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Objective:To investigate the clinical features and treatment status of immune-related myositis (IRM) caused by immune checkpoint inhibitors (ICIs) in order to improve the diagnosis and treatment rate of the disease.Methods:Two cases of IRM combined with the diagnosis and treatment were described and the literature about IRM in the past 10 years was reviewed, and the clinical data of 59 patients were analyzed.Results:IRM was more common in males, with a total of 47 (79.7%). IRM usually occurred after 45 days of medication or after two doses. The clinical manifestations were mainly myalgia and muscle weakness, which were more common in the limbs. The initial symptoms were ptosis and diplopia. Fifty patients (84.7%) had serum creatine kinase (CK) levels higher than twice the upper limit of normal (UNL). In immunological examinations, 18 patients were found to be positive for anti-rhabdoid muscle antibody (AsM-Ab), while most of the myositisspecific antibodies (MSAs) and myositis-associated antibodies (MAAs) were negative. Thirty-four patients (75.6%) had abnormal EMG, and most patients showed myogenic injury. Muscle magnetic resonance imaging (MRI) showed muscle edema and inflammation in 8 patients. Muscle biopsies from 18 (45.0%) patients showed varying degrees of necrotic myofibers. Fifty-seven patients (96.6%) discontinued ICIs after developing IRM, 54(91.5%) received cortico-steroids, and 20(33.9%) received other treatments including intravenous immuno-globulin (IVIG), plasma exchange.Conclusion:IRM can occur in the early stage of ICIs treatment. Electro-myography, muscle MRI and muscle biopsy in suspicious cases can improve the diagnosis rate of the disease. Early use of corticoteroid, IVIG and other immunotherapy can effectively alleviate the disease.
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Clinical data of 28 patients diagnosed with retroperitoneal fibrosis (RPF) in Shanxi Bethune Hospital from September 2014 to September 2020 were retrospectively analyzed. There were 16 males and 12 female with a mean onset age of (56±11) years. The clinical manifestations were lumbago (16/28, 57.14%), abdominal pain (9/28, 32.14%) and back pain (8/28, 28.57%). Inflammatory indexes were elevated in 25 cases (89.29%), and 3 cases had renal insufficiency. Serum IgG4 was elevated in 3 cases (10.71%). Scheel imaging evaluation showed that proportion of type Ⅰ combined with type Ⅲ (abdominal aorta and/or iliac vascular involvement combined with unilateral or bilateral ureteral involvement) was the highest(50.00%, 14/28). followed by. Twenty-seven patients (96.43%) were treated with glucocorticoids and immunosuppressants; 14 patients (50.00%) underwent surgical intervention for ureteral obstruction or hydronephrosis; 6 patients (21.43%) relapsed during hormone withdrawal; 6 patients (21.43%) recovered from the disease and terminated medication; and 13 patients (46.43%) successfully removed the double J tube after lifting ureteral obstruction and hydronephrosis. It is suggested that RPF is more likely to occur in middle-aged and elderly men, with low back pain as the main clinical feature, and ureteral involvement as the main imaging feature. Glucocorticoid combined with immunosuppressive therapy is the conventional treatment. Surgical intervention can relieve acute obstruction and effectively improve the prognosis of patients.
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Psoriatic arthritis is a chronic systemic autoimmune disease, characterized by psoriasis skin lesions and inflammation of the spine and joint. It has complicated clinical manifestations and individual variations. Nearly half of the patients will have joints erosion in two years, which is crippling. The severity of the skin and joint disease frequently do not correlate with each other. Currently, the understanding of the disease is insufficient in China with the lack of standardized diagnosis and treatment. Therefore, researchers from the Chinese Rheumatology Association formulated this specification based on the diagnosis and management experience together with guidelines at home and abroad. The specification summarizes the present situation of domestic diagnosis and treatment, aiming to standardize the diagnosis process and treatment protocols of psoriatic arthritis. Furthermore, it can reduce misdiagnosis and missed diagnosis, as well as improve the prognosis.
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Clinical characteristics, treatments and prognosis of 10 primary Sj?gren syndrome (pSS) patients with lymphoma were retrospectively analyzed. All 10 patients were female. Dry mouth, dry eyes and lymph node enlargement were common. Laboratory tests showed positive antinuclear antibody(ANA), anti-SSA antibody, anti-SSB antibody and rheumatoid factor(RF); lower lymphocyte counts and high IgG level. All patients were not treated regularly after pSS was diagnosed; 9 cases of non-Hodgkin lymphoma (NHL) and 1 case of Hodgkin lymphoma (HL) were finally diagnosed. The main histological types of NHL were mucosa-associated lymphoid tissue marginal zone lymphoma (MALT) and diffuse large B cell lymphoma (DLBCL). Both intranodal and extranodal involvement was common. Patients were followed up for 1-144 months, 8 patients were treated with R-CHOP regime, CHOP regime or rituximab; 5 patients were stable, 4 patients died, and 1 case lost to follow up. Patients with pSS are closely associated with an enhanced risk of lymphoma, especially NHL. The clinical manifestations were complicated and varied.
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Objective:To identify the characteristics of nailfold capillaroscopy (NFC) of systemic sclerosis (SSc) and investigate whether more severe peripheral microangiopathy at NFC were related to the development of SSc.Methods:① The study included 115 patients (60 cases with SSc and 55 patients with other connective tissue diseases). All patients were treated with neither prednisone nor immunosuppressive drugs within 3 months before enrollment. We collected the following data: age, disease duration, disease onset, mRSS, high-resolution chest tomography (HRCT), echocardiography, pulmonary function, nailfold capillaroscopy and routine laboratory assessments. ② All the NFC definitions were used for semi-quantitatively scoring and Cutolo's qualitative assessment. ③ The relationship between NFC changes and joint, visceral involvement and autoantibodies in SSc patients was analyzed. ④ T test, Rank sum test and chi-square test were applied to analyze data. Results:① According to Cutoloqualitative assessment of NFC, patients of SSc with active/late pattern ( n=52) were very common than other CTD ( n=21) ( Z=-3.853, P<0.01). ② According to semiquantitative assessment, the scores of loss of capillaries [(1.67±0.60) vs (0.72±0.46), t=8.347, P<0.01)], irregular enlarged capillaries [(1.22±0.88) vs (0.74±0.50), t=3.178, P<0.01)], hemorrhage [(0.30±0.39) vs (0.10±0.21), t=3.090, P<0.01)], disorganization of the microvascular array [(0.38±0.38) vs (0.18±0.32), t=2.729, P<0.01)] were significantly higher than CTD. ③ The NFC of SSc patients was significantly different from CTD. The number of capillary loss ( Z=-4.194, P<0.01), input capillary dimensions ( t=3.704, P<0.01), output capillary dimensions ( t=3.913, P<0.01), wide diameter of capillary ( t=4.586, P<0.01), tortuous capillaries ( Z=-2.677, P<0.01), gaint capillary ( χ2=8.040, P=0.013), effusion ( Z=-2.278, P=0.023) were more increased than CTD. ④ The NFC pattern of SSc with lung involvement were mainly active and late (66%, 33/50), whereas early and active pattern (60%, 6/10) for those without respiratory system involvement ( Z=10.114, P=0.045) . The NFC pattern of SSc patients with joint involvement were mainly active and late (75%, 12/16), whereas early and active (66%, 29/44) for those without joint involvement ( Z=5.550, P=0.057) . Conclusion:The NFC of SSc patients is significantly different from CTD. NFC may be a suitable tool for disease evaluation.
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Objective:To analyze the clinical characteristics and risk factors of rheumatic diseases complicated with Pneumomediastinum (PnM).Methods:A retrospective analysis of 94 inpatients with rheumatic diseases associated PnM from Peking Union Medical College Hospital and Shanxi Bethune Hospital between January 1998 and October 2018 was carried out. Patients were divided into idiopathic inflammatory myopathies (IIM) and the non-IIM group. Clinical features, laboratory examinations and treatment were compared between the two groups. Cox proportional hazard model was used to investigate the risk factors for prognosis.Results:A total of 94 patients were included in the study, with an average age of (45±14) years. Forty-five (48%) of them were male. There were 62 patients in the IIM group and the other 32 were in the non-IIM group. Sixty-nine patients had predisposing factors before PnM. Severe cough and assisted mechanical ventilation were the most common causes. Compared with the non-IIM group, the incidence of digital vasculitis (29% vs 6%, χ2=6.540, P=0.008), arthritis (60% vs 28%, χ2=8.409, P=0.004), interstitial lung disease (ILD)(98% vs 78%, χ2=11.129, P=0.002) were higher in the IIM group, treatment with cyclophosphamide was higher in the IIM group ( χ2=4.458, P=0.035). There was non-significant difference in mortality between the two groups during hospitalization (50% vs 59%) and 6 months after PnM (64% vs72%) ( P>0.05). Pulmonary infection was the only risk factor for poor prognosis [ HR=3.131, 95% CI (1.025, 9.561), P=0.045], in which bacteria infection was the most common cause (65/75, 86.7%). Conclusion:PnM is a severe complication of rheumatic diseases. To get a good prognosis, rheumatol-ogists should balance the benefit and risk of infection of immunosuppressive therapy.
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Objective:To analyze the clinical features of patients with cardic involvement in eosinophilic granulomatosis with polyangiitis (EGPA), and to enhance the understanding.Methods:We retrospectively reviewed the clinical data of 16 patients with EGPA with cardiac involvement in Bethune hospital of Shan-xi from Jan 2012 to Jun 2019. T test, rank sum test and χ2 test were used for statistical analysis. Results:16 patients with cardiac involvement. There were 11 males and 9 female. The age of 16 patients with cardiac involvement ranged from 14 to 82 years old, and the average age of onset was (58±14) years. Compared with patients without cardiac invo-lvement was (41±15) years, the difference between the two groups was statistically significant ( t=3.230 , P<0.01). The analysis suggested that age was related to whether or not cardiac involvement. Cardiac related clinical symptoms occurred in 4 patients (25%). One patient presented with cardiac involvement as the initial symptom. The other 12 patients presented abnormal electrocardiogram (ECG), cardiac ultrasound or cardiac magnetic resonance imaging (MRI), including 10 patients (62%) with abnormal ECG, 13 patients (81%) with abnormal cardiac ultrasound examination, and1patient with cardiac MRI suggesting endocarditis. Among 16 patients with EGPA cardiac involvement, 14 presented with pulmonary involvement, 10 cases with nasal involvement, 9 cases with perip-heral neurological involvement, 9 cases with skin involvement, 6 cases with gastrointestinal involvement, 2 cases with kidney damage. Eosinophils (EO) were increased in all 16 patients, with a median value of 2.46 (1.49, 3.94) ×10 9/L, and EO was associated with cardiac involvement. Analysis of perinuclear anti-neutrophil cytoplasmic antibo-dies (pANCA) positive rate showed that only 2 of the 16 patients were positive. There was statistically significant difference ( P=0.017) compared with the group without cardiac involvement (8 patients were positive). All 16 patients were treated with glucocorticoid, 12 patients received immunosuppressive therapy, and 10 patients were treated with cyclophosphamide. During the ollow-up, 1 case died of heart failure, 1 case died of cerebral hemorrhage, 3 cases were lost to follow-up, and the other 11 cases were all stable after discharge. Conclusion:EGPA patients have a high incidence of cardiac involvement, and all cardiac stru-ctures can be involved, and most cardic involvement happens in ANCA negative patients. Cardiac involvement is one of the factors with poor prognosis.
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@#Objective To evaluate the prognosis of interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma by single-arm meta-analysis. Methods Related studies on treating retrograde Stanford type A aortic dissection and intramural hematoma with covered stent graft were retrieved from the databases by computer, including PubMed, EMbase, The Cochrane Library, Wanfang Data, VIP, CNKI and CBM, from inception to January 2020. Literatures were screened by researchers step by step according to the predefined inclusion and exclusion criteria. Quality of the enrolled literatures was evaluated, and data were extracted from the included studies. Afterwards, single-arm meta-analysis was carried out by the R3.6.3 software. Results A total of 12 English and 5 Chinese studies were included, which were all case series, and the quality of all literatures was moderate evaluated by Newcastle-Ottawa Scale (NOS). After analyzing the clinical prognosis of 260 patients, the 30-day mortality was 6% (95%CI 0.04 to 0.11, P=0.97), the late mortality was 8% (95%CI 0.05 to 0.14, P=0.78), the incidence of endoleak was 21% (95%CI 0.16 to 0.29, P=0.06), the incidence of stroke was 5% (95%CI 0.03 to 0.09, P=0.99), the incidence of new aortic dissection was 7% (95%CI 0.04 to 0.11, P=0.96), the incidence of dissection progression was 10% (95%CI 0.07 to 0.16, P=0.24), and the absorption rate of intramural hematoma was 84% (95%CI 0.37 to 1.00, P<0.01). Conclusion Interventional treatment with covered stent graft for retrograde Stanford type A aortic dissection and intramural hematoma can obtain good early treatment results for some patients, and can be used as a safe and effective treatment for aged patient with high risk who cannot tolerate surgery. Endoleak, stroke and new aortic dissection are the early serious complications of this method.
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ObjectiveTo investigate the expression of the long non-coding RNA (lncRNA) EXOC7 in serum and liver biopsy tissue of patients with nonalcoholic fatty liver (NAFLD) and its clinical significance. MethodsA total of 120 patients who underwent liver biopsy in The Affiliated Hospital of Southwest Medical University from January 1, 2013 to December 31, 2018 and were diagnosed with NAFLD based on imaging and histopathology were enrolled, among whom 47 had nonalcoholic fatty liver (NAFL) and 73 had nonalcoholic steatohepatitis (NASH). A total of 50 liver disease patients without steatosis or steatohepatitis were enrolled as control group. Real-time PCR was used to measure the expression of lncRNA EXOC7 in liver tissue and serum. The t-test was used for comparison of continuous data between two groups; an analysis of variance was used for comparison between multiple groups, and the SNK-q test was used for further comparison between two groups. A chi-square test was used for comparison of categorical data between groups. A Pearson correlation analysis was used to investigate the correlation between lncRNA EXOC7 and biochemical parameters. The receiver operating characteristic (ROC) curve was plotted to investigate the diagnostic value of lncRNA EXOC7. ResultsCompared with the control group, the patients with NAFL or NASH had significant increases in the expression of lncRNA EXOC7 in liver tissue and serum (all P＜0.05), and the level of such expression increased with the aggravation of hepatic steatosis and inflammation (F=19.96, P＜0.05). The correlation analysis showed that the expression of lncRNA EXOC7 was positively correlated with total triglyceride and low-density lipoprotein cholesterol (r=0.785 and r=0.847, both P＜0.001) and was negatively correlated with high-density lipoprotein cholesterol and insulin sensitivity index (r=-0.726 and -0.709, both P＜0.001). LncRNA EXOC7 had an area under the ROC curve of 0.812 (95% confidence interval: 0.599-0.915, P＜0001), a sensitivity of 8542%, and a specificity of 81.17% in the diagnosis of NAFLD. ConclusionLncRNA EXOC7 is highly expressed in patients with NAFLD, and the expression of lncRNA EXOC7 increases with the aggravation of hepatic steatosis and inflammation, suggesting that lncRNA EXOC7 may be a potential new target for the prevention and treatment of NAFLD.
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Objective To analyze the clinical features and treatment of connective tissue disease (CTD) complicated with acquired hemophilia A (AHA).Methods A retrospective analysis of 8 cases of CTD [5 cases of systemic lupus erythematosus (SLE),2 cases of Sj(o)gren's syndrome (SS),1 case of rheumatoid arthritis (RA)] related to clinical manifestations,diagnostic methods,treatment options and outcomes.Results At the onset of AHA,active disease was shown in 7 patients with CTD,and 5 cases had bleeding symptoms in different parts.There were 3 cases of anti-phospholipid syndrome in 5 cases of SLE,2 of which had thrombosis.In 8 patients,the activated partial thromboplastin time (APTF) was prolonged by 1.7 to 3.times,FⅧ∶ C was 9.2％ to 21％ (50％ to 150％),and the factor Ⅷ inhibitor titer was increased by 7.6 to 56 BU/m1 (Bethesda method).Seven patients were treated with sufficient hormones,immunosuppressive agents,human immunoglobulin (IVIG),and blood products.Five patients had clinically improved bleeding tendency and APIT,and one patient was ineffective.Conclusion CTD is easy to combine with AHA.Glucocorticoid combined with immunosuppressive agent can effectively treat CTD-related AHA.For refractory patients,rituximab can be an alternative.
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Objective To improve the clinical understanding of the disease by retrospective analysing 55 cases of patients with panniculitis. Methods The hospitalized patients with panniculitis were collected from December 2011 to October 2018 in the Shanxi Dayi Hospital Affiliated to Shanxi Medical University. The demographics, clinical manifestations, laboratory examinations and treatments were analyzed and summarized, rate or composition ratio were applied for statistical description of the counting data. Results The proportion of males and females in the 55 patients was 1:2.23, with an average of (53±15) years (18-82 years). A total of 52 cases of nodular panniculitis (including 14 cases of mesenteric involvement) and 3 cases of special type of panniculitis were collected. Patients with nodular panniculitis were often presented with subcutaneous nodules or masses. According to the affected parts, they cowld be divided into skin sub-type and systemic sub-type. Among them, 32 cases were skin sub-type and 20 cases are systemic sub-type. The most frequently involved organs were mesenteric and kidney involvement. Nine of 55 patients was complicated with tumor. Patients with mesenteric panniculitis mainly presented with abdominal pain and bloating, which were mainly diagnosed according to CT findings. Patients with systemic panniculitis could be significantly relieved after treatment with coricosteroids and immunosuppressive agents. Conclusion Panniculitis is an inflammatory disease of unknown etiology. It is frequent in middle-aged and elderly people. It presents with various clinical manifestations and lacks specificity. The diagnosis is mainly based on pathological results. It is easy to be complicated with tumors. When subcutaneous nodules are found, pathological examination should be performed in order to avoid misdiagnosis.
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Objective To explore the feasibility of the deep convolutional neural network (DCNN) judging the indications and prognosis of the total knee arthroplasty based on the trained DCNN computer learning system.Methods C1FAR-10 DCNN model based on TensorFlow (an open source system,Google,USA) optimized by Alex Krizhevsky were constructed.There were 400 cases with knee osteoarthritis from different databases used for analysis.Three hundred patients underwent total knee arthroplasty,while 100 did not.X-ray of 200 preoperative cases from the 400 cases and their enlarged image (50 times) were applied for training DCNN,while the enlarged images from other 200 cases were used to test the DCNN.The correlation and the regression between judgment of the DCNN and clinical truth were analyzed.The clinical truths were rechecked three times and were confirmed by treatment results.Pearson correlation and linear regression analysis were used.The relation test of the software was only used as a reference.Results There was no significant difference between the baseline of cases for learning and test.After learning 200 cases,the DCNN judged the 10 000 cases enlarged from remaining 200 cases.The correlation between the DCNN judgment and the clinical truth was not significant (r=0.000,F=0.001,P=0.970).False positive was observed in 1 681 cases,false negative in 3 296.After enlarged to 10 000 images,the correlation between the two judgments was significant (F=11 228.735,P=0.000,r=0.727 and R2=0.529).The software detection precision was 0.860.Conclusion DCNN can be applied in judging the indications of the total knee arthroplasty.Large sample size can improve the accuracy of the judgment significantly.
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Objective Endothelial microparticles (EMPs) are direct indicator of endothelial cell activation or apoptosis,and may also reflect endothelial inflammation,increased coagulation,and vascular tone.The aim of this study is to investigate whether EMPs would be able to evaluate systemic involvement and be a new indicator of disease activity in Beh(c)et's disease (BD).Methods Thirty-nine consecutive BD patients (who fulfilled the modified International Study Group on BD in 1990 or International Criteria for BD in 2006) and 67 age and sex-matched healthy controls were enrolled (Including 37 patients with hypertension and 30 healthy subjects).The plasma levels of EMPs were measured by flow cytometry utilizing specific labels for endothelial MPs (CD31+ and CD42b-).The measurement data of each group were expressed as-x±s,and the comparison data betwen groups were analyzed by independent sample t test and analysis of variance,Spearman/Pearson correlation analysis,P＜0.05 was statistically significant.Results The levels of circulating EMPs (CD31 + and CI42b-) were significantly elevated in the case group compared with the healthy control group and hypertension (F=6.845,P＜0.05).Moreover,BD patients plasma EMPs were positively correlated with active BD (r=0.802,P＜0.05).Vascular involvement in BD patients was higher than in patients without vascular EMPs,t=4.707,P＜0.05.Gastrointestinal involvement in BD patients was more frequent than that in patients without Gastrointestinal involvement,t=2.673,P＜0.05.Conclusion Levels of circulating EMPs are elevatedd in BD patients and correlated with disease activity in BD.Elevated EMPs may be a potential indicator to predict disease activity of BD.The plasma level of EMPs is increased,which indicats increased risk of vascular and digestive tract involvement in BD.
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Objective To evaluated the safety and clinical efficacy of CT-guided percutaneous radioactive 125I seeds implantation in treatment of spinal metastatic tumors.Methods Totally 20 cases (23 lesions) of spinal metastatic tumors with spinal compression and severe back pain were treated by CT-guided percutaneous 125I seeds implantation.Intractable pain and nerve function before and after therapy were evaluated.And the postoperative cumulative local tumors control rates and cumulative survival rates were calculated.Results The median follow-up period was 14 months (range 7-32months).There was no patient lost follow-up.And no severe complication occurred.Intractable pain significantly relieved one month after therapy.The neural retention rate of 12 patients with nerve function impairment was 85.00％ (17/20) and the neural function recovery rate was 30.00％ (6/20) three months after 125 I seeds'implantation.The local tumors control rates in 3-,6-,and 12-month were 100％,100％ and 90％,respectively.The survival rates in 6-and 12-month was 100％and 78.81％,respectively.Conclusion CT-guided percutaneous radioactive 125I seeds implantation for spinal metastatic tumors is safe and feasible.It can relief pain and improve neural function effectively.
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Objective To evaluate the clinical efficacy of intra-articular injection of ozone in collagen-induced arthritis (CIA) rats and to assess its effects on serum receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin (OPG) levels. Methods Forty weight age malched Wistar rats were randomly divided into normal control group (normal group), the CIA model group (CIA group), ozone (O 3 group), and methotrexate (MTX group). In addition to the normal control group, Freund's complete adjuvant and bovine type Ⅱ collagen were injected to establish the rat model of CIA. After the model was sucessfully developed, double ankle injection concentration ozone group of 40 μg/ml of O3 each 1 ml, 1 times a week, a total of injection for 3 weeks for the experimenal group. MTX group of 0.9 mg/kg was injected 1 times a week for 3 weeks for the MTX group. Degree of foot swelling was measured, and radiographic assessment of arthritis index (AI) score was performed. One week after treatment, angular vein blood was collected for the rats after the intervention, flow multi-factor detection technology was used to test each rat. T test or Wilcoxon rank test was used to compare the difference between groups. Results ① After 3 week administration with O3, dcgree of foot swelling, and AI of the O3 group was reduced significanly than the CIA group during the same period (foot swelling degree: O3 group: (4.21±0.14) ml, CIA group (9.12±0.17) ml, T=64.08, P=0.00; AI O3 group: [(2.97± 0.18) ml, CIA group: 5.76 ±0.13, T=37.24, P=0.00], and X-ray showed joint damage was alleviated. ② The serum level of RANKL in the CIA group was significantly higher than of the normal group [CIA model group 1890.70(797.03, 10571.94)], normal group [74.46(29.21, 95.37), T=43, P=0.005] during the same period; The serum level of RANKL in the O3 group was significantly lower than the CIA group [O3 group 28.09 (14.11, 207.30), CIA group 1890.70 (797.03, 10571.94), T=39, P0.05).③Serum RANKL/OPG of the CIA group was significantly higher than that of the normal group during this period, the difference was statistically significant [CIA group 250.68(42.33, 2959.78), normal group 4.32(3.16,5.30), T=36, P0.05). Conclusion Intra-articular injection of concentration of 40 μg/ml of O3 can reduce RA rat joint swelling degree, which may relate to the mechanism that O3 can lower levels of serum RANKL and RANKL/OPG ratio, reduce osteoclast formation and activation.
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Objective To observe the effects of intra-articular ozone injection on the secretion of tumor necrosis factor (TNF)-α,Interleukin (IL)-6,IL-17A,and vascular endothelial growth factor (VEGF) in the serum of rats with collagen-induced arthritis (CIA) and explore the therapeutic mechanism of ozone in RA treatment.Methods Thrity-two Wistar rats were randomized into 4 groups,including the ozone groups that receivedintra-articularinjection of 40 μg/ml ozone (O3 group),a blank control group (normal group),a methotrexate (MTX) group (MTX group) anda collagen-induced arthritismodel (CIA group).All the rats,except for those in the blank control group,were subjected to hypodermic injection of bovine collagen Ⅱ and complete Freund's adjuvant to induce CIA.Ozone treatment was administered once weekly for 3 weeks starting at 14 days after the model were established.MTX group were treated with methotrexate 0.9 mg/kg,once a week,a total of three weeks.The swelling degree of the foot were observed,and the serum contents of TNF-oα,IL-6,IL-17A and VEGF were detected.One-way analysis of variance or Kruskal-Wallis test was used to evaluate the experimental data.Results At the end of treatment,the degree of foot swelling was reduced significantly in rats with O3 group compared with that in the CIA group [(4.21±0.14) ml vs (9.12±0.17) ml,t=8.43,P=0.023].The serum concentration of TNF-α,IL-6 and VEGF showed significant difference between the CIA group and the O3 group[91.55(86.55,98.53) pg/ml vs 14.45 (12.55,16.15) pg/ml,x2=6.216,P=0.002;145.08(37.44± 362.82) pg/ml vs 5.84(5.47,15.93) pg/ml,x2=13.136,P=0.004;51.56(46.09,74.10) pg/ml vs.36.22(32.18,41.69) pg/ml,x2=3.732,P=0.002].There was no statistically significant difference between the O3 group and MTX group [14.45(12.55,16.15) pg/ml vs [12.45(11.80,15.60) pg/ml,x2=0.243,P＞0.05;5.84(5.47,15.93) pg/ml vs 7.86(5.25,15.23) pg/ml,x2=0.058,P＞0.05;36.22(32.18±41.69) pg/ml vs 40.17(35.47,50.73) pg/ml,x2=0.516,P＞0.05].The serum concentration of IL-17A showed no significant difference between the normal group,the CIAgroup,the MTX group and the O3 group (F=1.827,P=0.165).Conclusion Intra-articular injecfion of 40 μg/ml ozone can attenuate synovitis in rats with CIA,the mechanism may relate to the inhibition of TNF-oα,IL-6 and VEGF in the serum.
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Rheumatoid diseases (RD) are a group of diseases affecting bones,joints,and the surrounding soft tissues,such as muscle,synovial membrane,tendons,fascia,nervus.The etiology and pathogenesis are complicated.Since most RD are systemic diseases,traditional imaging techniques have limited value for the diagnosis and treatment monitoring of RD.18F-FDG PET/CT can display morphologic and metabolic information simultaneously,and is considered as a potential tool for the diagnosis of RD.This review summarizes the application of 18F-FDG PET/CT in RD,such as systemic vasculitis,relapsing polychondritis and rheumatoid arthritis.
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Objective:To study the effect of metformin on proliferation,cell cycle and apoptosis of U937 cells.Methods: U937 cells were treated with different concentrations of metformin,collected cells in 24,48 and 72 hours.Subsequently,cell proliferation was assessed by CCK-8 assay,and the cell cycle and apoptosis were analyzed by flow cytometry (FCM).The expression of Bcl-2,Bax,p-AMPK,p53 were determined by Western blot.Results: The proliferation of U937 cells was inhibited by metformin in a time-and dose-dependent manner.Metformin-treated cells were arrested at G0/G1 phase,the cell frequency at G0/G1 phase was increased in a time-and dose-dependent manner.Metformin also induced cell apoptosis in a dose-dependent manner.It showed that 20 mmol/L metformin induced cell apoptosis in a time-dependent manner.The expression of p-AMPK,p53,Bax was up-regulated while Bcl-2 expression was down-regulated after metformin treatment.Conclusion: Metformin could inhibit the U937 cell proliferation,block the cell cycle at G0/G1 phase,and induce cell apoptosis,which may partially be attribute to the up-regulation of Bax,down-regulation of Bcl-2,activation of AMPK/p53 signaling.
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Objective:To study the effect ofmetformin combined with insulin aspart on the serum cholesterol(TC),total Bilirubin (TBil),uric Acid(UA),urinary Micro Protein(mAlb) levels and Maternal and Infant Outcomes of gravida with Gestational Diabetes Mellitus.Methods:84 patients ofgestational diabetes mellitus who received therapy from June 2014 to June 2016 in our hospital were selected.According to random number table,those patients were divided into the observation group (n=42) and the control group (n=42),on the basis of routine treatment,The control group was treated with insulin aspart,while the observation group was combined with metformin hydrochloride.The blood glucose index and the levels of TC,TBil,UA,mAlb and maternal and infant outcomes were compared.Results:After treatment,the levels of fasting blood glucose (FBG),postprandial 2h blood glucose (2hPG),glycosylated hemoglobin (HbA1c),TC,TBil,UA and mAlb in the observation group were significantly lower than the control group,the levels of TBil was significantly higher than the control group (P＜0.05);the incidence ofgestational hypertension,hydramnios,premature birth,cesarean section,giant child and neonatal jaundice were significantly lower than the control group (P ＜0.05).Conclusion:Metformin combined with insulin aspart was well for gestational diabetes mellitus,which could effectively improve the blood glucose indicators and TC,TBil,UA,mAlb levels,maternal and infant outcomes.
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Objective To explore the status of glucocorticoid application in patients with systemic lupus erythematosus (SLE) in China.Methods Epidemiological survey was used.The SLE patients who met the 1997 classification criteria of American College of Rheumatology were enrolled.The usage of glucocorticoid and related adverse reactions were recorded and analyzed.Results A total of 400 SLE patients were enrolled,including 35 men and 365 women.The average age was (37.4 ± 14.0) years old,and the average duration of disease was (6.7 ± 5.8) years.There were 310 patients using glucocorticoid as maintenance.Sixty-one percent (n =244) patients started using medium dose (prednisone 30-＜ 60 mg/d) as the initial treatment of glucocorticoid,which lasted for (37 ± 11) days.The time of drug duration in patients with low dose prednisone (7.5-＜30 mg/d)and high dose (60-100 mg/d) was(92 ± 20)and (17 ± 3) days respectively (P ＜ 0.05 between 3 groups).However,patients receiving different initial dosage were of no discrepancy in the maintenance therapy.During maintenance,even though 51.0％ (n =158) patients were on prednisone 2.5-5 mg/d,the duration of drug use in ＞ 5-10 mg/d groupwas longer [(29.9 ± 3.3) months].Patients with involvement of internal organs had a higher tendency to use 60-100 mg/d prednisone or pulse-dose therapy in the initial treatment,nevertheless these two groups had no difference of maintenance dosage.Among all 400 patients,62 patients withdrew glucocorticoid,including 17 patients with disease remission (4.3％),44 by self-withdrawal and one with adverse reaction.Conclusion In China,the medium dosage of glucocorticoid is the most common initial treatment in patients with SLE.Prednisone 2.5-5 mg/d was the most common choicefor maintenance therapy.Currently,the proportion of glucocorticoid withdrawal remains low in SLE patients achieving remission.