoid tapering and were undercontrol when the dosage of glucocorticoid was increased and immunosuppressive agents were added.Levels of inflammatory biomarkers,titers of MPO-ANCA and p-ANCA recovered to normal,and the dural thickness on MRI was reduced in the remission stage.Conclusion MPO-ANCA associated HP is a type of central nervous system involvement in ANCA associated vasculitis (AAV).It involves the upper respiratory tract more frequently,and less frequently progresses to systemic AAV.This should be taken into consideration when middle-aged and elderly patients presented with headache and multiple cranial neuropathies.Enhanced MRI is the preferred examination for diagnosis,and dural biopsy should be done when necessary.
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Objective Through the detection of the levels of serum betatrophin,anthropometric and biochemical indices,to determine the alteration of betatrophin levels in patients with polycystic ovary syndrome (PCOS) and the relationship between betatrophin levels and metabolic indexes such as 25-hydroxy vitamin D3 [25 (OH) D3].Methods The study group was composed of 24 women with PCOS and 20 age-natched healthy women as controls.Following general physical examination of the subjects,anthropometrie measurements were performed (height,weight,waist circumference,hip circumference).Body mass index (BMI) and waist-hip ratio were calculated;25 (OH) D3,Ca2+,fasting blood glucose,fasting insulin,triglycerides,high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C) were also measured and homeostasis model assessment of insulin resistance (HOMA-IR) were evaluated in all subjects.Serum betatrophin levels were examined with an enzyme-linked immunosorbent assay (ELISA).Using independent sample T test to compare the differences between groups,the linear correlation analysis was performed to study the correlation of betatrophin with anthropometric and biochemical indices,the influencing factors of betatrophin were analyzed by multiple linear regression.Results Circulating betatrophin levels [(0.341±0.034) ng/ml vs.(0.810±0.162) ng/ml,t=4.271,P＜0.001] and HDL-C [(1.014±0.321) mmol/L vs.(1.419±0.287) mmol/L,t=2.218,P＜0.05] significantly decreased in women with PCOS compared with controls,and BMI [(27.691±4.392) kg/m2 vs.(23.310±4.781) kg/m2,t=-2.073,P＜0.05],fasting blood glucose [(5.950±0.411) mmol/L vs.(4.883±0.314) mmol/L,t=-2.142,P＜ 0.05],HOMA-IR [(4.946 ± 0.741) vs.(3.387± 0.397),t=-2.493,P＜0.05],triglycerides [(1.510± 0.848) mmol/L vs.(1.037±0.402) mmol/L,t=-2.223,P＜0.05],LDL-C [(3.431±0.479) mmol/L vs.(2.396±0.435) mmol/L,t=-2.433,P＜0.05] were obviously increased.Moreover,there was a postive correlation between betatrophin and HOMA-IR (r=0.425,P＜0.05) as well as 25(OH)D3 (r=0.577,P＜0.05) and Ca2+ (r=0.448,P＜0.05),while the betatrophin was negatively related to BMI (r=-0.451,P＜0.05),triglycerides (r=-0.454,P＜0.05),LDL-C (r=-0.551,P＜0.05).Circulating betatrophin levels were higher when 25 (OH) D3 levels were beyond 35 nmol/L in PCOS patients [(0.539±0.092) ng/ml vs.(0.199±0.031) ng/ml,t=3.072,P＜0.001],and the multiple linear regression analysis showed that the main factors affecting the levels of betatrophin were BMI (OR=-0.260),HOMA-IR (OR=0.218),25(OH)D3 (OR=0.238),and glycerol (OR=-0.162).Conclusion It is speculated that betatrophin may be a valuable predictive factor of PCOS because betatrophin is closely associated with insulin resistance,lipid metabolism disorders and the lack of 25-hydroxy vitamin D3 in PCOS patients.
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Objective To investigate the level of Irisin in polycystic ovarian syndrome ( PCOS) patients and analyze its potential correlation with 25 (OH) vitamin D3 and other metabolic indicators , with an attempt to explore the role of Irisin in PCOS and thus inform the diagnosis and treatment of this condition .Methods Totally 67 PCOS patients presenting in the reproductive infertility center of the First Hospital of Shanxi Medical University from April 2015 to January 2016 were enrolled as the PCOS group;meanwhile, 72 women of child-bearing age from the health check-up center were included as the control group .We measured the height , body mass, waist circumference, abdominal girth, hip circumference, and blood pressure and calculated their body mass index (BMI) and waist-to-hip ratio (WHR).The serum biochemical indicators including Irisin , 25(OH) vitamin D3, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol ( LDL-C ) , fasting plasma glucose ( FPG ) , fasting insulin ( FINS ) , follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TES) , and Homeostatic Model Assessment of Insulin Resistance ( HOMA-IR ) were measured .Results The body mass [ ( 66.074 ± 12.952) kg vs.(57.671 ±8.806) kg, P =0.000], BMI [ (25.340 ±4.149) kg/m2 vs.(22.201 ± 3.585 ) kg/m2 , P=0.003 ] , waist circumference [ ( 88.829 ±12.212 ) cm vs.( 80.550 ±10.343 ) cm, P=0.007], hip circumference [ (100.805 ±8.614 ) cm vs.(92.007 ±9.325 ) cm, P=0.000], WHR (1.279 ±0.082 vs.0.857 ±0.071, P=0.000), diastolic blood pressure [ (78.548 ±8.936) mmHg vs. (73.071 ±10.614) mmHg, P=0.036], TG [ (2.263 ±1.142) mmol/L vs.(1.330 ±1.329) mmol/L, P=0.019], FPG [ (5.128 ±0.392) mmol/L vs.(4.809 ±0.394) mmol/L, P=0.008], FINS [ (13.319 ± 8.122) mU/L vs.(4.921 ±2.028) mU/L, P=0.000], LH [ (8.153 ±2.271) IU/L vs.(3.811 ±2.607) IU/L, P=0.000], TES [ (63.068 ±25.704) ng/dl vs.(34.811 ±11.827) ng/dl, P=0.000] and, HOMA-IR (2.245 ±0.853 vs.1.021 ±0.153, P=0.000) in PCOS group were higher than those in the normal control group.Serum irisin level in PCOS group was significantly elevated when compared with control group [ (831.542 ± 98.484) ng/ml vs.(612.345 ±86.308) ng/ml, P=0.006], while HDL-C [ (1.278 ±0.345) mmol/L vs. (2.493 ±0.262) mmol/L, P=0.011], and 25 (OH) VD3 concentrations [ (17.181 ±5.078) nmol/L vs. (20.823 ±5.305) nmol/L, P=0.009] were decreased significantly .Linear regression analysis showed that iri-sin was positively associated with body mass (r=0.396, P=0.028), BMI (r=0.712, P=0.000), waist circ-umference (r=0.462, P =0.021), hip circumference (r =0.478, P =0.006), WHR (r =0.686, P =0.002), TG (r=0.397, P=0.036) and HOMA-IR (r=0.467, P=0.019) in the PCOS patients and there was a negative correlation between irisin and 25 (OH) VD3 (r=-0.654, P=0.004).Multiple regression analysis in PCOS group with irisin as dependent variable and other anthropometric and biochemical indicators as independent variables revealed that there was linear regression relationship between serum irisin and BMI (β=0.822, P<0.001), TG (β=0.076, P=0.035), and 25 (OH) VD3 levels (β=-0.242, P=0.027). Conclusions Serum Irisin level is increased in PCOS patients and it is correlated with 25 ( OH) vitamin D3 , BMI, HOMA-IR, and TG.Irisin provides a new method for the diagnosis and treatment of PCOS .
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Objective To investigate the clinical value of serum Haptoglobin (Hp)levels in cervical cancer patients.Methods Serum Hp (with immunoturbidimetry method),SCC,CA125 (with electrochemiluminescence immunoassay method)level were detected in 45 patients with cervical cancer,37patients with cervical benign disease and 41 female healthy controls.Re-sults Serum Hp level of cervical cancer patients (mean:1.69 g/L)was strongly higher than the level of cervical benign dis-ease patients (mean:0.90g/L)and healthy subjects (mean:0.69 g/L)(t=3.26,4.42,P=0.001,0.000,respectively).Hp level rises highly in the early stage of cervical cancer.The area under receiver operating characteristic curve (AUCROC)of Hp was 0.853 which was higher than SCC (AUC=0.751)and CA125 (AUC=0.494).The sensitivity of Hp,SCC,and CA125 were 87%,49% and 29% respectively.The specificity of Hp,SCC and CA125 were 68%,88% and 83% respective-ly.Three tumor markers combined together could produce a positive detection rate of 93%.Conclusion The detection of Hp has clinic significance on diagnosis of cervical cancer,and it’s possible to become a serum tumor marker.
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respectively)was significantly higher than that for digital anterograde venography (0.684 and 0.587,P =0.026,respectively).Conclusion Diagnostic accuracy and detection rate of residuaI or recurrent varicose veins with CT phlebography are found to be more superior than that with digital anterograde venography which has high guidance value in preoperation and assesses the efficacy of post-surgery treatment.
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BACKGROUND:Fetal congenital malformation is an important cause of perinatal fetal death,in which neural tube defects (NTDs) in prenatal deformity screening is more common.In recent years,with the deterioration of environment and the increase in the number of elderly maternal,patients with NTDs are increasing,bringing serious social and family economic burden.Therefore,modern imaging methods are used to provide theoretical basis for prenatal screening NTDs.OBJECTIVE:To study the development of fetal spinal cord morphology by means of imaging,so as to provide reference for the diagnosis of prenatal screening.METHODS:A computer-based retrieval of CNKI,WanFang,VIP,CBM and PubMed databases was conducted for the report on the development of fetal spinal cord from 1959 to 2017,and their different imaging studies were summarized.RESULTS AND CONCLUSION:In view of the impact of radiation on pregnant women and the fetus,in order to better imaging,for different organizational structures using different detection methods.(1) X-ray and CT:due to radiation damage to pregnant women and fetuses,they are only used for the cadaveric spine ossification center development,X-ray has been abandoned,and CT has not seen a live report.(2) Ultrasound is easy to operate,and non-invasive for pregnant women and fetuses,which is the preferred method of inspection.(3) MRI,as an important supplement means of ultrasound,can provide imaging basis for the prenatal assessment of fetal spinal cord development and diagnosis of related diseases.(4) Noticeably,harm of radiation to fetus should be considered.
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Objective To observe the antitumor effect of 153Sm-DTPA-c (CGRRAGGSC) on MHCC97-H human liver cancer using a nude mice model.Methods 153Sm-DTPA-c(CGRRAGGSC) was indirectly synthesized by the reaction of 153SmC13 with DTPA-c(CGRRAGGSC).Western blot was used to detect the expression changes of IL-11 receptor of eight different cell lines.20 MHCC97-H tumor-bearing nude mice were randomly divided into four groups by random number table method with five mice in each group,administered with different activities of 153 Sm-DTPA-c (CGRRAGGSC) by tail vein injection (5.5,11.0,22.0 MBq/0.2 ml and physiological saline/0.2 ml in turn).All nude mice were terminated after 16 d then the tumor tissue was observed and analyzed with microscopy,electron microscopy and immunohistochemistry for Ki-67,Bc1-2 and IL-11 receptor.Western blot was used to evaluate the expression changes on IL-11 receptor of tumor tissue at different doses.Results After administration with 153 Sm-DTPA-c(CGRRAGGSC),the central region in the early stage of tumor became dry,necrosis,and crusting.In the late stage,tumor continually grew surrounding necrosis tissue.The inhibition rates in the low,middle and higher dose group were (22.72 ±2.76)％,(34.65 ±2.36)％ and (85.13 ±5.78)％,respectively(F =89.32,P ＜ 0.05).The morphologic results showed that tumor structures were severely damaged along with radiation dose.The results of immunohistochemistry showed that the IL-11 receptor-positive cells in the control group and 5.5 MBq group was (84.13 ± 5.71) ％ and (61.57 ± 5.98) ％ (t =13.62,P ＜0.05),respectively.The Ki-67 and Bcl-2 positive cells were decreased in the injection group (t =20.91,6.68,P ＜0.05).Western blot analysis showed that the expression of IL-11 receptor protein decreased with antitumor-effect of radiation.Conclusions 153Sm-DTPA-c (CGRRAGGSC) effectively depresses the growth of MHCC97-H human liver cancer and suppresses the expression of IL-11 receptor,and hence could be a promoting agent for the treatment of MHCC97-H human liver cancer.
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Objective To compare the disease activity score (DSA) 28-CRP and DAS28-ESR in patients with rheumatoid arthritis.Methods Two hundred and twenty-two patients were enrolled,and their sex,age,disease duration,swollen joint count,tender joint count,CRP,ESR,visual analogue scale were recorded.DAS28-ESR and DAS28-CRP were calculated and then analyzed by t test and Pearson's correlation test.Results There was a significant linear correlation between DAS28-ESR and DAS28-CRP (P＜0.05),with correlation coefficient of 0.968.Both DAS28-CRP (3.3±1.7) and DAS28-ESR (3.9±1.8) scores presented with normal distribution (P＞0.05),with the peak of the DAS28-CRP left to that of the DAS28-ESR.There was statistically significant difference between these two (P＜0.05).The difference between DAS28-CRP and DAS28-ESR was much higher in female (0.59±0.43) than in male (0.24±0.45,P＜0.05).The difference between DAS28-CRP and DAS28-ESR was not related to age and disease duration.Conclusion Attention should be paid to the assessment score when making the plan of treating to target since there is difference between DAS-28-ESR and DAS-28-CRP.
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Objective To evaluate the clinical efficacy and safety of methotrexate(MTX) plus low dose glucocorticoid in the treatment of rheumatoid arthritis (RA) from thetarget control point of view.Methods Patients diagnosed as RA according to American College of Rheumatology(ACR)/European League against Rheumatism (EULAR) 2010 classification criteria were enrolled.All of the patients were prescribed with 15 mg/week MTX,5 mg/week folic acid and prednisone (not exceeding 10 mg/day) orally.At week 0,4,12,disease activity and clinical efficacy were recorded.Co-primary assessment criterion was disease activityscore (DAS28)-based on C-reactive protein (CRP).Secondary assessment criteria included EULAR response criteria,ACR response criteria,simplified disease activity index(SDAI),clinical disease activity index(CDAI).The tolerability and toxicity of MTX was recorded at week 4,12.All patients were evaluated for the occurrence of adverse drug reactions associated with prednisone at week 12.Results A total of 76 patients were enrolled in the study.At week 4 and 12,68 and 65 patients completed regular follow-up respectively.At week 12,there were 30(46.2％),9(13.8％),26(40.0％) patients who met DAS28-CRP remission,low disease activity,middle and high disease activity criterion respectively.Three of nine patients who grouped in low disease activity after therapy were early or intermediate patients and didn't reach the target.Thus 36 (55.4％) patients met the standard of target control.The percentage of patients who met the criteria of EULAR good response,the ACR criteria for 20％ improvement (ACR20),the ACR criteria for 50％ improvement (ACR50),the ACR criteria for 70％ improvement (ACR70) were 29.2％,75.4％,69.2％,64.6％,respectively.The proportion of patients meeting the standard of treat to target using SDAI and CDAI were 76.9％,58.5％ respectively.The rate of liver injury,abdominal pain,abdominal distention and acid reflux,nausea were 11.8％,4.4％,4.4％,2.9％ respectively at week 4.At week 12,4.6％ of patients reported abdominal distention.There was only one patient (1.5％) each who complained of abdominal pain,nausea,loss of hair,varicella zoster virus infection and pulmonary infection at week 12.No serious adverse event was observed during the study.Conclusions Based on the view of target control,drug efficacy and safety,MTX plus low dose prednisone is still a useful therapeutic regimen for RA at present.
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Objective To investigate the affect of rhTNFR:Fc on the postoperative recovery of patients with inflammatory arthritis after arthroplasty. Methods Patients with inflammatory arthritis undergoing arthroplasty were included and divided into rhTNFR:Fc group (rhTNFR:Fc only or combined with conven-tional DMARDs) and conventional DMARDs group (monotherapy with or combination of conventional DMARDs). We retrospectively analyzed the incidence of postoperative infection, wound healing time, the febrile period (body temperature ≥37.5 ℃) and the duration of antibiotics treatment after arthroplasty. x2 test and t test were used for statistical analysis. Results Sixty-seven patients were included, 18 in the rhTNFR: Fc group and 49 in the conventional DMARDs group. One postoperative infection occurred in rhTNFR :Fc group but none in the DMARDs group. There was no significant difference by Fisher's exact test (P＞0.05). The febrile duration was (4±3) days in the rhTNFR :Fc group and (3±3) days in the conventional DMARDs group, the difference was not statistically significant (P＞0.05). The wound healing time was (14.0±3.1) days in the rhTNFR :Fc group and (14.7±2.9) days in the conventional DMARDs group, which was not statistically different(P＞0.05). The duration of antibiotics treatment after operation was (14.8±9.3) days in the rhTNFR: Fc group and (10.3±2.7) days in the conventional DMARDs group, the difference was statistically significant (P＜0.05). Conclusion Using rhTNFR:Fc during perioperative period in patients with inflammatory arthritis does not increase the risk of infectious complications or extending wound healing time and the febrile duration.
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Objective To evaluate the clinical efficacy of local intra-arterial thrombolysis (LIT) with urokinase in patients with acute ischemic stroke.Methods One hundred and sixty two patients with acute ischemic stroke were treated with LIT by using urokinase and relationship of reconalization for different occluded arteries with the Glasgow outcome scale (GOS) scores three months later was analyzed. Results Angiography showed occlusion of the cerebral artery in 162 patients, among which 119(73.5%) patients showed the sites in the internal carotid artery system, with 27 occlusions in the internal carotid artery (ICA)trunk, 63(38.89%) in the middle cerebral artery (MCA)and 29(17.9%) in the anterior cerebral artery (ACA), and the remaining 43(26.5%)patients of vertebrobasilar artery (VBA); successful recanalization was achieved in 103 (63.58%)patients, including 11 (40.7%), 49(77.8%), 20(69.0%) and 23(53.3%), respectively, after intraarterial infusion of urokinase. Unsuccessful recanalization occurred in 59patients (36.42%). Followed up for 90 days, 90 (55.6%) patients obtained a good outcome; 72(44.44%) had poor prognosis including 20(12.35%) deaths. 8 patients associated with hemorrhage (4.9%) 73 with reperfusion injury (45.1%) and 5 arterial re-occlusion (3.1%). Based on statistic analysis, ICA trunk and VBA had low ratio of successful recanalization with poor clinic prognosis MCA and ACA possessed high ratio of successful recanalization and good clinic outcomes. There was a significant relationship between arterial recanalization rate and clinic prognosis (r=0.86).Conclusions Successful recanalization of cerebral occlusive artery by using intra-arterial thrombolysis could improve clinic prognosis in patients with acute ischemic stroke. Clinical prognosis has a significant relationship with both initial treatment time and arterial recanalization rate.
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Objective To assess the applied value of proton magnetic resonance spectroscopy(1HMRS) in evaluating the canine model of acute ischemic cerebral damage and intra-arterial thrombolytic therapy.Methods 18 adult hybrid canines were all occluded with self-thromboses and randomly divided into 6 groups(three canines in each group),group B1,B3,B6,B9 and B12 were given intra-arterial thrombolytic therapy with urokinase(10,000IU/kg) at 1.5,3.5,6.5,9.5 and 12.5 hours after embolism respectively.The axial diffusion-weighted images(DWI) and 1HMRS were performed in all canines at 1,3,6,9,12 and 24 hours after embolism respectively.24 hours after embolism,one canine in every group was randomly selected to be executed pathologic examination.Results NAA,Cho and Cr decreased in non-thrombolytic group,specially NAA in the first 6 hours.Cho and Cr decreased a little,but they were not so significant compared with NAA.The relative value of Lac was persistent elevation within 24 hours.In thrombolytic group,the degree of elevation of Lac was significantly smaller than in group A(P