An Unusual Case of DRESS Syndrome Presenting with Marked Leucocytosis.

Drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a rare severe drug-induced idiosyncratic hypersensitivity characterized by maculopapular and/or erythrodermic eruption, fever, peripheral lymphadenopathy, eosinophilia or atypical lymphocytosis, and visceral organ involvement. The estimated incidence of this syndrome ranges from 1/1000 to 1/10,000 drug exposures. In this report, we describe a case of DRESS syndrome in a young female with a unique presentation. The DRESS syndrome can be difficult to diagnose as its clinical findings can mimic those of other systemic diseases. This case emphasizes the importance of incorporation of the patient’s clinical and medication history in the interpretation of hematological investigations.

Sulfasalazine prevents lung injury due to intra-abdominal sepsis in rats: possible role of Nrf2 and angiopoietin-2

This study aimed to investigate the effect of sulfasalazine in preventing and treating intra-abdominal sepsis-induced acute respiratory distress syndrome (ARDS) in a rat model. Forty male Wistar albino rats were used. The rats were randomly divided into four equal groups, and sepsis was induced in 30 rats by intraperitoneal administration of a fecal saline solution prepared from rat feces. Group 1: normal control (n=10) [non-surgical], Group 2: fecal intraperitoneal injection (FIP) (n=10) [untreated septic group], Group 3: FIP+saline (placebo) (n=10) [saline administered intraperitoneally], Group 4 (n=10): FIP+sulfasalazine [250 mg/kg per day administered intraperitoneally]. Computed tomography was performed and blood samples were collected for biochemical and blood gas analysis. The lungs were removed for histopathological studies. Statistically significant reductions in interleukin (IL)-6, IL1-β, tumor necrosis factor (TNF)-α, malondialdehyde (MDA), and angiopoietin-2 (ANG-2) levels were observed in the sulfasalazine group compared to the FIP+saline group (P<0.001). Nrf2 levels were significantly higher in the sulfasalazine-treated group than in the FIP and FIP+saline groups (P<0.01). Lung tissue scores were significantly reduced in the sulfasalazine group compared to the other sepsis groups. The Hounsfield unit (HU) value was significantly lower in the sulfasalazine group than in the FIP+saline group (P<0.001). PaO2 values were significantly higher in the sulfasalazine-treated group than in the FIP+saline-treated group (P<0.05). Sulfasalazine was shown to be effective in preventing and treating ARDS.

Spondyloarthritis: Characterization of a cohort. Pablo Tobón Uribe Hospital. Medellín, Colombia / Espondiloartritis: caracterización de la cohorte del Hospital Pablo Tobón Uribe, Medellín, Colombia

ABSTRACT Introduction: Spondyloarthritis is a group of chronic inflammatory diseases. Several factors of the disease remain unknown, including clinical and radiological behavior, the demographic characteristics and burden of disease in Colombian patients. Objective: To characterize the demographic aspects, the clinical and paraclinical behaviour, and the therapeutic requirements of a cohort of patients with spondyloarthritis followed-up in the Hospital Pablo Tobón Uribe from January 1, 2005 to December 31, 2017. Methodology: Cohort study. The population was characteriszed using descriptive statistics, qualitative variables using simple and relative frequencies, and quantitative variables using means and standard deviation or medians with their interquartile ranges. Results: The cohort consisted of 181 patients, 100 men (54.9%) and 81 women (44.5%). Just under one half (45.1%) had ankylosing spondylitis, 18.1% undifferentiated spondyloarthritis, 17.1% psoriatic arthropathy, 14.8% reactive arthritis, and 4.4% inflammatory bowel disease. More than two-thirds (69.8%) of the patients had peripheral manifestations, and 67% had axial. A positive HLAB27 was observed in 55.6% of patients. The MRI showed acute and chronic changes in the sacroiliac in 69% and 37%, respectively, with radiological sacroiliitis being observed in 59.5% of cases. The large majority (91.1%) of the patients were treated with PII of original article: S0121-8123(21)00018-9 NSAIDs, 60.1% with sulfasalazine, 43.4% with COX2 inhibitors, and 33.7% with methotrexate. TNFa inhibitors were required by 56.6% of the subjects 3 years after the onset of symptoms. The most commonly used biological drugs were Adalimumab (31.1%), etanercept (21.7%), infliximab (13.1%), golimumab 6.1%, and certolizumab 0.5%. Conclusions: Ourpopulation was characterized by a high activity and functional compromise demonstrated by the high scores of BASDAI and BASFI, and because 56.6% of the patients required anti-TNFa agents.

RESUMEN Introducción: Las espondiloartritis son un grupo de enfermedades inflamatorias crónicas. Se desconoce su comportamiento en nuestro medio, al igual que el comportamiento clínico y radiológico, las características demográficas y la carga de enfermedad en los pacientes colombianos. Objetivos: Caracterizar los aspectos demográficos, el comportamiento clínico y paraclínico y los requerimientos terapéuticos de la cohorte de pacientes con espondiloartritis seguidos en el Hospital Pablo Tobón Uribe desde el 1.° de enero del 2005 hasta el día 31 de diciembre del 2017. Metodología: Estudio de cohorte. La población se caracterizó mediante estadística descrip tiva, las variables cualitativas mediante frecuencias simples y relativas, en tanto que para las cuantitativas se emplearon medias y desviación estándar o medianas con sus rangos intercuartílicos. Resultados: La cohorte está constituida por 181 pacientes, 100 hombres (54,9%) y 81 mujeres (44,5%). El 45,1% tenía espondilitis anquilosante, el 18,1% espondiloartritis indiferenciada, el 17,1% artropatía psoriásica, el 14,8% artritis reactiva y el 4,4% enfermedad inflamatoria intestinal. El 69,8% de los pacientes tenía manifestaciones periféricas y el 67% axiales. El 55,6% de los pacientes tuvo HLAB27 positivo. La RMN mostró cambios agudos y crónicos en las sacroilíacas en el 69% y 37%, respectivamente; en el 59,5% de los casos se observó sacroileítis radiológica. el 91,1% de los pacientes se trató con AINE, el 60,1% con sulfasa lazina, el 43,4% con inhibidores COX2 y el 33,7% con metotrexato. El 56,6% de los sujetos requirió inhibidores-TNFa 3 arios después del inicio de los síntomas. Los biológicos más uti lizados fueron adalimumab (31,1%), etanercept (21,7%), infliximab (13,1%), golumimab (6,1%) y certolizumab (0,5%). Conclusiones: Nuestra población se caracterizó por una alta actividad y gran compromiso funcional, lo que se refleja en altos puntajes de Basdai y Basfi y en que el 56,6% de los pacientes requirió agentes anti-TNFa.

Sulfasalazine increases the radiosensitivity of colorectal cancer cells by promoting ferroptosis / 中华放射肿瘤学杂志

Objective:To investigate the radiosensitization effect of low-dose sulfasalazine (SAS) on colorectal cancer (CRC) cells.Methods:Proliferation inhibition effect of SAS on CRC cells was detected by CCK-8 assay, and the concentration of SAS in vitro assays was based on its IC10 value. CRC cells were treated with SAS alone or combined with inhibitors of apoptosis, autophagy, ferroptosis and necroptosis, then cell viability was detected by CCK-8 assay. Trypan blue staining, clone formation assay and cell growth curves were used to verify the radiosensitization effect of SAS on CRC cells in vitro. CRC cells were treated with SAS and radiotherapy, then the intracellular contents of lipid peroxidation and the protein levels of GPX4, PTGS2, cleaved PARP and active caspase 3 were evaluated, respectively. Subcutaneous xenograft tumor mouse model was established to further verify the radiosensitization effect of SAS in vivo. Results:High dose (lethal dose) of SAS could induce apoptosis and ferroptosis in CRC cells. Low dose (non-lethal dose) of SAS enhanced the radiosensitivity of CRC cells in vitro, and the radiosensitivity effect of SAS could only be abolished by ferroptosis inhibitor (Fer-1). Low dose of SAS combined with radiotherapy significantly down-regulated the expression of GPX4, whereas increased the intracellular lipid peroxidation levels and the expression of PTGS2. SAS also showed significant radiosensitization effect in subcutaneous xenograft tumor model. Conclusion:Our findings suggest that low-dose SAS could increase the radiosensitivity of CRC cells by promoting ferroptosis.

The effect of sulfasalazine in pentylenetetrazole-induced seizures in rats

We aimed to reveal the anti-convulsant effects sulfasalazine and its mechanism in pentylenetetrazole (PTZ)-induced seizures in rats. Forty-eight male Wistar albino rats (200-250 g) were randomly divided into two groups: 24 for electroencephalography (EEG) recording (group A) and 24 for behavioral studies (group B). About 70 mg/kg PTZ was used for behavioral studies after sulfasalazine administration and 35 mg/kg PTZ was used for EEG recording after sulfasalazine administration. Electrodes were implanted on the dura mater over the left frontal cortex and the reference electrode was implanted over the cerebellum for EEG recording. Racine's convulsion scale, first myoclonic jerk onset time, spike percentages, brain malondialdehyde (MDA), superoxide dismutase (SOD), and prostaglandin F2α (PGF2α) levels were evaluated between the groups. First myoclonic jerk onset time was significantly shorter in the saline group than both 250 and 500 mg/kg sulfasalazine groups (P<0.05). Racine's convulsion scores were significantly lower in the 250 and 500 mg/kg sulfasalazine groups than the saline group (P<0.05, P<0.001). The two sulfasalazine groups had lower spike percentages than the saline group (P<0.05). Significantly lower MDA and PGF2α levels were observed in the 250 and 500 mg/kg sulfasalazine groups compared with the saline group (P<0.05, P<0.001, respectively). SOD increased significantly in both sulfasalazine groups compared with the PTZ+saline group (P<0.05). Our study demonstrated that sulfasalazine had protective effects on PTZ-induced convulsions by protecting against oxidative and inflammatory damage associated with PTZ.

Study on the effect of the treatment of Periplaneta americana L. extract Ento-B by Dinitrochlorobenzene combined with acetic acid induced UC in rats

ABSTRACT Purpose To study the Periplaneta americana L. extract Ento-B on the treatment of chronic ulcerative colitis induced by 2,4-dinitrochlorobenzene and acetic acid in rats and to explore its primary mechanism of action. Methods Using 2,4-dinitrochlorobenzene combined with acetic acid to induce chronic ulcerative colitis (chronic UC) in rats. The sulfasalazine (400 mg/kg) and Ento-B (200 mg/kg, 100 mg/kg,50 mg/kg) were given by intragastric administration and the effect was evaluated according to the disease activity index (DAI) score, colon mucosal injury index (CMDI) score, histopathological score (HS) and the serum levels of Interleukin-4(IL-4), Interleukin-10(IL-10), Tumor necrosis factor-α(TNF-α), Malondialdehyde(MDA), Superoxide dismutase(SOD) and Inducible nitric oxide synthase(iNOS.) Results Compared with the model group, all doses of Ento-B could reduce the score of CMDI (p < 0.05), HS(p < 0.05 or p < 0.01), significantly increased the expression of IL-4, IL-10, SOD (p < 0.01) and decreased the levels of TNF-α, MDA, iNOS in serum of UC rats, significantly improving the degree of colon lesionsin UC rats. Conclusions Ento-B may play an important role in the treatment of ulcerative colitis induced byUC rats. The mechanism may be related to the increased expression of IL-4, IL-10, SOD and reduced expression of TNF-α, MDA, iNOS.

Clinical Efficacy of Kuijietong Against Mild to Moderate Active Ulcerative Colitis / 中国实验方剂学杂志

Objective:To re-evaluate the intervention effect of Kuijietong（KJT） on ulcerative colitis（UC）. Method:Sixty patients with mild-to-moderate UC in the active stage were enrolled and randomized into a KJT group （<italic>n</italic>=30） and a sulfasalazine （SASP） group （<italic>n</italic>=30）. Patients in the KJT group were treated with KJT granules， one bag divided in two daily doses， once in the morning and once in the evening， while those in the SASP group received SASP， 1 g per time， four times per day. Then the clinical efficacy was evaluated. Result:According to the modified Mayo score，the clinical remission rates of the KJT group and SASP group were determined to be 46.7% （14/30）and 40% （12/30），exhibiting no significant difference between the two groups （<italic>P</italic>>0.05）. The clinical effective rate of the KJT group was 83.3% （25/30），which was better than 60% （18/30） of the SASP group （<italic>P</italic><0.05）. The mucosal healing rate in the KJT group was 36.7% （11/30）， not significantly different from 30% （9/30） in the SASP group. In the alleviation of UC symptoms，the score of large intestine dampness heat syndrome in the KJT group was remarkably better than that in the SASP group （<italic>P</italic><0.05），but there was no significant difference in inflammatory bowel disease questionnaire （IBDQ） score between the two groups. In terms of physical and chemical indexes，serum erythrocyte sedimentation rate （ESR） in the KJT group after intervention was lower than that in the SASP group （<italic>P</italic><0.05），whereas the interleukin-10 （IL-10） level was higher（<italic>P</italic><0.05）. The comparison between the two groups revealed no significant difference in C-reactive protein （CRP）， tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>）， CD4⁺ T cells and regulatory T （Treg） cells after intervention. During the intervention，no obvious adverse reactions were found in the two groups，indicating good safety. Conclusion:KJT is not inferior to SASP in relieving mild-to-moderate UC in the active stage.

Effects of Esomeprazole on Pharmacokinetic Behavior of Sulfasalazine in Rats / 中国药房

OBJECTIVE：To develop a metho d for determining the plasma concentration of sulfasalazine （SSZ）metabolite sulfapyridine（SP）in rats ，and to investigate the effects of esomeprazole （ESOM）on the pharmacokinetic behavior of SSZ in rats. METHODS：Male SD rats were randomly divided into SSZ group and SSZ+ESOM group ，with 6 rats in each group. SSZ+ESOM group were given Esomeprazole enteric-coated tablets [ 90 mg/（kg·d）] intragastrically for 14 days. On the 15th day ，the rats in 2 groups were given Sulfasalazine enteric coated tablets （90 mg/kg）intragastrically，and blood sample was collected from the inner canthus at 0.5，1，1.5，2，3，4，6，8，10，12，24，36，48，72 h after administration. After protein precipitation with methanol ， using diazepam as internal standard ，Agilent XDR-C 18 column was adopted with methanol- 0.1％ formic acid solution （gradient elution）as mobile phase. The concentration of SSZ metabolite SP in plasma was determined by LC-MS/MS. The pharmacokinetic parameters were calculated by using DAS 3.0.1 software and compared between 2 groups. RESULTS ：The linear range of SP were 2-1 000 ng/mL. The methodology met the requirements of Chinese Pharmacopeia . There was no statistical significance in pharmacokinetic parameters of SP between 2 groups，such as AUC 0－t，tmax，t1/2z，cmax，MRT0－t（P＞0.05）. CONCLUSIONS ：The established method is simple ，rapid and sensitive ；it can be used for the concentration determination of SSZ metabolite SP in plasma. ESOM has no significant effect on the pharmacokinetic behavior of SSZ in rats.

Síndrome de DRESS inducido por sulfasalazina. ¿Consideramos esta reacción adversa grave al indicar el fármaco? Caso clínico

DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe, rare and potentially lethal idiosyncratic condition associated with the use of some drugs. Given its broad spectrum of presentation, clinical suspicion is essential for management, since it requires the immediate withdrawal of the culprit drug, support measures and the use of corticosteroids as the first line of treatment. We report a 24-year-old woman with a diagnosis of ulcerative colitis with joint involvement despite the use of infliximab, who presented symptoms, signs and laboratory compatible with DRESS syndrome on the third week after indicating sulfasalazine for her baseline disease.

Sociodemographic and drug prescription pattern in patients with rheumatoid arthritis in a tertiary care teaching hospital

Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease that affects mainly the small joints of the hands and feet. RA is widely prevalent throughout the world.Methods: A prospective and observational study was carried out on 44 patients for 6 months. Patients of either sex, aged between 18 to 70 years diagnosed with rheumatoid arthritis were screened and recruited in the study. Patients were diagnosed on the basis of clinical assessment and the lab parameters assessed were rheumatoid factor and anti-CCP (anti-cyclic citrullinated peptide antibody). Prescriptions were analyzed for socio-demographic details and drug prescribing pattern.Results: Out of 44 patients, 36 (81.82%) were females, 8 (18.18%) were males. Maximum occurred 19 (43.18) between 31 to 40 years of age. Out of 19 (43.18%), females were 16 (36.36%), males were 3 (6.83%). 39 (88.63%) were from rural and 5 (11.37%) from urban area, 21 (47.73%) illiterate, 15 (34.09%) primary educated, 7 (15.91%) secondary educated, 1 (2.27%) educated above higher secondary, 4 (9.08%) unemployed, 2 (4.55%) students, 19 (43.18%) housewives, 7 (15.91%) agricultural workers, 7 (15.91%) non-agricultural outdoor workers and 5 (11.37%) non-agricultural indoor workers. Most common co-morbidity was hypertension 28 (63.63%). Anti-CCP was positive in 38 (86.36%). All of the patients 44 (100%) received disease-modifying anti-rheumatic drugs (DMARDs). Majority of the patients were prescribed with triple DMARDs combination 30 (68.18%).Conclusions: We observed that female were dominant over the male with male: female ratio of 1: 4.5. Prescriptions pattern was primarily based on DMARDs.

Ferruginol alleviates inflammation in dextran sulfate sodium-induced colitis in mice through inhibiting COX-2, MMP-9 and NF-κB signaling

Objective: To assess the anti-inflammatory efficacy of ferruginol on dextran sulfate sodium (DSS) stimulated ulcerative colitis mice. Methods: Ulcerative colitis was induced in C57BL/6J mice by administering 2% of DSS through drinking water for 7 d. The mice in the treatment group were treated with DAA+50 mg/kg/day ferruginol orally. In the positive control group, sulfasalazine (50 mg/kg/day) was used alongside with DSS. After induction, the bodyweight, character of stool and feces occult blood were recorded daily, the disease activity index was calculated, and the colon length, colon weight, and spleen weight were recorded. The myeloperoxidase activity was assayed by spectrophotometry. Interleukin (IL)-6, IL-1β, and tumor necrosis factor-a were determined by ELISA method, and nuclear factor-κB, cyclooxygenase-2, matrix metalloproteinases-9, and inducible nitric oxide synthase by Western blotting assays. Results: Ferruginol significantly increased the bodyweight, colon weight, colon length, and decreased disease activity index and spleen weight. It exhibited anti-inflammatory activity against DSS induced ulcerative colitis in mice by reducing the activities of myeloperoxidase, tumor necrosis factor-α, nuclear factor-κβ, IL-1β, cyclooxygenase-2, matrix metalloproteinases-9, IL-6, and inducible nitric oxide synthase. Conclusions: Ferruginol could be used to treat ulcerative colitis by attenuating the inflammation in colon cells and maintaining colonic mucosal barrier integrity.

Effects of Biqi Capsules on clinical efficacy and cytokines of patients with ankylosing spondylitis / 中草药

Objective: To observe the effects of Biqi Capsules on clinical efficacy and cytokines of patients with ankylosing spondylitis. Methods: Patients (120 cases) with ankylosing spondylitis were randomly divided into control group and treatment group for 60 cases in each group. Patients in the control group were po administered with Sulfasalazine Tablets, four tablets twice a day. Patients in the treatment group were po administered with Biqi Capsules, 1.2 g for each time, three times daily. Four weeks were a course. Patients in two groups were treated for three courses. After treatment, the clinical efficacy was evaluated, and visual analog scales (VAS), Bath ankylosing spondylitis disease active index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), and Bath ankylosing spondylitis metrological index (BASMI) in two groups before and after treatment were compared. Enzyme linked immunosorbent assay (ELISA) were employed to measure the expression levels of cytokines IL-1β, TNF-α, IL-4, and IL-10. Erythrocyte sedimentation rate (ESR) was detected by instrument method and hs-CRP was detected by automatic biochemical analyzer. Results: After treatment, the compliance rate of ASAS20 (20%) and BASDAI50 (50%) in the treatment group was higher than that in the control group, but the difference was not statistically significant. After treatment, VAS, BASDAI, BASFI, BASMI, ESR, and hs-CRP in two groups were significantly decreased, with significantly difference between two groups before and after treatment (P < 0.01). And BASDAI and hs-CRP were significantly lower than those in the control group (P < 0.05). After treatment, IL-4 and IL-10 were significantly increased, but TNF-α and IL-1β were significantly decreased, with significantly difference between two groups before and after treatment (P < 0.01). And IL-10 was significantly higher than that in the control group (P < 0.05). Conclusion: Biqi Capsules has certain therapeutic effect on ankylosing spondylitis, and it may be associated with increasing anti-inflammatory factors, decreasing inflammatory factors and regulating inflammatory immunity.

Ferruginol alleviates inflammation in dextran sulfate sodium-induced colitis in mice through inhibiting COX-2, MMP-9 and NF-κB signaling

Objective: To assess the anti-inflammatory efficacy of ferruginol on dextran sulfate sodium (DSS) stimulated ulcerative colitis mice. Methods: Ulcerative colitis was induced in C57BL/6J mice by administering 2％ of DSS through drinking water for 7 d. The mice in the treatment group were treated with DAA+50 mg/kg/day ferruginol orally. In the positive control group, sulfasalazine (50 mg/kg/day) was used alongside with DSS. After induction, the bodyweight, character of stool and feces occult blood were recorded daily, the disease activity index was calculated, and the colon length, colon weight, and spleen weight were recorded. The myeloperoxidase activity was assayed by spectrophotometry. Interleukin (IL)-6, IL-1β, and tumor necrosis factor-α were determined by ELISA method, and nuclear factor-κB, cyclooxygenase-2, matrix metalloproteinases-9, and inducible nitric oxide synthase by Western blotting assays. Results: Ferruginol significantly increased the bodyweight, colon weight, colon length, and decreased disease activity index and spleen weight. It exhibited anti-inflammatory activity against DSS induced ulcerative colitis in mice by reducing the activities of myeloperoxidase, tumor necrosis factor-α, nuclear factor-κB, IL-1β, cyclooxygenase-2, matrix metalloproteinases-9, IL-6, and inducible nitric oxide synthase. Conclusions: Ferruginol could be used to treat ulcerative colitis by attenuating the inflammation in colon cells and maintaining colonic mucosal barrier integrity.

A meta-analysis of Gegen-Qinlian decoction for ulcerative colitis / 国际中医中药杂志

Objective To systematically evaluate the effectiveness and safety of Gegen-Qinlian decoction in treating ulcerative colitis.Methods We searched Cochrane Library, PubMed, CNKI, VIP, CBM and Wanfang online Data bases June, 2017. All of the randomized controlled trials(RCTs) of Gegen-Qinlian decoction compared with sulfasalazine in treating for ulcerative colitis were searched. The quality of RCTs meeting inclusion criteria was evaluated and the data were extracted; meta-analyses were performed with RevMan 5.3 software, and then the GRADE system was used to rate the level of evidence and strength of recommendation.Results Totally 5 RCTs were included into the study. The group treated withGegen-Qinlian decoction or combined with sulfasalazine was superior to the control group in total effective rate (RR=1.18, 95％ CI(1.06-1.30),P=0.002). There were no significant differences between the two groups in clinical symptom curative effect [RR=1.09, 95％CI (0.72-1.64), P=0.69], adverse reactions [RR=0.11, 95％ CI (0.01-1.92),P=0.13], Symptom curative effect [RR=1.33, 95％CI (0.95-1.88),P=0.10], mucosal lesions curative effect [RR=1.33, 95％CI(0.95-1.88), P=0.10]. Based on the GRADE system, the level of total effective rate and adverse reactions evidence was Grade C, and the strength of recommendation was 2. the level of the rest of the evidence was Grade D.Conclusions Compared with sulfasalazine,Gegen-Qinliandecoction or combined with sulfasalazine can be used as a treatment option.

Meta analysis of the clinical effect of sulfasalazine combined with probiotics on the treatment of inflammatory bowel disease / 中国医师杂志

Objective To evaluate the clinical efficacy of domestic sulfasalazine (SASP) combined with probiotics on the treatment of inflammatory bowel disease (IBD).Methods According to the search of Chinese periodical full-text database,PubMed and other Chinese databases as well as English databases,the cases of IBD treated with SASP combined with probiotics or metronidazole in China were collected and screened for randomized controlled trials (RCT).The results between combined group and control group were compared using odds ratio (OR) and 95％ Confidence Interval (CI) indicates.The evaluation indicator was the remission rate.According to the inclusion and exclusion criteria,the literature was selected,and data was extracted.Quality assessment of the included methodologies was performed,and RevMan 5.3 software was used for meta-analysis.Results 26 studies including a total of 2 403 patients were adopted in the present study.Among them,13 studies suggested that the remission rate of IBD in SASP combined with probiotics group was significantly improved compared with that in the SASP group alone (x2 =10.29,df =12,I2 =0％,P ＜0.05,the effect model OR =3.70,95％ CI as 2.62-5.21),demonstrating that the combined treatment was superior to monotherapy in IBD.10 studies suggested that the remission rate of ulcerative colitis (UC) in SASP combined with probiotics group was significantly improved compared with that in the SASP group alone (x2 =2.59,df =9,I2 =0％,P ＜ 0.05,the effect model OR =3.84,95％ CI as 2.52 -5.86),demonstrating that the combined treatment was superior in UC.The other 3 studies showed that the remission rate of UC with infection in SASP combined with probiotics group was significantly improved compared with that in SASP combined with metronidazole group (x2 =0.07,df =2,I2 =0％,P ＜ 0.05,the effect model x2 =4.77,95％ CI as 2.27-10.02),demonstrating that treatment of SASP combined with probiotics was superior in UC with infection.Conclusions SASP combined with probiotics can improve the effective response rate in the treatment of IBD.

Efficacy of herb-separated moxibustion combined with sulfasalazine enteric-coated tablets for ankylosing spondylitis with cold-dampness obstruction type / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between herb-separated moxibustion and conventional moxibustion on ankylosing spondylitis (AS) based on oral administration of sulfasalazine enteric-coated tablets.@*METHODS@#A total of 64 patients with AS of cold-dampness obstruction type were randomly divided into an herb-separated moxibustion group and a conventional moxibustion group, 32 cases in each one. Based on oral administration of sulfasalazine enteric-coated tablets, the patients in the conventional moxibustion group were treated with moxibustion at the area with Dazhui (GV 14) to Changqiang (GV 1) as center and about 10 cm in width; the moxibustion was given for 1 hour. In the herb-separated moxibustion group, the gauze was soaked in the medicinal liquor and ginger juice, and placed on the same moxibustion area as the conventional moxibustion group, followed by moxibustion for 1 hour. The treatment in the two groups was given once a week, three treatments constituted a course and totally three courses were given. The symptom quantification score, occipital-wall distance, Schober test, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were observed before and after treatment in the two groups, and the clinical efficacy was evaluated.@*RESULTS@#Compared before treatment, the symptom quantification score, occipital-wall distance, CRP and ESR levels were lower but the Schober test was higher after treatment in the two groups (all 0.05). The total effective rate was 90.0% (27/30) in the herb-separated moxibustion group, which was higher than 73.3% (22/30) in the conventional moxibustion group (<0.05).@*CONCLUSION@#The herb-separated moxibustion combined with sulfasalazine enteric-coated tablets has significant efficacy for AS with cold-dampness obstruction type, which could obviously relieve pain symptoms, improve occipital-wall distance, Schober test and other physical signs, and improve the quality of life.

Study on mechanism of action of Blattidae compound PB against chronic ulcerative colitis induced by alloantigen and acetic acid in rats / 中国药理学通报

To study the effect of Blattidae compound PB on chronic UC induced by alloantigen combined with acetic acid in rats, and to preliminarily explore its mechanism. Methods Chronic UC model was established using alloantigen combined with acetic acid. Normal group and model group were given sodium chloride solution by enema, while the other groups were given respectively to the SASP, the Changyanning and PB low, medium and high doses. The experiment was determined by evaluating DAI, CMDI, HS and the visceral index. Serum IL-4, IL-8, IL-17, CRP, IgG and colonic mucosa TNF-MPO EGF were detected by ELISA. Results Compared with normal group, the levels of IL-8, IL-17, INF-7, CRP, IgG, TNF-a, MPO in model group significantly increased, while the levels of 1L-4, EGF decreased significantly (P <0. 01, P <0. 05). But the levels of DAI,CMDI, HS, IL-8, IL-17, INF-7, CRP, IgG, TNF-ot, MPO in each dose of PB groups were significantly lower than those of model group, and the levels of IL-4, EGF were significantly higher than those of model group (P <0. 01, P < 0. 05). Conclusions Blattidae compound PB can effectively relieve chronic ulcerative colitis induced by alloantigen combined with acetic acid in rats, and its mechanism may be related to promoting Th2 cell activation, changing Thl-prone Thl/Th2 balance to Th2, which regulated cell immunity and humoral immunity to achieve the steady state immune balance.

Sulfasalazine induces ferroptosis of breast cancer ZR-75-1 cells and its mechanism / 肿瘤

Objective: To observe the activation effect of sulfasalazine on ferroptosis of breast cancer ZR-75-1 cells, and to explore its possible mechanism. Methods: The different concentrations of sulfasalazine (0, 1.0, 0.5, 1.0, and 2.0 mmol/L) were used to treat ZR-75-1 cells. The morphological change of ZR-75-1 cells was observed under an inverted microscope. The proliferation inhibitory rate of ZR-75-1 cells was detected by CCK-8 method. The expression levels of glutathione peroxidase 4 (GPX4) and cysteine-glutamate antiporter subunit (xCT) proteins in ZR-75-1 cells were detected by Western blotting. The fluorescent probe was used to label the ZR-75-1 cells treated with different concentrations of sulfasalazine, then the change of reactive oxygen specie (ROS) level (as indicated by fluorescence intensity) was detected by FCM method. The expression level of divalent metal transporter 1 (DMT1) mRNA was detected by real-time fluorescent quantitative PCR. Results: Sulfasalazine caused the morphological changes and death of ZR-75-1 cells. The low doses of sulfasalazine had little effect on the proliferation of ZR-75-1 cells (P > 0.05), but the high concentrations of sulfasalazine inhibited cell proliferation significantly (P < 0.05). The high concentrations of sulfasalazine inhibited the expressions of GPX4 and xCT proteins in ZR-75-1 cells (both P < 0.05), and also promoted the accumulation of intracellular ROS (P < 0.05). Sulfasalazine increased the expression of DMT1 mRNA in ZR-75-1 cells (P < 0.05). Conclusion: Sulfasalazine can increase the accumulation of ROS by inhibiting the expressions of GPX4 and xCT proteins to induce the ferroptosis of ZR-75-1 cells. In which, the activation of DMT1 expression may be one of the mechanism.

Expression of fibronectin and MMP-3 and its significance in the patients with ankylosing spondylitis

Objective:To observe the expression and significance of fibronectin and metalloproteinase-3 (MMP-3) in patients with ankylosing spondylitis (AS).Methods:A total of 30 AS patients in our hospital and 30 healthy volunteers were selected in our study. Fibronectin and MMP-3 were measured and compared between these two groups. The AS group received sulfasalazine 2 g daily for 3 months. Bath ankylosing spondylitis disease activity index, bath ankylosing spondylitis functional index, bath ankylosing spondylitis metrology index, erythrocyte sedimentation rate and C-reactive protein were compared before and after treatment. Pearson's linear-correlation analysis was used to determine relationships between parameters.Results:Totally 28 patients in the AS group completed the study. Fibronectin and MMP-3 in peripheral blood of AS patients were evidently higher than that in the normal control group (P<0.05). After treated by sulfasalazine, the level of expressing Fibronectin and MMP-3 significantly decreased compared with baseline values (P<0.05). Pearson's linear-correlation analysis showed that serum fibronectin and MMP-3 level had a positive correlation with bath ankylosing spondylitis disease activity index global assessment, spine pain, night pain, general pain, erythrocyte sedimentation rate and C-reactive protein (P<0.05).Conclusions:The expression of fibronectin and MMP-3 in AS patients were significantly higher than that in the normal control group, and they all decreased significantly after treatment. It indicated that both fibronectin and MMP-3 were correlated closely with the onset of AS.

Effect of Kangfuxin on ulcerative colitis induced by trinitrobenzene sulfonic acid in rats / 中国药理学通报

Aim To study the effect of the Kangfuxin liquid on 2,4,6-trinitrobenzene sulfonic acid (TNBS) induced ulcerative colitis in rats, and to explore its mechanism. Methods Male SD rats were divided into normal control, model control, SASP groups, and Kangfuxin low,medium and high dose groups. In ad-dition to the normal control group, other groups were induced ulcerative colitis with TNBS solution. Disease activity index (DAI), organ index, colon mucosa damage index (CMDI) and histopathological score (HS),the expression levels of IL-4, IL-17 in serum, and MPO, EGF, TGF-β1 in colonic mucosa were de-termined. Results The DAI score showed that the model was successful. Compared with the normal group,the level of IL-4 and IL-17, EGF and TGF-β1 in the model group were reduced significantly, while the CMDI score,HS score,colon index and MPO were elevated significantly. The DAI, CMDI, HS and MPO were reduced (P<0.05 or P<0.01), and the levels of IL-4, IL-17, EGF and TGF-β1 increased signifi-cantly(P <0.01). Conclusions Kangfuxin liquid can effectively alleviate ulcerative colitis induced by TNBS in rats. The mechanism may be related to the down-regulation of MPO expression and up-regulation of IL-4,IL-17,EGF and TGF-β1 levels.