Relationship of serum 25- hydroxy vitamin D and systemic lupus erythematosus / 北京大学学报(医学版)

OBJECTIVE@#To investigate the application value of serum 25-hydroxy vitamin D [25(OH)D] in systemic lupus erythematosus (SLE).@*METHODS@#Data of 158 patients with SLE in Department of Rheumatology and Immunology in the People's Hospital of Xinjiang Uygur Autonomous Region from July 2016 to July 2019. All the SLE patients were divided into two groups by SLE scores of the disease activity index (SLEADI): 59 cases of active group (SLEADI > 4), 99 cases of non-active group (SLEDAI ≤4). Fifty healthy people were selected as healthy control group. The patients' general information and their laboratory data including serum 25(OH)D levels were collected. Statistical methods used were t-test, Spearman's correalation analysis and Logistic regression analysis.@*RESULTS@#(1) A total of 208 cases were included in this study. The level of 25(OH)D in SLE group [10.4(5.6, 15.8) μg/L] was significantly lower than that in healthy control group [25.5(22.8, 32.3) μg/L, P < 0.01]. 25(OH)D level in active SLE patients [6.2(3.7, 13.8) μg/L] was significantly lower than that in remission SLE patients [12.3(7.2, 16.7) μg/L, P < 0.01]. The serum 25(OH)D level in lupus nephritis [6.7 (4.4, 12.9) μg/L] was significantly lower than that in SLE without renal involvement [13.3 (7.4, 18.7) μg/L, P < 0.01]. (2) A significant negative correlation was demonstrated between the serum level of 25(OH)D and SLEDAI (r=-0.35, P < 0.01), and the 24h urinary protein excretion (r=-0.39, P < 0.01).Positive correlation was demonstrated between the serum level of 25(OH)D and C3 that decreased (r=0.249, P < 0.05). (3) Univariate analysis showed anti- dsDNA antibodies(ds-DNA), anti-Sm antibodies(Sm), IgG, C3, C4, erythrocyte sedimentation rate (ESR), 24h urinary protein quantification(24h-pro) and 25(OH)D were associated with disease activity in the SLE patients; Multivariate Logistic regression analysis showed that 25(OH)D was associated with the disease activity of the lupus patients.@*CONCLUSION@#The decrease of vitamin D level is related to the disease activity of SLE patients, and may be related to lupus nephritis, which plays an important role in the occurrence and development of SLE.

Clinical features of patients with Rhupus syndrome / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical and serological features of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) overlap syndrome (Rhupus syndrome).@*METHODS@#We retrospectively reviewed the medical records of 21 patients with Rhupus syndrome who were hospitalized at Department of Rheumatology and Immunology, People's Hospital of Xinjiang Uygur Autonomous Region between January 2010 and January 2018. We compared the joint involvement, autoantibodies and clinical manifestations of Rhupus syndrome with 81 cases of RA-alone and 51 cases of SLE-alone.@*RESULTS@#In 21 patients with Rhupus syndrome, there are 3 males and 18 females. Compared with the SLE-alone group, the patients with Rhupus syndrome were older [(49.43±11.66) vs. (40.59±12.73), P=0.008]. The median age of the patients with Rhupus syndrome at RA onset was significantly younger than that of the RA-alone patients [(32.58±11.14) vs. (43.11±11.83), P=0.010]. Of the 21 patients with Rhupus syndrome, the initial diagnosis was RA in 57% (12/21), except 2 male patients, the other 10 patients with SLE manifestations were menopause, the mean age of amenorrhea or menopause was (44.30±5.33) (36-50) years. The mean interval between the onset of SLE and RA was 10.83 years. Two patients started with SLE manifestations. Moreover, both diseases simultaneously developed in 33.3% of the patients. Except one male patient, 3 patients were in menopause stage when RA and SLE appeared. The positive rate of specific antibody Rhupus syndrome was similar to that of RA. Renal damage was relatively rare in SLE related manifestations, but the incidence of interstitial lung disease was higher. There were no significant differences in the prevalence of complements C3 and C4, antinuclear antibody (ANA), anti-double-stranded DNA (anti-dsDNA), anti-SSA or anti-SSB antibody between the Rhupus syndrome and SLE-alone group.@*CONCLUSION@#Rhupus syndrome is an overlapping syndrome in which RA and SLE coexist. Most of the diseases occur in RA and the related manifestations of RA are more serious than those of SLE. The incidence of Rhupus syndrome may be related to the change of sex hormone levels.

Treatment satisfaction with rheumatoid arthritis in patients with different disease severity and financial burden: A subgroup analysis of a nationwide survey in China / 中华医学杂志(英文版)

BACKGROUND@#Despite the recent advances in treatments for rheumatoid arthritis (RA), there are still unmet needs in disease outcomes. This study aimed to analyze the satisfaction with drug therapies for RA according to the levels of disease severity (patient-assessed) and proportions of treatment cost to household income.@*METHODS@#This was a subgroup study of a cross-sectional study in patients with RA and their physicians. The patients were subdivided into different subgroups based on their self-assessed severity of RA and on the proportions of treatment cost to household income (50%). The Treatment Satisfaction Questionnaire for Medication version II was used to assess patients' treatment satisfaction.@*RESULTS@#When considering all medications, effectiveness, convenience, and global satisfaction scores were lower in the severe and moderate RA subgroups than those in the mild and extremely mild RA subgroups (all P 50% subgroup (all P 50% subgroups (F = 12.646, P = 0.005). Global satisfaction score was higher in the <10% subgroup than that in the 31% to 50% subgroup (F = 8.794, P = 0.032).@*CONCLUSION@#Higher disease severity and higher financial burden were associated with lower patient satisfaction.

Effects of Extracorporeal Shock Wave Therapy on Tendon Adhesion in Late Period after Hand Tendon Repair / 中国康复理论与实践

Objective:To observe the effect of extracorporeal shock wave therapy on tendon adhesion in late period after hand tendon repair. Methods:From July, 2017 to December, 2018, 40 patients with tendon adhesion after hand tendon repair more than three months were collected. They were randomly divided into control group (n = 20) and experimental group (n = 20). Two groups received routine therapy, and the experimental group added extracorporeal shock wave therapy. Before and two months after treatment, the total active movement (TAM) of the fingers and the grip strength were messured. Results:There was no significant difference in TAM of the fingers and the grip strength before treatment (P > 0.05). After treatment, TAM of the fingers and the grip strength significantly increased (|t| > 10.284,P < 0.001), and were higher in the experimental group than in the control group (t > 0.386,P < 0.001). Conclusion:Extracorporeal shock wave therapy could facilitate to improve the tendon slippage and hand function in patients with tendon adhesion after hand tendon repair.

Secukinumab provided significant and sustained improvement in the signs and symptoms of ankylosing spondylitis: results from the 52-week, Phase III China-centric study, MEASURE 5 / 中华医学杂志(英文版)

BACKGROUND@#Secukinumab demonstrated sustained efficacy in patients with ankylosing spondylitis (AS) through 5 years in pivotal Phase III studies. Here, we present efficacy and safety results (52-week) of secukinumab in patients with AS from the MEASURE 5 study.@*METHODS@#MEASURE 5 was a 52-week, Phase III, China-centric study. Eligible patients were randomly assigned (2:1) to receive subcutaneous secukinumab 150 mg or placebo weekly for the first five doses and then once every 4 weeks (q4w). All placebo patients switched to secukinumab 150 mg q4w starting at Week 16. Primary endpoint was Assessments of SpondyloArthritis international Society (ASAS) 20 at Week 16. Randomization was stratified by region (China vs. non-China).@*RESULTS@#Of 458 patients (secukinumab 150 mg, N = 305; placebo, N = 153) randomized, 327 (71.4%) were from China and 131 (28.6%) were not from China. Of these, 97.7% and 97.4% patients completed Week 16 and 91.1% and 95.3% (placebo-secukinumab) patients completed Week 52 of treatment. The primary endpoint was met; secukinumab significantly improved ASAS20 response at Week 16 vs. placebo (58.4% vs. 36.6%; P < 0.0001); corresponding rate in the Chinese population was 56.0% vs. 38.5% (P < 0.01). All secondary efficacy endpoints significantly improved with secukinumab 150 mg in the overall population at Week 16; responses were maintained with a trend toward increased efficacy from Week 16 to 52. No new or unexpected safety signals were reported up to Week 52.@*CONCLUSIONS@#Secukinumab 150 mg demonstrated rapid and significant improvement in signs and symptoms of AS. Secukinumab was well tolerated and the safety profile was consistent with previous reports. Efficacy and safety results were comparable between the overall and Chinese populations.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT02896127; https://clinicaltrials.gov/ct2/show/NCT02896127?term=NCT02896127&draw=2&rank=1.

Multicenter performance of the different classification criteria for rheumatoid arthritis / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the classification criteria of early rheumatoid arthritis (ERA) and compare the sensitivity and specificity with the criteria of 1987 American College of Rheumatology (ACR) criteria and 2010 ACR/European League Against Rheumatism (EULAR).@*METHODS@#Patients from 4 hospitals, aged more than 16 years, with arthritis, whose disease duration was ≤1 year, and with ≥1 joint pain and swelling were enrolled in the study. The indicators including clinical manifestations, laboratory tests and imaging examinations were observed. The ERA patients were dignosed by two experienced rheumatologists based on the clinical features, drug therapy information and radiography features.@*RESULTS@#(1) A total of 325 patients with arthritis were enrolled, including 98 males (30.15%) and 227 females (69.85%), The average age was (47.53±14.44) years, and the median disease duration was 5 (2, 8) months. Finally, 236 patients were dignosed with ERA, and 89 patients were dignosed with other diseases (Non-ERA, including osteoarthritis, reactive arthritis, undifferentiated arthritis, spondyloarthritis, etc). (2) The sensitivity of ERA criteria was 87.29%, and the specificity was 84.37%. The sensitivity was higher than that of 1987 ACR criteria (χ2=43.641, P < 0.001), and had no significant difference compared with 2010 ACR/EULAR criteria (χ2=0.446, P=0.593). But the specificity of ERA criteria was lower than that of 1987 ACR criteria (χ2=4.891, P=0.027), which was not statistically significant compared with 2010 ACR/EULAR criteria (χ2=0.044, P=1.000). (3) In the patients with arthritis whose disease duration was ≤3 months and ≤6 months, the sensitivity of ERA criteria was 81.71% and 86.79%, respectively, both were higher than the 1987 ACR criteria (χ2=7.131, P=0.008; χ2=22.015, P < 0.001) and had no statistically difference compared with the 2010 ACR/EULAR criteria (χ2=0.220, P=0.755; χ2=0.473, P=0.491). The differences of the three criteria in specificity were not statistically significant. (4) The three different classification criteria were consistent with the clinical diagnosis, among which the ERA criteria and 2010 ACR/EULAR criteria were slightly higher (Kappa>0.6). The results of the consistency comparison between the three criteria showed that the ERA criteria and 2010 ACR/EULAR criteria had a better consistency (Kappa=0.836).@*CONCLUSION@#The sensitivity of ERA classification criteria in the diagnosis of ERA was higher than that of 1987 ACR criteria, and was equivalent to that of 2010 ACR/EULAR criteria. There is no significant difference in specificity between these three criteria. The ERA criteria can also identify patients with RA at a very early stage in arthritis with disease duration ≤3 months.

Development trends and future of medical library / 中华医学图书情报杂志

Following are the speeches on 4 topics at the Chinese and American Medical Library Symposium held at Fudan University:new trends of medical library development;roles of medical library in research,management and decision-making;transformation and development of medical library;role of medical library in medical education. The management systems and development prospects of medical library were fully discussed among the attendances at the symposium.

Construction of a 3D finite element model of temporomandibular joints including the musculoskeletal system / 医用生物力学

Objective To discuss the feasibility of constructing a 3D finite element model of the temporomandibular joint (TMJ) including the musculoskeletal system based on imaging and anatomy, and to provide new ideas of modeling for TMJ biomechanical researches. Methods CT images of the skull, MRI images of masticatory muscles and bilateral TMJ from No.23 Chinese virtual human in the second generation were collected and imported in batches into Mimics in format of DICOM for 3D reconstruction. Then the model was integrated and optimized by Geomagic Studio, and the TMJ capsule and articular cartilage were also constructed. After the material properties of TMJ tissues were defined, a 3D finite element model of TMJ including the musculoskeletal system was finally constructed by ANSYS. Results The 3D finite element model of TMJ with the musculoskeletal system was constructed, including TMJ disc, articular cartilage, TMJ capsule, maxilla (including zygoma and nasal), mandible, sphenoid, temporal bones (including part of parietal), maxillary teeth, mandibular teeth, temporalis muscles, masseter muscles, medial/lateral pterygoid muscles, temporomandibular ligaments, sphenomandibular ligaments and sylomandibular ligaments. Conclusions Based on CT and MRI images and anatomy, the 3D finite element model of TMJ including the musculoskeletal system can be precisely and feasibly constructed by Mimics, Geomagic Studio and ANSYS. This model can restore the biomechanical environment of the TMJ, provide new ideas of modeling for biomechanical researches on the TMJ, and offer the simulation platform for visualization treatment of TMJ disease in clinic.

Biomechanical characteristics analysis on discs with coflex fixation on the different segments of lower lumbar spine / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the biomechanical differences between the surgery and adjacent segments of intervertebral discs in the lower lumbar spine, which were implanted with Coflex into the segments of L4, and L5S1, respectively.</p><p><b>METHODS</b>Three finite-element models (the model of the intact lower lumbar sacrum,the L4.5 and L5S1 segments implanted by Coflex) were developed, respectively. According to the spinal three-column loading theory, three models were forced by the physiological loads of upright standing, flexion and extension. The stress of the different areas of the disc annulus, the changes of intervertebral dorsal height and the degree of nucleus pulposus pressure were compared and analyzed.</p><p><b>RESULTS</b>Coflex implanted into the L4.5 and L5S1 segments in compression and extension could both decrease the stress of the posterior area of intervertebral disc in the surgery segment, resist the changes of the intervertebral disc dorsal height and reduce the perssure of nucleus pulposus. Furthermore, the stress of the L5S1 segment decreased when Coflex fixed the L4.5 segment in extension. However, when Coflex fixed the L5S1 segment, the stress of L4.5 segment had no significant changes.</p><p><b>CONCLUSION</b>Coflex fixing the L4,5 and L5S1 segments can effectively decrease the stress of the surgery segmental discs, respectively. Furthermore, Coflex fixing L4,5 segment may play a biomechanical role in reducing the stress of L5S1 segment.</p>

Enhanced immune response of a bicistronic DNA vaccine expressing fusion antigen Hsp65-Esat-6 of Mycobacterium Tuberculosis with GM-CSF as a molecular adjuvant

This study aimed to construct a bicistronic DNA vaccine expressing fusion antigen Hsp65-Esat-6 of Mycobacterium tuberculosis with cytokine GM-CSF as a molecular adjuvant (pIRES-Hsp65-ESAT-6-GM-CSF, pIRHEG), and the immune response in mice. C57BL/6 mice were immunized with the recombinant plasmid to detect the titer of antibodies, lymphocyte proliferation, the ratio of CD4+, CD8+T cell and IFN ~ γﻌIL-2 secretion. The titer of antibody, lymphocyte proliferation, the ratio of CD4+T and CD8+T cells and IFN ~ γ, IL-2 secretion of pIRHEG group was significant higher than other recombinant plasmid groups, which significant differed by statistical mean. The bicistronic DNA vaccine could induce an effective immune response in mice and could be used as vital ingredient of a new tuberculosis vaccine candidate.

Risk of obesity-related gene polymorphism on the incidence and durative of childhood obesity / 中华流行病学杂志

Objective To examine the impact of single nucleotide polymorphisms (SNPs) in obesity-related genes on the incidence and durative of obesity in childhood and adolescence.Methods Based on the Beijing Child and Adolescent Metabolic Syndrome (BCAMS) Study,780 school children aged 6 to 16 years were followed-up in 2010,and assessed for body size parameters.Venipuncture blood samples were collected after a 12-hour overnight fast.Genomic DNA was isolated from peripheral blood white cells under the salt fractionation method.SNPs were genotyped by ABI 5700 real time PCR (FTO rs9939609) and TaqMan Allelic Discrimination Assays with the GeneAmp 7900 Sequence Detection System (Applied Biosystems,Foster City,CA,USA) (FTO rs6499640,FAIM2 rs7138803,NPC1 rs1805081,MC4R rs17782313,BDNF rs6265,GNPDA2 rs10938397).Both overweight and obesity were diagnosed by the Chinese age-and sex-specific body mass index (BMI)cutoffs.Two independent sample t-test,Chi-square test and multiple logistic regression analysis were performed.Results During the 6 years follow-up period,the incidence of obesity in the total sample 8.5％,and 65.1％ individuals had persisted their obese status.The genotypes of the SNPs except BDNF rs6265 were in Hardy-Weinberg equilibrium in each group (P＞0.05).The incidence rates of obesity increased with FTO rs9939609 TT,TA and AA genotypes (x2 for trend=8.030,P＜0.05).In the non-obese sub-cohort,after adjusted for sex,age at the initial time of follow up and residential area,when compared with children carrying FTO rs9939609 T-allele,a significantly relative risk of obesity was observed for children carrying the rs9939609 A-allele (OR=2.42,95％CI:1.31-4.47,P=0.005).In the obese sub-cohort,FTO rs9939609 A-allele was significantly associated with durative of obesity (OR=1.72,95％CI:1.07-2.77,P=0.026).However,no statistical significant associations were seen between other SNPs (FTO rs6499640,FAIM2 rs7138803,NPCI rs1805081,MC4R rs17782313,GNPDA2 rs10938397) and the incidence or durative of obesity (all P＞0.05).The genetic risk scorewas associated with the risk of occurrence of obesity (OR=16.42,95％ CI:3.59-75.10,P＜0.001)after adjusted for residential area,sex,age at the initial time of follow up and baseline BMI.Conclusion We confirmed the association of FTO rs9939609 with incidence and durative of obesityin children.Early intervention was recommended on the high risk individuals who carrying more riskalleles in obesity-related genes.

Finite element model testing on Coflex dynamic fixation for L4/5 and L5/S1 segment of lower lumbar / 医用生物力学

Objective To simulate clinical operation and investigate feasibility of Coflex dynamic device for fixing L5/S1 segment of lower lumbar degenerative diseases. Methods The lower lumbar-sacral digital model was extracted from platform of the second generation of Chinese Digitized Human “Male No.23” data set, and three finite element (FE) models (the model of normal lower lumbar sacrum, L4/5 and L5/S1 segment fixed with Coflex) were developed respectively using a series of CAX software. According to the spinal three-column loading theory and the lower lumbar physiological behaviors, FE model tests were analyzed, validated and compared under the physiological load of upright standing, anteflexion and extension. Results The FE models of normal lower lumbar sacrum (Healthy), Coflex fixed-L4/5 segment (L4/5), Coflex fixed-L5/S1 segment (L5/S1) were developed, respectively. Based on biomechanical indexes (stability and compatibility) of the controlled trial for the FE model, the two Coflex-fixed FE models showed similar biomechanical effects for fixing the lower lumbar. Conclusions The controlled trials of FE models provide biomechanical evidence for the fixation of lower lumbar L5/S1 segment by Coflex dynamic device, which is of significance for application of Coflex in fixing L5/S1 segment in clinic.

Experiment study of SDF-1 expression during the survival process of the narrow pedicle flap with hypoxia and ischemia / 中华整形外科杂志

<p><b>OBJECTIVE</b>To detect the stromal cell derived factor 1 (SDF-1) expression during the survival process of the narrow pedicle flap with hypoxia and ischemia and to investigate the role of SDF-1/ CXCR4 axis in flap neovascularization.</p><p><b>METHODS</b>The narrow pedicle flaps were formed on the bilateral back of 5 pigs. The pedicle ratio of length to width was 4:2. The flap size was 2 cm x 2 cm (group A), 3 cm x 3 cm (group B), 4 cm x 4 cm (group C), 5 cm x 5 cm(group D), 6 cm x6 cm (group E). The flaps survival rate was observed and HE staining was performed. The SDF-1 expression at the distal end of flaps was detected by ELISA during the operation and 3, 5, 7, 14 days after operation.</p><p><b>RESULTS</b>(1) SDF-1 expression at the same group increased after operation until it reached the peak value at 5 days after operation; then it decreased to basic value. (2) SDF-1 expression in different groups was higher in bigger flaps until the flaps size reached 5 cm x 5 cm. Then partial necrosis happened at the distal end of flaps.</p><p><b>CONCLUSIONS</b>The SDF-1 expression may be related to the blood supply during the survival process of the narrow pedicle flap with hypoxia and ischemia.</p>

Clinical evaluation of interspinous process device Coflex for degenerative disk diseases / 中华外科杂志

<p><b>OBJECTIVE</b>To study indications and complications of interspinous process device Coflex for degenerative disk diseases.</p><p><b>METHODS</b>One hundred and eight patients with degenerative lumbar disc diseases were underwent procedures of surgical decompression and additional fixation of Coflex between November 2007 and October 2010. Sixty-eight patients were male and the other fourty were female, and their average age was 53.5 years (range from 37 to 75 years). Fifty-nine patients were underwent surgery of excision of nucleus pulposus and Coflex fixation, 41 patients were underwent surgery of decompression by fenestration and Coflex fixation, 6 patients were underwent surgery of topping-off, and 2 patients were underwent surgery of Coflex fixation for two level. Preoperative and postoperative visual analogue scales (VAS) and Oswestry disability index (ODI) were recorded, as well as height of ventral intervertebral space (HV), height of dorsal intervertebral space (HD), height of intervertebral foramen (HIF) and segmental range of motion (ROM). One-way ANOVA was used for statistical analysis. Surgical complications were also recorded.</p><p><b>RESULTS</b>The average follow-up time was 28.8 months. All groups had apparent improvement of VAS and ODI, and maintained well to last follow-up (F = 6.16-25.92, P = 0.00). Statistical analysis showed that HD and HIF increased significantly in group with excision of nucleus pulposus and Coflex fixation and group with decompression by fenestration and Coflex fixation (F = 7.37 - 11.68, P < 0.05). Although both HD and HIF decreased one-year after surgery, they were still higher than those preoperatively (F = 6.31 and 7.05, P = 0.00). Preoperative segmental ROM was respectively 6.3° ± 1.8° and 6.2° ± 1.7° in group with excision of nucleus pulposus and Coflex fixation and group with decompression by fenestration and Coflex fixation, and 3.1° ± 0.6° and 3.0° ± 0.8° at last follow-up. Three cases were found with device-related complications and five with non-device-related complications, and all five cased were cured after appropriate treatment.</p><p><b>CONCLUSIONS</b>Surgical method assisted with Coflex has significant clinical efficacy for degenerative disc disease, it can maintain segmental stability, simultaneously, partly reserve movement. It's key to strictly master indications and precisely choose patients.</p>

Recent progress in the treatment of posterior tibial plateau fractures / 中国骨伤

There is a lack of ideal clinical classification systems for posterior tibial plateau fractures, and they need to be perfected in clinical practices. There are controversies over surgical approaches due to special characters of posterior tibial plateau fractures. It is difficult for the conventional techniques and approaches to achieve satisfactory reduction and fixation. A modified posterior approach is an ideal approach for the treatment of posterior tibial plateau fractures. This paper summarizes the classification, approach and internal fixation of posterior tibial plateau fractures.

Experimental study of the effect of deferasirox on the micro-angiogenesis in narrow pedicle flap through epithelial-mesenchymal transition / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Deferasirox on the micro-angiogenesis in narrow pedicle flap through Epithelial-Mesenchymal Transition.</p><p><b>METHODS</b>32 male rats were randomly divided into group I and II which were subdivided into Ia and Ib, IIa and IIb, 8 rats in each group. The rats were administrated intragastrically for 7 days with Deferasirox 100 mg/kg in group Ia and IIa, with the same dose of N. S. in group Ib and IIb. After that, narrow pedicle flaps were formed on the rats back. In group I, the subcutaneous vascular network was observed intraoperatively. The flap survival rate was recorded. In group II , specimens were collected at the distal end of flaps 3 days after operation. IHC and Western Blot were done to examine the expression of CD34, E-cadherin, Vimentin. The microvessel density was also calculated.</p><p><b>RESULTS</b>The subcutaneous micro-angiogenesis in group Ia was more exuberant than that in group Ib. The narrow pedicle flaps in group Ia survived completely, while the survival rate was 62.5% in group Ib (P < 0.05). The percentage of flap survival area for Ia and Ib was (100 +/- 0.00) % and (84.06 +/- 4.42)% (P < 0.05). The expression of E-cadherin in IIa was lower than that in IIb, while the expression of Vimentin and CD34 were higher in IIa, showing statistically difference (P < 0.05).</p><p><b>CONCLUSION</b>Deferasirox can improve the flap micro-angiogenesis through inducing epithelial-mesenchymal transition, so as to improve the survival rate of narrow pedicle flap.</p>

Anti-EPO receptor antibodies in systemic lupus erythematosus with anemia / 中华风湿病学杂志

Objective To investigate the presentationand significance of circulating autoantibodies to erythropoietin receptor (EPOR) in sera from patients with systemic lupus erythematosus (SLE). Methods One hundred and twenty-four consecutive patients with SLE, seven with autoimmune hemolytic anemia (AIHA), 19 patients with iron deficiency anemia (IDA) and 45 normal individuals were involved in this study. In all patients with SLE, the disease activity was evaluated using the European consensus Lupus Activity Measurement scale. Antibodies to EPOR were detected by enzyme-linked immunosorbent assay (ELISA). All data were tested with Chi-squared or Student's t tests by SPSS software. Results A higher frequency of antibodies to EPOR were detected in SLE patients than healthy controls (20.2% vs 2.2%, P=0.004), however, they could not be detected in AIHA and IDA patients. Moreover, anti-EPOR antibodies were detected in 17 (33.3%) of 51 SLE patients with anemia, compared with that in 8 (11.0%, P=0.002) of 73 patients without anemia. Furthermore, patients with antibodies to EPOR had more severe anemia and often presented as microcytic anemia (P =0.005) than those without anti-EPOR antibodies. Finally, anti-EPOR antibodies seemed to be more likely to occur in patients with skin rash (P=0.014), low levels of C3 component of complement (P=0.01), positive anti-dsDNA antibodies (P=0.000) and higher disease activity scores (P= 0.024). Conclusion The higher incidence of antibodies to EPOR in SLE patients with anemia suggest that anti-EPOR antibodies might play a vital role in the development of anemia in SLE patients. Thus, detecting anti-EPOR antibodies in SLE patients with anemia may be helpful.

Detecting anti-megakaryocyte antibodies in serum of systemic lupus erythematosus patients by indirect immunofluorescence / 中国实验血液学杂志

This study was purposed to investigate the mechanism of thrombocytopenia in patients with systemic lupus erythematosus (SLE) through detecting anti-megakaryocyte antibodies in SLE patients. The serum anti-megakaryocyte antibodies in 36 SLE cases with thrombocytopenia were detected by using indirect immunofluorescence, the detected results were compared with detected results of 30 SLE cases without thrombocytopenia and 30 healthy persons. The results showed that the positive incidences of anti-megakaryocyte antibody in serum of 36 SLE cases with thrombocytopenia, 30 SLE cases without thrombocytopenia and 30 healthy persons were 19.4% (7/36), 6.7% (2/30) and 3.3% (1/30) respectively. As compared with SLE patients without thrombocytopenia and healthy persons, SLE patients with thrombocytopenia had higher incidence of anti-megakaryocyte antibodies, moreover there was significant difference between SLE patients with thrombocytopenia and healthy persons (p < 0.05), while there was no significant difference between SLE patients with or without thrombocytopenia (p > 0.05). It is concluded that autoantibodies against megakaryocytes exist in SLE patients and may partially contribute to the incidence of thrombocytopenia in SLE patients. The detection of anti-megakaryocyte antibodies with a enough case number is needed to make a final conclusion on thrombocytopenia pathogenesis in SLE.

Analysis and strategy on the early complications of lumbar disc herniation with Coflex system / 中国骨伤

<p><b>OBJECTIVE</b>To explore the short-term effectiveness and the cause of the early complications of lumbar disc herniation with Coflex system in order to provide evidence for the prevention.</p><p><b>METHODS</b>From November 2007 to August 2008, 37 patients (20 males and 17 females) were treated with Coflex system. The age was from 33 to 70 years with an average of 52 years and the history was from 6 to 50 months with an average of 16.5 years. Complications were observed and the short-term effectiveness was evaluated by scores of JOA and ODI before and after operation.</p><p><b>RESULTS</b>All patients were followed up from 1 to 2 years with an average 20 months. The JOA score increased from 9.09 +/- 1.10 preoperatively to 25.40 +/- 1.20 in the last follow-up. ODI decreased from 24.70 +/- 4.80 preoperatively to 4.80 +/- 1.00 in the last follow-up. The VAS score decreased from 7.86 +/- 0.80 preoperatively to 3.20 +/- 0.50 in the last follow-up. The symptoms remarkably improved. Complications occurred in 4 pa-tients (10.8%), among them, persistent low back pain was in 1 case and conservative treatment did not work; opposite lower limb pain was in 1 case at the 3rd week after operation and symptomatic treatment was effective; displacement of Coflex was in 1 case and Coflex breakage happened in 1 case at the 6th month after operation, but both did not have related clinical symptom.</p><p><b>CONCLUSION</b>Coflex can obtain good clinical outcomes in treating lumbar disc herniation, but it has special complications. The indications and manipulations should be chosen properly.</p>

Finite element analysis on internal fixation biomechanics for vertical sacrum fractures in the second generation of Chinese digitized human / 医用生物力学

Objective This study aims at comparing and optimizing postoperative stability and biomechanical compatibility in treating different types of vertically unstable sacrum fractures by using percutaneous posterior-ring tension-band steel plate and percutaneous iliosacral screw. MethodUsing CT and MR images of the second generation of Chinese digitized human “male No. 23”, the finite element models were developed respectively for two groups of vertical sacrum fractures of Denis Ⅰ,Ⅱ,Ⅲ zone with ipsilateral superior and inferior pubis ramus fractures treated with percutaneous posterior-ring tension-band steel plate (P-group) vs percutaneous iliosacral screw (S-group). The multi-solution finite element analysis and experiment validations were adopted on the basis of lumbosacral spinal three-column loading modes and sacroiliac joint physiologic behaviour. Results When simulating vertical sacrum fractures of Denis Ⅰ zone, von Mises stresses of internal fixation device of posterior and anterior rings of P-group were significantly increased, while the sacrum displacements were also increased compared to those in S-group. Whereas as simulating vertical sacrum fractures in Denis Ⅱand Ⅲ zones, von Mises stresses of fixator of both rings in P-group were lower than those of S-group, and the sacrum displacements were also remarkably decreased. Conclusions Considering internal fixation stability, mechanical compatibility for fracture healing and surgical procedure security, percutaneous iliosacral screw is more appropriate for the treatment of vertically unstable pelvis fractures with sacrum Ⅰzone injury, whereas percutaneous posterior tension-band steel plate is in favor of the treatment of vertically unstable pelvis fractures with sacrum Ⅱ and Ⅲ zone injuries.