The central nervous system involvement of patients with microscopic polyangiitis / 中华风湿病学杂志

Objective:To explore the clinical features and prognosis of central nervous system involvement in patients with microscopic polyangiitis (MPA).Methods:We retrospectively investigated the clinical data of 138 MPA patients hospitalized with MPA in Tianjin Medical University General Hospital from January 1, 2010 to November 1, 2019. Patients were divided into two groups according to whether they had the central nervous system (CNS) involvement or not and then Kaplan-Meier survival curve was used to analyze the survival rate between the two groups, Logistic regression model analysis was adopted to analyze risk factors, and P<0.05 was considered statistically significant. Results:①29 patients (21.0%)among the 138 MPA had CNS-affected, including 13(44.8%) males and 16(55.2%) females. CNS involvement was present at the diagnosis of MPA in 20 cases (69.0%) and after the diagnosis of MPA in 9 cases (31.0%). ②The clinical manifestations were motor impairment in 14 cases (48.3%), sensory impairment in 10 cases (34.5%), speech loss in 9 cases (31.0%), headache in 8 cases (27.6%), consciousness disorder in 7 cases (24.1%), dysphagia and bucking in 4 cases (13.8%), cranial nerves involvement in 3 cases (10.3%). The imaging manifestations of the head included infarction, hemorrhage, infarction with hemorrhage and linear dural thickening. Five patients received lumbar puncture. One patient showed elevation of cerebrospinal fluid pressure, 1 patient had elevated protein and 5 patients showed elevation of LDH.③Eighteen patients received glucocortoid combined with cyclophosphamide. CNS symptoms recurred in 6 patients, four patients had recurrent cerebral infarction. ④Median survival time was 55 months in the CNS affected group [95% CI=(14.215, 95.785)] and 86 months in the N-CNS group [95% CI=(24.378, 147.622)]. Kaplan-Meier survival curve showed that there was no significant difference in survival rate between the two groups ( χ2=0.07, P=0.794) . Conclusion:The central nervous system involvement of microscopic polyangiitis is not uncommon. The clinical manifestations are various, with motor impairment the most. The most common imaging manifestation is cerebral infarction and the patients mainly presenteas multiple cerebral infarction. However, the CNS involvement of microscopic polyangiitis is not associated with mortality.

Clinical characteristics of idiopathic inflammatory myopathy patients with positive anti-melanoma differentiation-associated gene 5 antibody / 中华风湿病学杂志

Objective:To investigate the clinical characteristics and prognosis of idiopathic inflammatory myopathy (IIM) patients with positive anti-melanoma differentiation-associated gene 5 (MDA5) antibody.Methods:A total of 194 hospitalized IIM patients who were tested for myositis-specific autoantibodies (MSAs) in the Departments of Rheumatology and Immunology of Tianjin Medical University General Hospital from January 2015 to September 2020 were collected, including 29 cases with positive anti-MDA5 antibody and 165 cases with negative anti-MDA5 antibody. Their clinical data were analyzed retrospectively. T test was used for measurement data with normal distribution. Measurement data with non-normal distribution were tested by Mann-Whitney U rank sum test. χ2 test was used for counting data. Risk factors were analyzed by binary Logistic regression, survival analysis by Kaplan-Meier method and Cox regression analysis. Results:IIM patients with positive anti-MDA5 antibody had a high incidence of dermatomyositis specific skin rash, and the skin rash was the most common presenting symptom. In the positive anti-MDA5 antibody group, muscle symptoms were mild; and the patients were prone to have fever, arthritis, oral ulcer and weight loss. All patients were complicated with interstitial lung disease (ILD). In patients with negative anti-MDA5 antibody, white blood cell (WBC) count [7.59(5.61, 9.89)×10 9/L vs 4.07(3.17, 5.50×10 9/L, Z=-5.05, P<0.001], platelet (PLT) [249.00 (200.00, 302.00)×10 9/L vs 205.00 (178.00, 244.00)×10 9/L, Z=-2.59, P=0.010], lymphocyte (LY) [1.34(0.85, 1.94)×10 9/L vs 0.64(0.40, 0.83)×10 9/L, Z=-5.78, P<0.001), serum creatine kinase (CK) [558.00 (72.00, 2 959.00) U/L vs 64.00 (35.00, 149.50) U/L, Z=-3.97, P<0.001], creatine kinase isoenzymes (CK-MB) [38.00 (17.00, 127.00) U/L vs 16.00 (14.00, 25.00) U/L, Z=-3.84, P<0.001], myoglobin (MYO) [243.65 (60.50, 829.83) ng/ml vs 34.55(21.00, 104.23) ng/ml, Z=-3.98, P<0.001], troponin T (TnT) [0.09(0.03, 0.44) ng/ml vs 0.02(0.01, 0.04) ng/ml, Z=-4.17, P<0.001], albumin (ALB) [34.00(30.00, 38.00) g/L vs 31.00 (26.50, 36.00) g/L, Z=-2.68, P=0.007], cluster of differentiation 4 (CD4) + T cells [498.00(276.00, 752.00) cells/μl vs 259.50 (179.00, 498.25) cells/μl, Z=-2.79, P=0.005], partial pressure of carbon dioxide (PaCO 2) [39.00(36.13, 42.00) mmHg vs 35.35 (31.30, 38.88) mmHg, Z=-3.75, P<0.001], partial pressure of oxygen (PaO 2) [82.00(71.90, 90.20) mmHg vs 73.25(64.30, 84.05) mmHg, Z=-2.08, P=0.037], arterial oxygen saturation (SaO 2) [96.50% (95.05%, 97.30)% vs 95.80%(93.70%, 96.55%), Z=-2.11, P=0.035], diffusion capacity for carbon monoxide of the Lung (DLco) [(63±21) % vs (52±14)%, t=0.96, P=0.006] were significantly reduced, while UTP [260.50 (172.25, 401.25) g vs 331.00 (252.75, 666.25) g, Z=-2.18, P=0.029], alanine aminotransferase (ALT) [40.00 (21.00, 83.00) U/L vs 56.00(40.00, 107.50), Z=-2.27, P=0.023], glutamyltranspeptidas (GGT) [22.50(15.00, 42.00) U/L vs 57.00 (38.00, 101.50) U/L, Z=-4.98, P<0.001], D-Dimer [850.00 (485.00, 1 799.50) ng/ml vs 1 346.00 (896.50, 2 527.00) ng/ml, Z=-2.55, P=0.011], immunoglobulin (Ig)E [60.00 (25.60, 147.50) U/ml vs 173.00(68.25, 471.50) U/ml, Z=-3.06, P=0.002], C4[20.25(16.68, 25.03) mg/L vs 23.60(20.20, 28.35) mg/L, Z=-2.38, P=0.017], Fer [228.01 (115.40, 513.36) ng/ml vs 1 636.39 (851.80, 3 888.82) ng/ml, Z=-6.01, P<0.001], krebsvondenlungen-6 (KL-6) [365.00 (180.25, 1 018.75) U/ml vs 788.00 (406.00, 1 364.00) U/ml, Z=-2.10, P=0.035] were higher when compared to patients with positive anti-MDA5 antibody. In the anti-MDA5 antibody positive group, patients had high mortality rate [8.5%(14/165) vs 34.5%(10/29), χ2=13.07, P<0.001], and the use of intravenous immunoglobulin [32.7%(54/165) vs 65.5%(19/29), χ2=11.30, P=0.001] and steroid pulse therapy [4.8%(86/165) vs 27.6%(8/29), χ2=13.98, P<0.001] were more frequent. Patients in the positive anti-MDA5 antibody group were classified into two sub groups based on lung features: the rapidly progressive interstitial lung disease (RP-ILD) group (48.28%, 14/29) and the chronic interstitial lung disease (C-ILD) group (51.72%, 15/29). RP-ILD patients had significantly elder disease onset age, higher C-reaction protein (CRP), Fer, IgE levels and the positive rate of anti-Ro52 antibody, while ALT was lower. The difference was statistically significant. Regression analysis suggested that older onset age [ HR (95% CI)=1.154 (1.069, 1.246), P<0.001], male [ HR(95% CI)=6.383(1.038, 39.242), P=0.045], positive anti-MDA5 antibody [ HR(95% CI)=17.180 (2.900, 101.766), P=0.002], LY decrease [ HR (95% CI)=0.083 (0.008, 0.817), P=0.033], high serum Fer level [ HR (95% CI)=1.001(1.000, 1.001), P=0.016], increased D-Dimer [ HR(95% CI)=1.000(1.000, 1.001), P=0.004] and compicated with carcinoma [ HR (95% CI)=11.849 (1.978, 70.970), P=0.007] were independent risk factors for death in IIM patients. Binary logistic regression analysis suggested that late onset age [ OR(95% CI)=1.090 (1.005, 1.183), P=0.038], high Fer level [ OR (95% CI)=1.001 (1.000, 1.001), P=0.022] and decreased ALB [ OR (95% CI)=0.818 (0.696, 0.963), P=0.016] might be risk factors for RP-ILD in patients with positive anti-MDA5 antibody. Conclusion:In patients with positive anti-MDA5 antibody group, typical skin damage, mild muscle symptoms, high proportion of ILD and poor prognosis are chardcteristic when compared to patients without this autoantibody. It is necessary to monitor the disease activity closely and explore the treatment strategy.

Inhibitory of ginsenoside on proliferation of human thyroid cancer cells and expression of C -myc and Bcl -2 protein in vitro / 中国基层医药

Objective To explore inhibitory effects of ginsenoside on the proliferation of human thyroid canc-er SW579 cells in vitro and expression of C -myc and Bcl -2 protein.Methods Human thyroid cancer SW579 cells were cultured according to conventional method.The study was divided into the control group and ginsenoside group (20,40,8ug/mL).Inhibitory role of ginsenoside on proliferation of SW579 cells was detected by MTT assay.Western-blot method was used to determine expression levels of C -myc and Bcl -2 protein in different group.Results The inhibition rates of 20,40,80μg/mL ginsenoside to SW579 thyroid carcinoma cell were 22.35%,51.76% and 68.24% respectively.Which meaned ginsenoside had obvious inhibitory effect compared with the control group(P <0.01),and inhibition increased with the increase of solubility(P <0.01).C -myc and Bcl -2 protein were reduced progressively in place with the increase of ginsenoside concentration by Western -Blot analysis (P <0.01 ).Conclusion Gisenoside may play the inhibitory role on proliferation of human thyroid cancer SW579 cells in vitro, and its mechanism may be related with down -regulation of C -myc and Bcl -2 protein.

Research of Ginsenoside on proliferation inhibitory of cultured tumor stem cells of human rectal carcinoma in vitro / 中国基层医药

Objective To observe inhibitory effects of Ginsenoside on the proliferation cultured stem cells of human rectal carcinoma in vitro.Methods Tumor stem cells of rectal carcinoma in human were cultured in vitro and divided into saline water group,reltitrexed group(3mg/mL),and Ginsenoside(25μg/mL)plus reltitrexed(3mg/mL) group,with dosage of qd and for 2 weeks.Cells growth was observed under the microscope,and immunofluorescence staining was used to detect CD +133 expression of rectal carcinoma cells.MTT colorimetric method was taken to measure inhibitory of Ginsenoside on proliferation of tumor stem cells of rectal carcinoma.Apoptosis of tumor stem cells of rec-tal carcinoma lead by Ginsenoside was observed by DAPI staining.Results Part of cells were growing up like ball and CD +133 immunofluorescence staining was positive.Inhibitory role of Ginsenoside plus reltitrexed on CD +133 cells of rectal carcinoma appeared on the first day,which was bigger than that of retitrexed by MTT method (P =0.03).Com-pared with the retitrexed group,Gisenoside combined with reltitrexed reduced CD +133 cells expression of rectal carcino-ma,in which optical density and area density of CD +133 cells were obviously decreased with statistical significance (P =0.007,P =0.006,respectively).Conclusion Gisenoside plays the remarkably inhibitory role on proliferation of CD +133 cells of rectal carcinoma.

The expression of JNK and MRP1 in colorectal carcinoma / 中国基层医药

Objective To investigate the chnicopathogenical significance of c-jun N-terminal kinase(JNK) and multidrug resistance associated protein 1 (MRP1) expression in colorectal cancer. Methods The expression of JNK and MRP1 was detected in a tissue microarray containing 72 spots of colorectal cancer tissue and 40 spots of nor-mal colorectal tissue by immunohistochemisty. Results The positive expression rate of JNK and MRP1 expression was 47.22% and 51.39% respectively in colorectal cancer,significantly higher than that in normal colon tissue. JNK protein expression was not closely related to gender, age, tumor size and location (P>0.05), but closely related to tumor differentiation,lymph node metastasis,distsnt metastasis and Dukes staging (P<0.05). MRP1 protein expres-sion was not closely related to gender,age,tumor size,location and tumor differentiation(P> 0.05), but closely relat-ed to lymph node metastasis, distant metastasis, Dukes staging (P<0.05). Conclusions The JNK expression in cancer is corrlated with maligant biological behavior and may be involved in the chemotherapeutic resistance by upreg-ulating the expression of MRP1.

The expression of COX-2 and Survivin protein in gastric carcinoma and its clinical significance / 中国基层医药

Objective To investigate the expression and clinical significance of COX-2 and Survivin protein in gastric carcinoma.Methods In 76 gastric carcinoma specimen and 13 normal mucosa gastric specimen,the exprssion of COX-2 and Survivin protein were detectede by immunohistochemistry SP.The relationship between expression of COX-2 and Survivin protein and clinical pathological parameter were analyzed,also the relationship between COX-2 and Survivin protein.Results The positive expression rate of COX-2 and Survivin protein was 80.26% and 77.63%,and higher than those in normal gastric tissues (P＜0.01).The positive expression of COX-2 protein was negatively related to gender,age,cellular differentiation,serosa infiltration (P＞0.05),but associated with lymph node and TNM stage (P＜0.05).The positive expression of Survivin protein was not related to gender,age (P＞0.05),but associated with cellular differentiation,serosa infiltration,lymph node metastasis and TNM stage (P＜0.05),The expression of COX-2 protein was positively correlated with Survivin protein (P＜0.01).Conclusion COX-2,Survivin protein play an important role in the genesis and development of gastric carcinoma.The expression of Survivin and COX-2 protein may be the index of prognostic evaluation and determination of biological behavior in gastric carcinoma.