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The study aimed to analyze the efficacy and safety of rituximab in the treatment of 23 cases of lupus nephritis and explore the prospect of half-dose rituximab in lupus nephritis treatment. Twenty-three patients with lupus nephritis hospitalized in the Department of Rheumatology and Immunology at the First Medical Center of the PLA General Hospital from May 2013 to December 2021 were selected. Eighteen patients received rituximab 375 mg/m 2 on the first and 14th days, 5 patients received 500 mg of rituximab on the first and 14th days, and rituximab was used as needed 6 months later. Methylprednisolone (80-120 mg) was given together with rituximab. Afterward, 1 mg/kg prednisone was used for 4 weeks, which was progressively tapered to maintenance doses or discontinued. B lymphocyte level, renal function, 24-h urine protein level, and systemic lupus erythematosus (SLE) disease activity index 2000 (SLEDAI2K) score before and after treatment were recorded. The efficacy and adverse reactions were analyzed. The results showed that 11 patients suffered from renal insufficiency [creatinine (162.7±58.6) μmol/L ] at baseline, while the creatinine level of 9 patients returned to normal 12 months after the treatment [ (66.3±10.1)μmol/L ]. Normal renal function of the other 12 patients was maintained during treatment. After 12 months, the 24-h urine protein level decreased from 4.00 (2.00,6.80) g in the baseline period to 0.10 (0.08,0.40) g. SLEDAI2K score decreased from 22 (18,26) in the baseline period to 3 (0,6) 12 months after the treatment. The B lymphocyte level reached 0.00 (0.00,0.01)% at 3 months. Of 23 patients, 13 patients achieved complete remission, and 7 patients achieved partial remission after 6 months of rituximab treatment. Five patients experienced adverse reactions related to rituximab, including 1 case of transfusion reaction, 1 case of perioral herpes with pulmonary infection, and 3 cases of decreased IgG levels. Therefore, rituximab regimen used in this study can be an effective treatment strategy for lupus nephritis.
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To investigate the predictive value of [ 18F]fluorodeoxyglucose-positron emission computed tomography(PET)/CT for disease progression in patients with dermatomyositis (DM) and interstitial lung diseases (ILD). Sixty-seven DM patients who underwent [ 18F] FDG-PET/CT imaging were retrospectively analyzed from January 2012 to September 2017 at PLA General Hospital. Their clinical manifestations and imaging characteristics were recorded. Compared with those chronically progressed (C-ILD), patients with rapid progression (RP-ILD) had significantly higher erythrocyte sedimentation rate (ESR) and standardized uptake value (SUV) in lungs ( P<0.05). In patients with RP-ILD, SUV in lungs was positively correlated with age, disease course, and ESR. Receiver operating characteristic curve analysis suggested that when lung SUV cut off value was 2.25, the sensitivity and specificity to predict disease progression was 77.8% and 72.8%, respectively. Old age, longer disease course, low creatine kinase level, higher ESR, and high SUV are prognostic factors for DM-associated ILD.
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A 28-year-old man was admitted to the first medical center of Chinese People′s Liberation Army General Hospital because of multiple myalgia and intramuscular nodules for more than 2 months. The patient complained of dysphagia, fever and weight loss 2 months ago. Magnetic resonance imaging and biopsy revealed nodular fasciitis. Inflammatory indicators including C-reactive protein, erythrocyte sedimentation rate, platelet count and fibrinogen were slightly elevated. Urine occult blood was positive. Abdominal ultrasound revealed left hydronephrosis. Because nodular fasciitis could not explain the whole situation, a needle biopsy of intramuscular nodules was performed. Pathological examination revealed intramuscular metastatic adenocarcinoma with poor differentiation. Gastric endoscope and positron emission tomography-computed tomography confirmed the diagnosis of advanced gastric adenocarcinoma with extensive metastases of esophagus, lymph nodes, muscles, ureter and bone. Although chemotherapy was given, the patient died of disease progression six months later.
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Objective To observe in vitro the effect of mechanical stress at different intensities on the pro-liferation, apoptosis and extracellular matrix of degenerative human nucleus pulposus cells. Methods The cells were isolated and cultured in vitro, and divided into a control group, a low-intensity group, a medium-intensity group and a high-intensity group. The low-, medium- and high-intensity groups were stretched mechanically by 1000 μ, 2000μor 4000μrespectively for 6 hours using a four-point bending system, while the control group was not stressed. Flow cytometry was used to explore any changes in the cell cycle and the proliferation index ( PI) . The expression of proliferating cell nuclear antigen ( PCNA) , B-cell lymphoma-2 ( BCL-2)/Bax, collagen II and aggrecan were meas-ured using real-time quantitative polymerase chain reactions. Results The mechanical stretching significantly influ-enced proliferation, apoptosis and the extracellular matrices compared with the control group. The PI and PCNA ex-pression increased at first and then decreased gradually with the exercise intensity. Compared with the control group, the mRNA expression level of Bcl-2/Bax increased significantly to 1.53 times that of the control group after 1000 μstretching, but to only 0.71 times that of the control group at 2000μand 0.43 times at 4000μ. The gene expression of collagen II increased significantly by 1. 1 times and that of aggrecan by 1. 3 times after 1000 μ stress stimulation compared with the control group ( P≤0.05) . However, the expression of collagen II and aggrecan was inhibited sig-nificantly at 2000 and 4000 μ , with the lowest levels at 4000 μ (P≤0.05). Conclusion Stretching at different intensities has different effects on the proliferation, apoptosis and extracellular matrix of human pulposus cells with degenerate nuclei.
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Objective The aim of this study was to set up a large,longitudinal and prospective database to compare the clinical manifestations in human leucocyte antigen (HLA)-B27 positive and negative patients with ankylosing spondylitis(AS) based on real-world evidence in Chinese population.Methods A total of 897 outpatients with confirmed AS were recruited consecutively by smart management system for spondyloarthritis (SMSP) from April 13,2016 to June 6,2017 in Chinese PLA General Hospital from 30 provinces and autonomous regions.801 patients with HLA-B27 data were included in the analysis.Demographic and clinical parameters including Bath ankylosing spondylitis disease activity index (BASDAI),Bath ankylosing spondylitis functional index (BASFI),ankylosing spondylitis disease activity score (ASDAS),arthritis,enthesitis,Bath ankylosing spondylitis metrology index (BASMI),erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were compared between HLA-B27 positive and negative groups.Results A total of 801 patients were included in the analysis with an average age of (30.7± 8.8) years.There were 659 males and 142 females and HLA-B27 was present in 88.0％(705/801).Males were significantly more in HLA-B27 positive patients [83.3％ (587/705) vs.75.0％ (72/96);P=0.047].The average age at disease onset was (22.3 ±7.6)years in HLA-B27 positive patients and (24.4 + 8.7) years in HLA-B27 negative ones (P=0.028).There was significant difference in diagnose delay between two groups [14.3(2.5,43.6)months in HLA-B27 positive patients vs.20.3(5.0,67.4) months in HLA-B27 negative ones,P=0.041].Anterior uveitis was found to be significantly more common in HLA-B24 positive patients [18.9％ (133/705) vs.7.3％ (7/96),P=0.005],and knee involvement less common in HLA-B27 positive patients [4.0％ (27/682) vs.10.0％(9/90),P=0.010],conversely.CRP[6.5(3.0,16.4)mg/L vs.3.5(1.6,12.3)mg/L] and ESR[11.0(4.0,24.0)mrn/1h vs.7.0(3.0,16.0)mm/1h] were significantly higher in HLA-B27 positive patients(P=0.005,0.013,respectively).But no differences in BASDAI,ASDAS,BASFI and BASMI were obtained between two groups.Conclusions HLA-B27 positive patients had a higher proportion of males,a younger age of onset and a greater risk for occurrence of anterior uveitis,suggesting a poorer prognosis.
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Objective To analyze the expression and predictive value of serum tumor markers spectrum and chemokine protein in lung cancer and predictive value.Methods One hundred and fifty patients with lung cancer were selected as the observation group and contemporaneous 150 individuals undergoing physical examination served the control group.The levels of ProGRP,CEA,SCC and Cyfra21-1 were measured by chemiluminescence microparticle immunoassay.The chemokine protein was determined by multiple immunofluorescent assay.Results The levels of CCL28,LIF,LIGHT and GRO in the observation group were significantly higher than those in the control group (P＜0.05).The levels of CCL28,LIF,LIGHT and GRO in the observation group were higher than those in the control group.The levels of CCL28,NAP-2 and MDC in the observation group were lower than those in the control group (P＜0.05).Conclusion The regular detection of serum tumor markers spectrum and chemokine protein can predict the treatment prognosis and evaluate the clinical curative effect.
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Objective To evaluate the clinical value of low-dose semicoronal computerized tomography (CT) of sacroiliac joints (SIJ) in the early diagnosis of ankylosing spondylitis (AS).Methods Patients who were diagnosed with AS and had received axial CT examination of SIJs over the past 2 years were recruited.All of them simultaneously underwent a low-dose semicoronal CT of SIJs.The clinical data were recorded.Radiation dose was compared between low-dose CT and the previous conventional axial CT.Image quality of low-dose CT was assessed and correlation between image quality and weight or body mass index (BMI) was analyzed.CT images of the two groups were graded by modified New York criteria, the Lee criteria and the Innsbruck criteria.The kappa coefficient was used to assess the consistency of grading between the two groups.Results Thirty-three patients were enrolled in this study.The effective dose (ED) of semicoronal SIJ CT was 3.37 mSv which was 49％ lower than conventional axial CT (6.56 mSv).Lower dose had the potential protection of gonads.The quality of images in male patients with BMI ＜ 25 kg/m2 and all female patients were good or excellent.There was a significant negative correlation between image quality and BMI (r =-0.746, P =0.000;r =-0.784, P =0.000;respectively).All patients were diagnosed as sacroiliitis by modified New York criteria and the grading of two groups was consistent.The consistency of grading between two groups was satisfactory no matter which classification criteria was used.(k =0.897 with Lee criteria;k =0.814 with Innsbruck criteria;P ＞ 0.05).Conclusions The radiation dose of semicoronal SIJ CT is significantly lower than that of the conventional axial CT with comparable efficacy of diagnosis.
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Base on the clinical characteristics of septic arthritis in a group of systemic lupus erythematosus patients,this study has found out that high systemic lupus erythematosus disease activity index,leucopenia,high cumulative dose of glucocorticoid,methylprednisolone intravenous pulse therapy and joint cavity puncture were closely correlated with septic arthritis.Once septic arthritis is suspected,culture specimens should be collected and appropriate antibiotics are suggested immediately.Also,surgical drainage is a very useful approach.
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Objective To investigate the reliability and validity of Hospice care quality assessment scale. Methods Eight experts in the field of hospice revised the Scale after Chinese localization. The scale data were analyzed after collation of 181 families fulfill the scale. Results The total scale Cronbach′s a coefficient was 0.851. The first dimension′s coefficient was 0.796. The second dimension′s coefficient was 0.622 and the third dimension′s coefficient was 0.827. In factor analysis of the scale, after varimax rotation, the number of characteristic roots>1 was 10 and made up of 70.88%of the total variance. Conclusions The hospice care quality assessment scale after Chinese localization has good reliability and validity and could be a tool to evaluate the clinical quality of care for dying patients.
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Objective To investigate the effect of 620 nm red light on chondrogenic differentiation in rat precartilaginous stem cells (PSCs). Methods Rats' PSCs were isolated and purified using magnetically activated cell sorting and cultured in vitro.The PSCs were exposed once to 620 nm wavelength red light from a light-emitting diode (LED) with an irradiation energy of 0.5 J/cm2,1 J/cm2,2 J/cm2 or 4 J/cm2.Any effect was confirmed by Alcian blue staining,immunohistochemistry and observing histomorphological changes under a light microscope,as well as detection using a reverse transcription polymerase chain reaction (RT-PCR). Results After being induced for 14 d,the PSCs exhibited polygonal and round shapes. Alcian blue and type Ⅱ collagen immunohistoehemistry staining showed positive results,but the control group had no significant change.RT-PCR showed that the mRNA expression of Sox9 and type Ⅱ collagen increased significantly compared with the control group. Conclusion Low energy 620 nm red light can enhance chondrogenic differentiation in PSCs significantly.
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Objective To investigate the curative effects of damage control surgery in treatment of borderline severe multiple fractures.Methods The study involved 37 patients with severe multiple fractures(ISS of 16-42,Pape classification of borderline type)surgically treated from January 2009 to June 2010.All patients underwent staged surgeries according to damage control principles:hemostasis,debridement and provisional fixation were given in the first stage;antishock,anti-coagulation dysfunction,anti-hypothermy,anti-infection were performed in the second stage;definitive operations for fractures were performed as soon as possible in the third stage,provided that their physiological condition was permitted.Results All the patients received effective treatments such as debridement,provisional fixation and antishock in the first and second stages,with no iatrogenic secondary injury.The patients had significant recovery in the 6-14 months of follow-up,with total disability rate of 16％.Conclusion The staged operations according to damage control principles are effective and safe in treatment of borderline severe multiple fractures.
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Objective To understand the features of immunoglobulin G4-related diseases and to improve its diagnosis and treatment.Methods The clinical data of 20 cases discharged from our hospital were analyzed retrospectively.Results Twenty cases with IgG4 related diseases were reviewed retrospectively.IgG4-related diseasesis more prevalent in male than in female (14∶6),and the mean age was 58 years.Pancreas and bile ducts were the most commonly affected organs,2 and more than 2 organs were involved in 17 patients.All patients had significantly elevated serum immunoglobulin G4.Histopathological findings included diffuse tissue fibrosis with extensive lymphoplasmacytes infiltration.On immunohistochemical staining,the ratio of IgG4-positive plasma cells to IgG-positive plasma cells was higher than 40％.One patient deceased and one patient was left untreated,other patients responded well to the treatment.Conclusion There is no characteristic clinical symptoms for IgG4-related diseases,and serum immunoglobulin G4 is the essential diagnostic method in suspected cases.IgG4-related diseases can be well controlled with prompt use of glucocorticosteroid.
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Objective To improve the understanding of severe anaphylactic reactions to infliximab retreatment. Methods Delayed hypersensitivity to infliximab in two patients with ankylosing spondylitis who had previously received infliximab and resumed after discontinuation over 4 years were reported and the related literatures were reviewed. Results Two patients ( 1 male, 1 female ) who were diagnosised with ankylosing spondylitis for more than 10 years, both individuals had received infliximab treatment during a clinical trial approximately 4-5 years prior to further therapy. On day 6 after subsequent infusion, one patient had pruritic skin rash covering her whole body, followed by flustered, dyspnea, hypotension and anaphylactic shock, she was successfully treated with epinephrine and glucocorticoid. Another patient experienced a skin rash and itching 9 days after reinfusion, he was successfully treated with antihistaminics.Conclusion A distant infliximab retreatment is associated with high rates of reinfusion reactions, including fever, urticaria, myalgia, arthralgia,even hypotension, dyspnea, laryngeal edema and anaphylactic shock.We recommend careful monitoring of those patients who receive infliximab retreatment, particularly after a lengthy interval.
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Objective To establish the dose-effect curves of chromosome aberrations in human peripheral blood lymphocytes induced by different LET rays,including 60Co γ-rays,252Cf neutrons,14MeV neutrons and 12C heavy ions at low doses,respectively,in order to assess radiation-induced damages after occupational and accidental exposure.Methods Heparinized whole blood samples were irradiated with the various radiation devices and doses ranged from 0 to 1 Gy with the interval of 0.25 Gy.Conventional chromosome culture method was applied with adding colchicines at the beginning and chromosome specimens were prepared after 48 h incubation.The Metafer scanning system was used for automatical finder of chromosome metaphases.The mathematic models were fitted according to aberration data obtained.Results At the dose range of 0 - 1 Gy,the math models of dic + r were linear for 60 Co γrays and linear-quadratics for 252 Cf neutrons,14 MeV neutrons and 12 C heavy ions.The models of ace were linear-quadratic for 60Co γ-rays and 12C heavy ion beams,and linear for 252Cf and 14 MeV neutrons.The models of total aberrations were linear-quadratic for all types of radiation.Conclusions High LET rays have higher biological effects in inducing chromosome aberrations yields compared with low LET rays.Moreover,the severity of damage is 252Cf ＞ 14 MeV neutrons ＞ 12C heavy ions ＞ 60Co γ-rays in turn.Therefore,in the range of low doses,the dic + r may be a better target of radiation damage for high LET radiation.
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Objective To evaluate the effect of red yeast rice on chemokines of collagen-induced arthritis in rats. Methods Rat arthritis was induced by injecting bovine type Ⅱ collagen(BⅡC)to Wistar rats.The rats were randomly divided into six groups including the normal control group,the CIA control group which were treated with normal saline,ibuprofen group,large dose red yeast rice group,moderate dose of red yeast rice group and small dose of red yeast rice group.Mice were sacrificed after 48 days of immune injection and their venous blood were collected. The effect of cytokines and chemokinos on CIA was measured by ELISA.Results Red yeast rice significantly degraded the expression of TNF-α,IL-6 compared with the model groups,the difference was significantly different(P＜0.05).The degree of IL-8 decrease was more evident in the high dose of Red yeast rice group and moderate dose of Red yeast rice group than that of the model group(P＜0.05).Red yeast rice could significantly degrad the expression of MCP-1,R.ANTES and IP10 in serum of CIA rats(P＜0.05).Conclusion The mechanism of anti-inflammatory action of red yeast rice is related to the inhibition of inflammatory factors.
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Objective To investigate the epidemiological features of back pain, spondyloarthritis (SPA) and ankylosing spondylitis (AS) in Beijing Shougang district. Methods Set up Chinese version of questionnaire about incidence of spondyloarthro-pathy. Employees and retired ones were drawn out from subfactory units by non-randomized sampling. 15 357 subjects were investigated, of which 12 125 questionnaires were taken. Suspected cases were then screened with sacroiliac joint X ray and HLA-B27 testing. 2009 assessment in ankylosing spondylitis (ASAS) criteria were used for diagnosing SpA. Results Back pain is common with total incidence of 42.7%, and the most common pattern is mechanical pain. The incidence of SpA is 0.58% and that of AS is 0.36%, while only 28.9% AS patients had been diagnosed before and received treatment. Conclusion The AS incidence in Shougang district is similar with the epidemiological data got from other districts of China. And knowledge of SpA and AS is needed in China.
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The new techniques of three-dimensional (3D) reconstruction and segmentation, display and analysis of series slices of images including microscopic wide field optical sectioning by deconvolution method and Cryoelectron microscope slices by electron tomography (ET) and series of computed tomography (CT) were investigated. As a result, this paper presents the 3D reconstruction segmentation display, and analysis results of pollen spore, chaperonin, head, cervical vertabra, tibia and carpale. Mean while, this paper also proposes the application of these new techniques in biomedical field.
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Humans , Image Interpretation, Computer-Assisted , Methods , Imaging, Three-Dimensional , Microscopy, Electron, Transmission , Methods , Tomography , Methods , Tomography, X-Ray ComputedABSTRACT
AIM: To investigate the inhibitory effect of Co-SZ eye drops on apoptosis of lens epithelial cells(LEC) induced by H_2O_2 and to study the cellular and molecular mechanisms.METHODS:(1) All lenses of Sprague-Dawley rats were incubated with H_2O_2 and Co-SZ eye drops.The apoptosis rates of LEC were determined by TUNEL method.The changes of LEC ultrastructure and the formation of apoptotic body were observed by electron microscopy.(2) Bovine LEC were incubated with H_2O_2 and Co-SZ eye drops.The inhibitory of LEC apoptosis was detected by MTT after incubation.The changes of fractional DNA content in LEC were detected by flow cytometry(FCM).[Ca~(2+)]i,cAMP and cGMP of LEC were determined by spectrofluoremeter and radioimmunoassay,respectively.RESULTS: The LEC apoptosis rates in Co-SZ eye drops group were decreased significantly compared with H_2O_2 group by TUNEL.The ultrastructure changes in LEC of Co-SZ eye drops group were lighter than that in H_2O_2 group.The LEC apoptosis rates of Co-SZ eye drops group were dose-dependently decreased significantly compared with H_2O_2 groups via MTT assay.LEC apoptosis induced by H_2O_2 was inhibited by Co-SZ eye drops,and showing dose-dependent.The DNA contents in LEC of Co-SZ group were increased.The [Ca~(2+)]i and cAMP in Co-SZ group were decreased obviously.The cGMP was increased.CONCLUSION: The LEC apoptosis induced by H_2O_2 was inhibited by Co-SZ eye drops.The mechanism of apoptosis inhibition by Co-SZ eye drops maybe contribute to the increase in DNA content.The signal transduction mechanisms are related to the decrease in [Ca~(2+)]i and cAMP and the increase in cGMP.