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Objective To investigate the safety and efficacy of infliximab in the treatment of severe polyarticular juvenile idiopathic arthritis(JIA).Methods Forty-four patients with severe polyarticular JIA were treated with infliximab (3 mg/kg) on week 0,2 and 6,respectively,and then they were treated every 8 weeks,plus methotrexate or and leflunomide for oral intake,and meanwhile physical therapy and functional rehabilitation were carried out.Patients were assessed by the American College of Rheumatology (ACR) response criteria (30,50,70) on week 2,6 and 14 and followed up,including swollen joint count,tender joint count,duration of morning stiffness and fever,body functions,lab inflammatory index like CRP,ESR changes.Results Among 44 cases,according to ACR response criteria,which represents 30％,50％,70％ improvement from baseline,the cure rates with infliximab therapy in swollen joint count,tender joint count,duration of morning stiffness,CRP,ESR were achieved in 47.7％ (21/44 cases),20.5％ (9/44 cases),and 11.4％ (5/44 cases) of patients with JIA on week 2 ; 63.6％ (28/44 cases),43.2％ (19/44 cases),and 13.6％ (6/44 cases) of patients on week 6 ;81.8％ (36/44 cases),52.2％ (23/44 cases),27.2％ (12/44 cases) on week 14,respectively.Inflammatory index like CRP,ESR with infliximab treatment decreased considerably compared that before treatment(P ＜0.05).Side effects from infliximab treatment were well-tolerated.There was no abnormality in the liver and kidneys or complicated infections,and no negative cases turned into the positive.Conclusions Treating severe polyarticular JIA with infliximab showed a rapid cure rate,safety and better tolerance.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the correlation among the morphology of crown, alveolar ridge crest and gingiva in maxillary anterior region of adults and to provide anatomical basis for clinical implant esthetics.</p><p><b>METHODS</b>Sixty Han-Chinese with healthy peridontium were selected in this study. The curvature of labial alveolar crest, the length and height of inter-proximal bone were measured on 3-D model reconstructed from cone-beam CT (CBCT) images, and the curvature of free gingiva, the width and height of inter-dental papilla and central incisor crown were evaluated on casts. The ratio of crown width to height was ranked and the 10 ranked highest were categorized as group Short-Wide (SW), the 10 ranked lowest were selected as group Long-Narrow (LN).</p><p><b>RESULTS</b>In maxillary anterior region, the curvature angle of both alveolar crest and marginal gingiva were significantly different among different tooth regions, but the alveolar and gingival curvature was significantly correlated in the same region (P < 0.05). The morphology of inter-proximal bone and papilla was significantly correlated (P < 0.01), except the region between central and lateral incisors (P = 0.625, P > 0.05). Compared to group SW, group LN formed a pronounced scalloped contour of gingival margin (P = 0.002) and slender inter-dental papilla (P = 0.000).</p><p><b>CONCLUSIONS</b>The free gingival curvature and inter-dental papillary morphology are significantly correlated with the morphology of crown and alveolar ridge crest in maxillary anterior region of Han-Chinese. Individuals with long-narrow crown, pronounced scalloped marginal gingiva and slender inter-dental papilla are susceptible to risk implant esthetics.</p>
Subject(s)
Humans , Alveolar Process , Diagnostic Imaging , Crowns , Gingiva , Incisor , Maxilla , Radiography , Tooth CrownABSTRACT
<p><b>OBJECTIVE</b>To analyze the safety and efficacy of anti-CD20 monoclonal antibody in treatment of severe pediatric systemic lupus erythematosus (PSLE).</p><p><b>METHOD</b>The diagnosis of PSLE was made according to the criteria for the classification of systemic lupus erythematosus revised by the American College of Rheumatology in 1997. Severe cases with PSLE was selected by the following criteria: age ≤ 16 years, number of important organs involved > 1, SLEDAI score > 10 points and poor response to conventional immunosuppressive treatment. These patients received 2 doses of 375 mg/m(2) rituximab (RTX), 2 weeks apart. Clinical, laboratory findings and drug side effects were recorded at RTX initiation, 2 weeks, 1 month, 3, 6 and 12 months after infusion.</p><p><b>RESULT</b>A total of 20 patients. Male to female ratio was 1:3, were enrolled. They were 5-16 years old. The course of disease was (3.0 ± 2.5) years (range: 1 month-7 years), patients were followed up for 12 - 36 months [median: (27.0 ± 7.8) months]. Delirium and cognitive disorders were significantly improved in 10 cases of lupus encephalopathy after 1 month. Lupus nephritis in children were eased slowly, 14/15 patients with lupus nephritis were improved after 2-3 months. Four cases of lupus pneumonia were significantly improved within 1 month. Decreased blood cells counts were relieved at 1 month in 16/18 cases. Cellular immune function was assessed 2 weeks after application of anti-CD20 monoclonal antibody; we found B-cell clearance in 19 patients (95%). B lymphocyte count of 18 patients (90%) was restored within one year. SLEDAI score was reduced obviously. Dose of corticosteroid ranged from (45.0 ± 4.7) mg/m(2) before drug use to (12.0 ± 2.7) mg/m(2) 12 months later (P < 0.001). After the drug use, 5 patients had pneumonia within 6 months; 2 cases who suffered from aspergillus pneumonia and Pneumocystis carinii pneumonia respectively were severe. They accepted mechanical ventilation and anti-inflammatory support after being transferred to the intensive care unit, and their conditions improved at last. No death occurred. In 2 patients the disease recurred with B-cell recovery after 15 months and 18 months. Administration of another cycle of rituximab resulted in remission again in one case but not in the other.</p><p><b>CONCLUSION</b>Anti-CD20 monoclonal antibody is effective and safe in treatment of severe PSLE. But severe infections may occur in some cases. Focusing on prevention and early treatment can reduce the probability of adverse reactions.</p>