ABSTRACT
The 21-year-old male patient was admitted to the Department of Rheumatology and Immunology at Peking Union Medical College Hospital with chief complaints of "skin rash for 1 year and edema for 2 months". He was diagnosed with systemic lupus erythematosus (SLE) with renal, cardiac and hematological involvement. Remission was not achieved after glucocorticoid pulse treatment. The patient experienced oliguria, malignant hypertension, accompanied by thrombocytopenia and low serum complements, and elevated lactate dehydrogenase and serum creatinine. Schistocytes were seen in the peripheral blood smear. Thrombotic microangiopathy (TMA) secondary to SLE was diagnosed. Though plasma exchange was partially effective, TMA could not be controlled yet. The activity of serum von Willebrand factor -cleaving protease (ADAMTS 13) was 100%, and ADAMTS 13 inhibitor was negative. Finally, remission of the disease was achieved after second glucocorticoid pulse therapy and rituximab treatment. At the 3-month follow-up, the patient′s condition was stable with mild anemia and normal platelet count. Patients with TMA secondary to SLE are heterogenous, while normal ADAMT 13 activity indicates poor prognosis. Early and aggressive treatment is important for disease control, and plasma exchange is helpful as a supportive care.
ABSTRACT
The 21-year-old male patient was admitted to the Department of Rheumatology and Immunology at Peking Union Medical College Hospital with chief complaints of "skin rash for 1 year and edema for 2 months". He was diagnosed with systemic lupus erythematosus (SLE) with renal, cardiac and hematological involvement. Remission was not achieved after glucocorticoid pulse treatment. The patient experienced oliguria, malignant hypertension, accompanied by thrombocytopenia and low serum complements, and elevated lactate dehydrogenase and serum creatinine. Schistocytes were seen in the peripheral blood smear. Thrombotic microangiopathy (TMA) secondary to SLE was diagnosed. Though plasma exchange was partially effective, TMA could not be controlled yet. The activity of serum von Willebrand factor -cleaving protease (ADAMTS 13) was 100%, and ADAMTS 13 inhibitor was negative. Finally, remission of the disease was achieved after second glucocorticoid pulse therapy and rituximab treatment. At the 3-month follow-up, the patient′s condition was stable with mild anemia and normal platelet count. Patients with TMA secondary to SLE are heterogenous, while normal ADAMT 13 activity indicates poor prognosis. Early and aggressive treatment is important for disease control, and plasma exchange is helpful as a supportive care.
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Objective To investigate the feasibility of a model of vertebrobasilar dolichoectasia (VBD)in rats induced by injection of elastase into cisterna magna. Methods Forty male SD rats were randomly divided into elastase model group (n = 20) and saline control group (n = 20). The elastase model group was intracisternal injected with 0. 3 μl of elastase at a concentration of 1. 5 U/μl, and the saline control group was injected with 0. 3 μl of normal saline. All the animals were sacrificed at 28 d after model preparation.The degree of VBD was observed in both groups, and conventional HE and elastic fiber stain were performed. The tortuosity index and increased percentage of artery diameter were used to determine whether the model was successful. Results One and three rats died in the saline control group and the elastase model group, respectively. The diameter of the basilar artery in the elastase model group was significantly thicker than that in the saline control group (0. 452 ± 0. 062 mm vs. 0. 284 ± 0. 046 mm; t = 9. 113, P < 0. 001).None of the saline control groups showed morphological characteristics of VBD, and 15 in the elastase model group met the morphological characteristics of VBD. The success rate of model preparation was 88. 2％ (15/17 ). Histopathological examination showed that the structure of the vascular wall of was destroyed, the wall of the blood vessel was thinned, and internal elastic layer was discontinuous in the elastase model group; the saline control group had a clear wall structure, a uniform wall thickness, and a complete continuous elastic layer. Conclusion Injection of elastase into occipital cistern can successfully induce VBD in rats, which can be used to make a rat VBD model.
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A 28-year-old woman with multiple abscesses for 2 month and fever for 1 month was admitted in Peking Union Medical College Hospital.The skin abscesses gradually developed at skull,face,abdominal wall and pelvis.Laboratory examinations related to inflammatory reactions were strongly high including erythrocyte sedimentation rate 99 mm/1 h,C-reactive protein160.28 mg/L and ferritin 1 584 μg/L.Multiple nodules and cavities were detected in lungs.And vesico-cervical fistula was found during exploratory laparotomy.The pathological tests of abdominal tissues demonstrated necrosis and granuloma.Evidence of infectious diseases was not definite.Positive anti-proteinase 3 (PR3) antibody confirmed the diagnosis of granulomatosis with polyangiitis.After treated with glucocorticoid and immunosuppressants,the patient's symptoms improved remarkably.This case suggested that systemic vasculitis should be considered as a differential diagnosis of multiple abscesses which are not explained by infections.
ABSTRACT
Vertebrobasilar dolichoectasia (VBD) is a progressive developmental variant cerebrovascular disease. With the development of imaging technology, the clinical detection rate of VBD is increasing year by year. This article reviews the risk factors for the progressive development of VBD in order to provide reasonable measures for clinical individualized intervention.
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Objective To observe the curative effect of clinically equivalent doses of Xuesaitong and ginaton injections on cerebral ischemia reperfusion (I/R) injury of rats.Methods Male rats were randomly divided into five groups:normal control group,sham-operation group,model control group,Xuesaitong group and ginaton group.The cerebral ischemia rat model was established by middle cerebral artery occlusion (MCAO).Rats in the Xuesaitong group were given 20 mg·kg-1 of Xuesaitong injection,and rats in the ginaton group were intravenously injected with 7.5 mg· kg-1of ginaton immediately after I/R injury and once daily for 7 days.Rats in the sham-operation group and model control group were given the same volume of 0.9％ sodium chloride solution.The score of ethology,volume of cerebral infarction,mortality,superoxide dismutase (SOD),malondialdehyde (MDA),xanthine oxidase (XOD),nitrogen oxide (NO) and NO synthase (NOS) in seruu were examined.Results Compared with model control group,Xuesaitong and ginaton effectively reduced behavioral score 96 h (P ＜ 0.05),120 h (P＜0.01),144 h (P＜0.01) and 168 h (P＜0.01) after I/R injury,the volume of cerebral infarction 168 h after I/R injury and NO content (P ＜ 0.05).But they had no effects on NOS,SOD,MDA,and XOD contents.Conclusion Curatively injecting Xuesaitong and ginaton can effectively reduce cerebral I/R injury,but no significant difference in curative efficacy is observed between Xuesaitong and ginaton at clinically equivalent doses.
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[ ABSTRACT] AIM:To investigate the antipyretic effect of patchouli oil on lipopolysaccharide ( LPS)-induced fe-ver in rabbits.METHODS:Male rabbits (n=42) were randomly divided into 7 groups according to their body weight and basal body temperature, including control group, model group, western medical positive group, traditional Chinese medical positive group, and high, middle and low doses (2%, 1%and 0.5%) of patchouli oil groups.Subsequently, except the controls, the rabbits were injected with LPS at a dose of 1 mL/kg (2 mg/L) through marginal ear vein to establish rabbit fever model and the rabbits in control group received the same volume of NS.The rabbits in control group and model group were injected with 0.5%Tween-80 0.5 h late, and the rabbits in the other groups were treated with correspoonding drugs. The effect of patchouli oil on the body temperature was observed, and the levels of interleukin-1β( IL-1β) and tumor nec-rosis factor-α(TNF-α) in the serum, and prostaglandin E2(PGE2) and cyclic adenosine monophosphate (cAMP) in the hypothalamus were measured by radioimmunoassay.RESULTS: The body temperature and the levels of IL-1β, TNF-α, cAMP and PGE2 in model group were significant higher than those in control group.Patchouli oil notably inhibited the body temperature in the febrile rabbits.From 1.5 h to 5.5 h after administration, the body temperatures were increased by (1.06 ±1.55), (1.62 ±1.36), (1.38 ±1.22), (0.98 ±0.98) and (0.48 ±0.95) ℃in high patchouli oil group, re-spectively.From 3.5 to 5.5 h after administration, the body temperatures were elevated by ( 1.47 ±0.73 ) , ( 1.15 ± 0.68) and (0.63 ±0.54) ℃ in middle patchouli oil group, respectively.A tendency of downregulation of the elevated body temperatures was observed at every time point after administration in low patchouli oil group.Patchouli oil significantly decreased the levels of TNF-αin the serum and cAMP content in the hypothalamus, and attenuated the elevated tendency of the IL-1βlevel in the serum and PGE2 level in the hypothalamus.CONCLUSION:Patchouli oil evidently has antipyretic effect on LPS-induced fever in the rabbits.The antipyretic mechanism might be related to the inhibition of TNF-αlevel in serum and cAMP content in the hypothalamus.