Recommendations of diagnosis and treatment of juvenile idiopathic arthritis in China / 中华内科杂志

The common clinical subtypes of juvenile idiopathic arthritis (JIA) include systemic onset juvenile idiopathic arthritis (SOJIA), oligoarthritis/polyarthritis juvenile idiopathic arthritis and juvenile spondyloarthritis. Juvenile idiopathic arthritis has no specific diagnostic index, and needs to be differentiated from infectious diseases and malignant diseases. The onset of SOJIA is rapid, the disease progresses rapidly, and it is easy to be complicated with macrophage activation syndrome (MAS) which is life-threatening. The experience of pediatric rheumatologists in dealing with JIA is still insufficient, and the standardized diagnosis and treatment level of this disease needs to be further improved. Based on the experience and guidelines of diagnosis and treatment in China and abroad, we formulated this diagnosis and treatment standard, aiming at standardizing the diagnosis and treatment of the subtypes of JIA and MAS, so as to reduce the incidence of disability and serious complications and improve the prognosis.

Analysis of the verification results of the laboratory ability to detect ammonia nitrogen in drinking water in the CDC in Hubei Province / 公共卫生与预防医学

Objective To understand the ability of the CDC to detect ammonia nitrogen in drinking water in Hubei Province. Methods The blind samples of two concentration levels were tested in the laboratories of the disease control institutions in the province, and the test results were evaluated by double-sample Z score. Results The satisfaction rate was 76.29% (74/97), the problem rate was 15.46% (15/97), and the dissatisfaction rate was 8.25% (8/97). Conclusion The detection ability of ammonia nitrogen in drinking water in laboratories of disease control institutions in Hubei Province is generally high，however，some laboratories need to be further improved.

Analysis of pregnancy outcome and mother-child related concerns in patients with Takayasu arteritis / 中华风湿病学杂志

Objective To assess pregnancy outcome and pregnancy related concerns in Takayasu arteritis (TA) patients.Methods We analyzed 68 female patients with TA retrospectively from Xijing hospital.Data on the number of pregnancies,births and pregnancy outcomes before and after disease onset were retrieved from medical charts,patient questionnaires and the department of Obstetrics in Xijing Hospital.Data on pregnancy related concerns were gathered from patient questionnaires.Results Altogether,68 women in the TA study cohort had 106 pregnancies,73 (in 41 patients) before disease onset and 33 (in 28 patients) after disease onset.There were no difference in the frequencies of miscarriages,induced abortions and maternal complications before and after TA onset.Pregnancy related hypertension was seen in 4.7％ of the TA patients compared to 2.0％ (x2=1.238,P＞0.05) of the reference cohort from the department of Obstetrics in Xijing Hospital and preeclampsia/eclampsia in 4.7％ of the TA patients compared to 2.8％ of the reference cohort (x2=1.835,P＞0.05).The mean gestational age at delivery in pregnancies after TA onset was (37±6) weeks compared to (39±4) weeks in the reference cohort (x2=14.665,P＜0.01).Caesarian sections were more frequent in deliveries after TA onset (36％) than in the reference cohort (15％) (x2=13.322,P＜0.01).86％ of the TA patients had pregnancy related concerns.Of these concerns,72％ was about passing the disease to offsprings.Conclusion In this population based TA cohort,the maternal and fetal outcomes are favorable.Pregnancy related concerns are very popular in TAK patients.

Association between platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with disease activity in Takayasu arteritis patients / 中华心血管病杂志

Objective@#To explore the relation between platelet-to-lymphocyte ratio (PLR) or neutrophil-to-lymphocyte ratio (NLR) with disease activity in Takayasu arteritis (TA) patients.@*Methods@#Present retrospective study involved 289 patients with TA, who were hospitalized in our department between January 2010 and October 2017, and 280 age and gender matched healthy controls,who underwent thealth examination in our health examination center during the same period (control group). TA patients were further divided into active and inactive groups (180 and 109 cases respectively) according to Kerr scores. The clinical data were compared between groups. Pearson correlation analysis was used to evaluate the relationship between PLR or NLR and disease activity (Kerr score or C-reactive protein or erythrocyte sedimentation rate). Receiver operating characteristic (ROC) curve was employed to judge the cut-off value of disease activity for TA patients.@*Results@#PLR and NLR were significantly higher in TA group than in control group(137.33 (97.38, 193.37) vs. 120.55 (96.86, 144.60) and 2.38 (1.76, 3.57) vs. 1.66 (1.35, 2.08) , respectively, all P<0.001). PLR and NLR were significantly higher in active TA group than in inactive TA group (163.43 (123.64, 224.15) vs. 110.53 (84.22, 147.24) and 2.59 (1.96, 3.94) vs. 1.95 (1.53, 2.86) respectively, all P<0.001). PLR and NLR of active group were significantly decreased after 6 months treatment (164.05 (123.29, 226.29) vs. 104.67 (77.22, 138.43) and 2.58 (1.96, 3.91) vs. 2.15 (1.67, 2.60) respectively, all P<0.001). PLR was positively correlated with Kerr score (r=0.439, P<0.001), C-reactive protein (r=0.328, P<0.001) and erythrocyte sedimentation rate (r=0.410, P<0.001). NLR also exhibited a positive relationship with Kerr score (r=0.235, P<0.001), C-reactive protein (r=0.169, P=0.005) and erythrocyte sedimentation rate (r=0.123, P=0.037). A PLR level of 176.709 was shown to be the best predictive cut-off value for TA disease activity (sensitivity 44.6%, specificity 93.0%, and area under the curve=0.766).A NLR level of 2.128 was shown to be the best predictive cut-off value for TA disease activity (sensitivity 70.9%, specificity 47.7%, and area under the curve=0.691).@*Conclusion@#PLR and NLR are useful markers for predicting disease activity of TA patients.

The role of vitamin D in rheumatoid arthritis / 中国医师杂志

Vitamin D deficiency is highly prevalent in the general population including rheumatoid arthritis (RA) patients.Autocrine regulation of vitamin D modulates important immune response.Vitamin D deficiency may be involved in the pathogenesis of many autoimmune diseases including RA.Vitamin D regulates both the innate and adaptive immune responses.Vitamin D's effects on the innate immune system are mainly through the toll-like receptor and on the adaptive immune system through T cell differentiation,particularly the Helper T cell (Th) 17 response.As Thl7 cells are critical in the pathogenesis in RA,what effect will vitamin D deficiency lead to on the RA? Many data have indicated the relationship between vitamin D deficiency and RA disease activities,but not all the results are consistent.Here,we review the immune-modulatory roles of vitamin D and its effects on disease activity,osteoporosis and cardiovascular disease risk in RA.

Clinical analysis of 38 patients with respiratory involvement in relapsing polychondritis / 中国医师进修杂志

Objective To analyze the clinical characteristics of respiratory involvement in relapsing polychondritis(RPC). Methods The clinical data of 38 patients with respiratory (larynx, trachea and bronchus) involvement in RPC were retrospectively analyzed. Results The incidence of respiratory involvement in patients with RPC was 51.35%(38/74), and the most common symptoms were cough, wheezing, chest tightness and dyspnea. The incidences of erythrocyte sedimentation rate (ESR) increasing, C- reactive protein (CRP) increasing, fibrinogen increasing, D- dimer increased and rheumatoid factor (RF) positive in patients with respiratory involvement were significantly higher than those in patients without respiratory involvement: 47.37% (18/38) vs. 30.56% (11/36), 52.63% (20/38) vs. 33.33% (12/36), 31.58% (12/38) vs. 25.00% (9/36), 21.05% (8/38) vs. 13.89% (5/36) and 36.84%(14/38) vs. 5.56% (2/36), and there were statistical differences (P<0.05). CT was the main method to discover the respiratory involvement, and MRI could detect early cartilage inflammation lesions. Laryngoscope and bronchoscope could early detect mucosa and cartilage damage. Pathology was given priority to lymphocytes and neutrophils infiltration. Some patients had epithelium metaplasia and even canceration. Primary treatment methods were glucocorticoids combined with immunosuppressant. Airway stenosis and infection was the main factors influencing the prognosis of patients. Conclusions The respiratory involvement is not uncommon in RPC, and early CT, MRI, laryngoscope and bronchoscope examination is an important means of early diagnosis.Early glucocorticoid combined immunosuppressive therapy is the key to achieve good prognosis.

Construction and operation status of management system of laboratories of schistosomiasis control institutions in Hubei Province / 中国血吸虫病防治杂志

Objective To analyze the construction and operation status of management system of laboratories of schistosomi?asis control institutions in Hubei Province,so as to provide the reference for the standardized detection and management of schis?tosomiasis laboratories. Methods According to the laboratory standard of schistosomiasis at provincial,municipal and county levels,the management system construction and operation status of 60 schistosomiasis control institutions was assessed by the acceptance examination method from 2013 to 2015. Results The management system was already occupied over all the labora?tories of schistosomiasis control institutions and was officially running. There were 588 non?conformities and the inconsistency rate was 19.60%. The non?conformity rate of the management system of laboratory quality control was 38.10%(224 cases)and the non?conformity rate of requirements of instrument and equipment was 23.81%(140 cases). Conclusion The management system has played an important role in the standardized management of schistosomiasis laboratories.

Effect of standardized construction of laboratories of schistosomiasis control institutions in Hubei Province in 2013 / 中国血吸虫病防治杂志

Objective To investigate the effect and current situation of the standardized construction of laboratories of schis?tosomiasis control institutions in Hubei Province,so as to provide the evidence for establishing and improving the quality control system of diagnosis of schistosomiasis after the transmission of schistosomiasis was under control. Methods According to the procedures of self?examination,field operation,and laboratory on?site,five laboratories were assessed,and all the results were analyzed comparatively. Results The average number of staffs were(7.00 ± 1.58)persons,and the staffs of the laboratories of the schistosomiasis control institutions with senior professional titles in the city level were more than that in the county level(t=5.563,P<0.05). The average space was(3.20±1.64)rooms,and the average area was(117.00±88.29)m2. The average score of field operation was(96.40 ± 4.49)points. The average score of laboratory on?site assessment was(106.6 ± 6.15)points. The highest and lowest of the laboratory on?site assessment scores were environment and facilities(19.60 ± 0.55)points and manage?ment system of laboratory quality control(15.70 ± 2.39)points(F=2.869,P<0.05),respectively. Conclusion The cultiva?tion of laboratory staff should be strengthened,and the diagnostic capacity should be maintained and improved. The laboratory quality control system should be paid more attention to,and the construction and management of schistosomiasis laboratories should be standardized.

Association of FCGR3B gene copy number variations and lupus nephritis in Henan Han populations / 中华肾脏病杂志

Objective To evaluate the copy number variation of FCGR3B gene in Henan Han systemic lupus erythematosus (SLE) patients and healthy controls,and explore the association between FCGR3B gene copy number variants (CNVs) and lupus nephritis (LN) susceptibility in Henan Han population.Methods FCGR3B CNVs was investigated in 142 SLE patients with nephritis,187 SLE patients without nephritis and 328 healthy controls.A modified methodology based on competitive PCR named Multiplex AccuCopyTM Kit was used to detect FCGR3B copy number.Clinical and laboratory data were collected retrospectively from the medical record.Logistic regression analysis was used to determine the association of FCGR3B copy number variants with LN susceptibility.Rank correlation was used to determine the correlations between FCGE3B copy number variants and clinical phenotypes of LN.Results No significant difference was detected in the copy number variations of FCGR3B in different groups.Low copy number of FCGR3B was more commonly seen in patients with nephritis (P=0.042),and was a risk factor for LN (OR=2.059; 95％ CI:1.081-3.921; P=0.028).However,high copy number (＞ 2) had no effect on SLE patients without nephritis(OR=1.152; 95％CI:0.711-1.866; P=0.565) and LN patients (OR=0.838; 95％ CI:0.529-1.329; P=0.454).There were no associations between FCGR3B copy number variants and clinical phenotypes and immunologic characteristics of LN.Conclusion The low copy number of FCGR3B is a risk factor for LN in Henan Han population.

Association of TLR7 gene copy number variations and systemic lupus erythematosus in Han population / 中华风湿病学杂志

Objective To examine the variation in TLR7 gene copy number of patients with systemic lupus erythematosus (SLE) in Han population,and investigate the relationship between TLR7 gene copy number variations and clinical phenotypes of SLE.Methods Determination of gene copy number of TLR7 was achieved by AccuCopyTM multiple gene copy number detection method in 337 cases of Han SLE patients and 338 healthy controls.According to the clinical phenotype stratification,all cases were divided into lupus nephritis and non-lupus nephritis group,the hematological involvement and non-hematological involvement group,anti-Smith antibody positive and negative group.The data were analyzed by non-parametric rank test.Results Based on sex,there was no significant difference in the variations in TLR7 gene copy number between in female SLE patients and female healthy controls (Z=-1.175,P=0.240).There was also no difference in male group (Z=-1.085,P=0.278).Comparing gene copy numbers variation based on the presence or absence of lupus nephritis,hematological involvement,and anti-Smith antibody,there was no statistical significant difference in female SLE patients(Z=-0.888,P=0.375; Z=-1.085,P=0.278; Z=-0.529,P=0.597).There was no difference in variation in male SLE patients,neither (Z=-0.460,P=0.646; Z=-0.340,P=0.733;Z=-0.158,P=0.874).Conclusion The variations in TLR7 gene copy number are not correlated with SLE and clinical phenotypes of SLE in Han population.

Clinicopathological analysis of lupus nephritis with antinucleosome antibody / 中华肾脏病杂志

Objective To explore the clinicopathological characteristics of lupus nephritis (LN) with antinucleosome antibody (AnuA).Methods Data of 481 patients with biopsy-proven LN in the First Affiliated Hospital of Zhengzhou University from 2004 to 2011 were analyzed retrospectively.The patients were divided into two groups:AnuA-positive group (76 patients) and AnuA-negative group (405 patients).The clinical manifestations,laboratory examinations,histopathologic classes of LN,disease activity measured by SLE disease activity index (SLEDAI) of two groups were investigated and compared.Results There were 15 male patients in positive group (15/76,19.74％) with mean age of (27.99±10.88) years and 45 patients in negative group (45/405,11.11％) with mean age of (31.15±12.15) years respectively,which showed that male patients were more common in positive group (P＜0.05).Incidences of oral ulcer,fever,anemia,low complement and positive anti-dsDNA antibody were higher in positive group (P＜0.05).Percentage of diffuse proliferative lupus nephritis (class Ⅳ ) and pathological activity index (AI) in positive group were higher compared to negative group (all P＜0.05),while no significant differences of other pathological types,chronic index (CI) and SLEDAI were found between two groups.Conclusion LN patients with positive AnuA have special clinicopathological characteristics and AnuA may be used as a promising biomarker for the proliferative LN.

Incidence of metabolic syndrome in systemic lupus erythematosus and its influence by glucocorticoids / 中华内科杂志

Objective To investigate the incidence and correlative factors of metabolic syndrome (MS) in patients with systemic lupus erythematosus (SLE).Methods A total of 116 SLE patients and 115 controls were enrolled into the study.The incidence of MS,SLE disease activity index(SLEDAI) of patients with SLE combined with MS (MS-SLE) and patients without MS (n-MS-SLE),lupus characteristics,cumulative glucocorticoids,administration dose of glucocorticoids and hydroxychloroquine were compared between SLE group and the control group.Results The incidence of MS of SLE group was obviously higher than that of the control ( 34.48％ vs 14.78％,P ＜ 0.05 ).The ratios of patients with lower HDL-C,higher TG and higher blood pressure in SLE group ( 50.86％,56.03％,46.55％ ) were higher than those in the controls ( 34.78％,16.52％,20.00％,all P ＜ 0.05 ).MS-SLE group had significantly higher mean waist circumference,BMI,systolic blood pressure and diastolic blood pressure and lower HDL-C than n-MS-SLE group (all P ＜0.05 ).No significant difference was found regarding duration of disease,renal involvement,ESR,C-reactive protein,high-sensitivity C-reactive protein,SLEDAI,cumulative and current glucocorticoids use in MS-SLE group and n-MS-SLE group.The ratio of patients taking hydroxychloroquine in n-MS-SLE group was higher than that of MS-SLE group (46.05％ vs 15.00％,P＜0.05).Conclusions Patients with SLE has a higher incidence rate of MS.Hydroxychloroquine may reduce their MS incidence.

The influence of glucose-lowering rate on CKMB and muscle hemoglobin in type 2 diabetes mellitus with coronary heart disease / 中华内分泌代谢杂志

One hundred and fifty-one type 2 diabetic patients with coronary heart disease ( T2 DMC) and 142 cases of type 2 diabetes mellitus were included for analyzing the influence of different glucose-lowering rates on MB isoenzyme of creatine kinase (CKMB) and muscle hemoglobin level changes to search for the rational glucose-lowering rate.The level of CKMB in type 2 deabetes mellitus group was significantly lower( P＜0.05 ) at follow-up than that before and after intensive therapy.In type 2 diabetes mellitus group,when the fasting or postprandial glucose-lowering rate was not greater than 6 mmol· L-1 · d-1,the level of CKMB and muscle hemoglobin were significantly lower at follow-up than that before intensive therapy ( P＜0.05 ).When the fasting glucose-lowering rate is greater than 6 mmol· L-1 · d-1,the level of CKMB is significantly higher after intensive therapy than that before glucose-lowering ( P＜0.05 ).In T2DMC group,when the fasting or postprandial glucose-lowering rate was not greater than 4 mmol· L-1 · d-1,the level of CKMB and muscle hemoglobin was significantly lower at follow-up than that before intensive therapy(P＜0.05 or P＜0.01 ),buthigher at follow-up when the fasting glucose-lowering rate was greater than 4 mmol· L-1 · d-1(P＜0.05).

Changes of high sensitive-C reactive protein and cardiac troponin I levels in patients with type 2 diabetes during glucose-lowering therapy / 中华内分泌代谢杂志

Objective To compare the changes of high sensitive-C reactive protein (hs-CRP) and cardiac troponin Ⅰ ( cTn Ⅰ ) levels before and after intensive therapy in patients with type 2 diabetes,and to find out the reasonable glucose-lowering rate.Methods One hundred and thirty-two cases of type 2 diabetes( T2DM group) and 135 cases of type 2 diabetes with coronary heart disease( T2DM+CHD group) received intensive therapy.After testing hs-CRP and cTn Ⅰ levels,the variations were analyzed.Results The ranges of the change in cTn Ⅰ and hs-CRP levels were different under four glucose-lowering rates in the T2DM+CHD group( P＜0.05 ).cTn Ⅰ and hs-CRP levels were higher than those before intensive therapy in the T2DM+CHD group with glucose-lowering rate greater than 4.0mmol· L-1 · d-1.The other two subgroups with glucose-lowering rate less than 4.0 mmol· L-1 · d-1 showed decreased cTn Ⅰ and hs-CRP levels.While at the end of 3 months follow-up,cTn Ⅰ and hs-CRP levels were all significantly lower than those before intensive therapy in four subgroups ( P＜0.05 ).Conclusions The increase of cardiovascular events after intensive therapy may be due to excessively fast glucose-lowering rate.The reasonable glucose-lowering rate for patients with type 2 diabetes should depend on whether there is accompanying coronary heart disease.For type 2 diabetes with coronary heart disease,excessively fast glucose-lowering rate could lead to acute rise ofcTn Ⅰ and hs-CRP levels,which causes myocardial injury.The mechanism of myocardial injury resulted from excessively fast glucose-lowering rate may be due to activation of the inflammatory pathway.In type 2 diabetes with coronary heart disease,long-term good control of blood glucose could alleviate inflammatory response and cardiac damage resulted from excessively fast glucose-lowering rate.

Influence of glucose-lowering rate on left ventricular function in type 2 diabetes mellitus patients with coronary heart disease / 中华内分泌代谢杂志

Objective To explore the influence of glucose-lowering rate on left ventricular function in patients with type 2 diabetes mellitus (T2DM). Methods One hundred and thirty-two cases of type 2 diabetes mellitus and 135 cases of type 2 diabetes mellitus with coronary heart disease (T2DM+CHD)received intensive glucose lowering therapy. Then, after measuring left ventricular ejection fraction (LVEF) and E/A ratio, the variation was analyzed. Results LVEF was significantly higher than that before intensive therapy in T2DMsubgroup with glucose-lowering rate less than 6 m mol · L-1 · d-1( P＜0.05 ). So was T2DM+CHD subgroup with glucose-lowering rate less than 4 mmol· L-1 · d-1 (P＜0.05). LVEF was significantly lower than that before intensive therapy in T2DM+CHD subgroup with glucose-lowering rate greater than 4 mmol · L-1 · d-1( P＜0. 05 ),while by the end of following up for 3 months, LVEF stepped up and no significant difference was observed between subgroups ( P ＞ 0. 05 ). The E/A ratio stepped up in both subgroups after intensive therapy ( P ＜ 0. 05 ).Conclusions For T2DM patients with coronary heart disease, excessively fast glucose-lowering rate may impair left ventricular function. Long-term good control of blood glucose restores the impaired left ventricular function causes by excessively fast glucose-lowering rate. After intensive therapy, left ventricular diastolic function finally improves in both subgroups regardless of the glucose-lowering rate and coronary heart disease.

The clinical analysis of steroldogenic diabetes in 38 patients with rheumatic disease / 中国医师进修杂志

Objective To study the characteristic and management method of steroidogenic diabetes in patients with rheumatic disease. Methods The follow-up data of steroidogenic diabetes in 38 patients with rheumatic disease were analyzed retrospectively. Results The nosogenesis of steroidogenic diabetes and fast blood sugar level was related with steroid dosage, using time, age, obesity and hypertipoidemia. The blood-fasting sugar level was not so obviously increased. Blood sugar at bedtime was (24.40±5.92)mmol/L,before breakfast was (9.52±3.64)mmol/L, after breakfast was (20.38±7.19)mmol/L, before lunch was(10.69±3.23)mmol/L, after lunch was (21.81±6.92) mmol/L, before dinner was (12.17±3.63)mmol/L. There was significant difference between blood sugar at bedtime and that in others (P<0.01 or<0.05). Most patients needed insulin to control blood sugar. Decreasing the daily dosage of steroid might be beneficial to the reduction of corticosteroid induced diabetes. Most patients could stop insulin injection when the daily dosage of steroid decreased to a certain level. Conclusions The prescription of corticesteroid in rheumatic diseases can cause temporal increase of blood sugar. Intensive follow-up aad blood sugar monitor is important for the diagnosis of steroidogenic diabetes. Promptly administration of insulin is required for blood sugar control.

Effects of rosiglitazone on the mRNA expressions of MMP-1、TIMP-1 and Collagen Ⅲ in rat kidney fibroblasts cultured in high glucose / 中国实用内科杂志

Objective To investigate into the protective effects of rosiglitazone on rat kidney fibroblasts(NRK)damaged by high glucose.Methods From Jan.2005 to Sep.2005,the NRK cells were cultured in vitro,and were divided into five groups:normal glucose group(NG,1 000 mg/L D-glucose),high glucose group(HG,4 500 mg/L D-glucose),HG+RGZ(5 ?mol/L),HG+RGZ(10 ?mol/L)and HG+RGZ(15 ?mol/L).The mRNA expressions of T MMP-1、TIMP-1 and Collagen Ⅲ were measured with RT-PCR.Results Compared with NG group,the mRNA expression of MMP-1 decreased markedly in HG group(P