Research progress on biomarkers related to ACPA-negative rheumatoid arthritis / 中国基层医药

Rheumatoid arthritis (RA) is a group of heterogeneous autoimmune diseases with erosive arthritis as the main clinical feature. The pathogenesis of RA remains unclear. Autoantibodies can be detected in blood or synovial fluid in approximately 70% of patients with RA in the early stage of the disease. Anti-citrullinated protein antibody (ACPA) is the most commonly used autoantibody in the diagnosis of RA. However, ACPA is not a specific antibody for RA. The discovery and clinical application of serum ACPA-negative RA biomarkers is of positive significance for the early diagnosis and prognosis improvement of RA. This paper reviews the research progress of ACPA-negative RA biomarkers.

Clinical characteristics of 272 437 patients with different histopathological subtypes of primary esophageal malignant tumors / 中华内科杂志

Objective:To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT).Methods:A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ 2 test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results:A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment.Conclusion:ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.

Reduced gout flares with stepwise dose increase of febuxostat during the initial introduction of urate-lowering therapy / 中华风湿病学杂志

Objective:To investigate whether febuxostat with stepwise dose increase is as useful as colchicine prophylaxis in comparison with febuxostat with no dose titration when initial introduction of urate-lowering therapy in patients with gout. And to determine the effect of urate-lowering therapy in the treat to target by febuxostat with stepwise dose increase.Methods:In this prospective, multicentre, randomized open-label comparative study, patients were randomized to group A (stepwise dose increase of febuxostat from 10 to 40 mg/d), group B (fixed-dose febuxostat 40 mg/d plus colchicine 0.5 mg/d) or group C (fixed-dosefebu-xostat 40 mg/d) and were followed-up for 24 weeks. Non-steroidal anti-inflammatory drug was used to control symptoms when acute flare occurred. Patients were follow-up every 4 weeks. The comparison between groups was made by single factor analysis of variance (ANOVA). χ2 test was used to compare groups. Results:A total of 276 patients were randomized, and 253 patients were treated. 211 patients completed the study and were follow-up. Among the treated patients, gout flares were experienced by 12/84(25.0%) in group A, 20/85(23.5%) in group B and 26/42 (61.9%) in group C. There was no significant difference between group A and group B ( χ2=0.050, P=0.824) in gout flares. There was significantly higher frequency in gout flares in group C than that in group A and group B ( χ2=22.040, P<0.01). The proportion of patients reaching the target of urate-lowering therapy in group A at 4 and 8 weeks was significantly lower than that in group B and C. And there was no significant difference among the three groups after 12 weeks. Conclusion:Stepwise dose increase of febuxostat and low-dose colchicine has the same prophylaxis effectiveness in reducing gout flares but are more effective in prevent acute flare when compared with fixed-dose febuxostat alone. Stepwise dose increase of febuxostat may be an effective alternative to low-dose colchicine prophylaxis during the introduction of urate-lowering therapy.

From the "WANG Zhongqi Cases" to Analyse WANG Zhongqi Kuxin Method Experience / 浙江中医药大学学报

[Objective] From the five aspects of WANG Zhongqi medical case, such as Qi syndrome, vomiting, cough, epigastric pain, wet temperature and so on, WANG Zhong Qi's bitterness in the treatment of various diseases, in order to learn and inherit the essence of WANG's academic thought and the characteristics of clinical diagnosis and treatment. [Methods] On the basis of the medical case contained in "WANG Zhongqi's Medical Cases", combined with classic treatise and academic thought of "Neijing", "Treatise on Typhoid Fever", ZHANG Jingyue, LI Dongyuan, YE Guangxi and WANG Zhongqi, this paper illustrates WANG's experience in the treatment of disease with "bitterness method" and analyzes the characteristics of the diagnosis and treatment. [Results] WANG inherited the experience and understanding of ZHANG Zhongjing, YE Tianshi and other doctors in the use of the method of bitterness, but didn't learn without change, depression causing Qi stagnation and bitter opening the pivot; Qi reverse vomiting, bitter descending pungent openning and promoting Qi function; cough of Qi inverse, pungent and bitter having catharsis to purge the lung Qi; for epigastric stomach pain, bitterness regulating middle warmer; damp heat diffusing, light bitter micro pungent regulating Qi function. [Conclusion] WANG's referred to "Neijing", Zhongjing, Dongyuan and YE Gui and had many innovations and flexible methods. It is worthy of further study to apply the method of bittern to the treatment of a variety of dysfunctional diseases of Qi, through the effect of the gasification and blood flow for regulating Qi function, to remove the pathogenic pathogenic factors in the body.

Interventional chemoembolization with drug-eluting microspheres of domestic CalliSpheres for the treatment of primary hepatocellular carcinomas: preliminary results in 12 patients / 介入放射学杂志

Objective To evaluate the clinical safety and efficacy of CalliSpheres,a domestic drugeluting microspheres,in treating primary hepatocellular carcinoma (HCC).Methods A total of 12 HCC patients were enrolled in this study.Interventional chemoembolization with CalliSpheres was carried out in all patients.The preoperative and postoperative clinical data,laboratory results and imaging findings were retrospectively analyzed.Results The success rate of initial interventional chemoembolization in 12 patients was 100％,the median follow-up time was 7.5 months (6-9 months).One week after the treatment,both AST and ALT levels were obviously increased when compared with preoperative ones,the differences were statistically significant (P＜0.05),although their mean values did not exceed the normal upper limit of 40 U/L.No statistically significant differences in Child-Pugh grading,creatinine level,hemoglobin,white blood cell count and platelet count existed between preoperative data and postoperative ones (P＞0.05).At 3 months and 6 months after treatment,the disease remission rates (CR+PR) were 75.00％ and 66.67％ respectively,the disease control rates (CR+PR+SD) were 91.67％ and 83.33％ respectively.In 10 HCC patients whose preoperative AFP was ≥ 200 μg/L,the postoperative AFP levels showed a significant decrease.Three months after the treatment,the complete remission rate,disease remission rate and disease control rate in the CalliSpheres combined with Lipiodol sequential transarterial chemoembolization group were better than those in the simple CalliSpheres embolization group,but the differences were not statistically significant (P＞0.05).Postoperative complications were mainly abdominal pain and fever.During follow-up period,the complications included pleural effusion (n=2),liver abscess (n=l) and lung metastasis (n=l).Conclusion The use of domestic CalliSpheres,as a drug-eluting microspheres,for the treatment of primary HCC is safe and feasible with satisfactory short-term efficacy.Its long-term efficacy and the effect of combination use of CalliSpheres and Lipiodol need to be further clarified with multicenter and large sample researches.

Value of dual source CT iodine concentration in the evaluation of pathological grades of esophageal carcinoma / 中华放射学杂志

Objective To investigate the value of dual source CT iodine concentration in the assessment of pathological grade of esophageal carcinoma. Methods Retrospective review was performed on 60 cases with pathologically?confirmed esophageal carcinoma. Among them, 17 tumors were well differentiated, 24 were moderately differentiated and 19 were poorly differentiated. The dual?energy plain scan and double phase enhanced scan of dual?source CT were performed on all 60 cases. Normalized iodine concentration (NIC) and the enhancement degree of the esophageal carcinoma in the arterial and venous phase were measured. The difference of NIC and enhancement degree among different grades of esophageal carcinoma were analyzed by analysis of variance. To evaluate the efficiency of NIC and enhancement degree in differentiating the well?moderately differentiated esophageal carcinoma from poorly differentiated esophageal carcinoma, ROC curve was plotted. Results The NIC values of the well differentiated, the moderately differentiated and the poorly differentiated esophageal carcinoma in the arterial phase were (1.54±0.34),(1.72±0.50)and(2.10±0.40)mg/ml, respectively;the NIC values in venous phase were(1.55± 0.52),(1.80±0.62)and(2.18±0.35)mg/ml,respectively, and the degrees of CT enhancement in venous phase were(25.65 ± 4.43),(27.55 ± 6.82)and(30.77 ± 6.38)HU, respectively. The differences between groups were statistically significant(P<0.05). The degrees of CT enhancement of well differentiated, moderately differentiated and poorly differentiated esophageal carcinoma in arterial phase were(14.40 ± 3.91),(14.26 ± 7.35)and(16.17 ± 6.89)HU, respectively, and there were no statistically significant differences(P=0.582). Areas under the ROC curves to differentiate well?moderately differentiated from poorly differentiated esophageal carcinoma for NIC in arterial phase, NIC in venous phase and the degree of CT enhancement in venous phase were 0.801, 0.817 and 0.730. Conclusion The iodine concentration measured on dual source CT has a certain value in evaluating the pathological grades of esophageal carcinoma.

Value of DWI for early assessment of response to concurrent chemoradiotherapy for esophageal cancer:a preliminary study / 中华放射肿瘤学杂志

Objective To investigate the feasibility and value of diffusion-weighted imaging (DWI) in the prediction and early assessment of response to concurrent chemoradiotherapy (CCRT) for esophageal cancer.Methods A total of 40 patients with pathologically confirmed esophageal cancer who received CCRT were included in the study.Routine 3.0 T MRI and DWI were performed at different time points of treatment.The RECIST standard was adopted to evaluate short-term outcomes and divide the patients into remission group (complete remission and partial remission) and non-remission group (stable disease and progressive disease).Group t-test was used for between-group comparison.The receiver operating characteristic (ROC) curve was used to analyze the change rates of apparent diffusion coefficient (ADC) value at different time points of treatment.Results There were 30 patients in the remission group and 10 patients in the non-remission group.The remission group had a significantly higher increase in ADC value than the non-remission group by the end of the first week of treatment (P =0.000).The maximum diameters of tumors for the emission group and non-remission group at the end of the first week of treatment were not significantly different from those before treatment (66.10 mm vs.62.63 mm,P =0.407 ; 70.90 mm vs.68.30 m,P =0.552).The ADC value before treatment had a negative correlation with the reduction rate of the maximum diameter of tumor (r =-0.680,P =0.000).The area under the ROC curve was the largest at the end of the first week of treatment (Az =0.783).If using 15.5 ％ increase in ADC value by the end of the first week as the threshold value for evaluating tumor response,the sensitivity,specificity,positive predictive value,and negative predictive value were 86.7％,70.0％,89.7％,and 63.6％,respectively.Conclusions DWI can be used as a new imaging method for the prediction and early assessment of the response to CCRT for esophageal cancer.The change rate of ADC value by the end of the first week of treatment is sensitive in assessing treatment response,so ADC value can be monitored at this time point.

CT-guided percutaneous acetic acid injection combined with transcatheter arterial chemoembolization in the treatment of primary hepatocellular carcinoma / 介入放射学杂志

Objective To study the curative effect of CT-guided percutaneous acetic acid injection(PAI)combined with transcatheter arterial chemoembolization(TACE)in the treatment of primary heaptocellular carconima.Methods 52 cases with primary heaptocellular carconima were divided into two groups.26 cases were treated with TACE and PAI,combined group comparing with other 26 cases treated with TACE group.Results Decrease of AFP,shrinkage of tumor mass and survival rate of 1-2 years of the combined group and TACE group were 78.3% vs 50.0%,65.4%(17/26) vs 38.5%(10/26)and 73.1%(19/26),52.6%(10/19) vs 57.7%(15/26),33.3%(5/15),respectively;with statistical significance(P

Valuation of dynamic MR imaging for diagnosis of pituitary microadenomas / 中华放射学杂志

Objective To evaluate the use of keyhole dynamic magnetic resonance (MR) imaging in evaluation of pituitary microadenomas. Methods Fifty three patients with pituitary microadenomas proved by operation or clinical findings such as headache, amenorrhea, lactating, fat or acromegaly were retrospectively studied on dynamic MR, conventional contrast enhanced MR, and unenhanced MR. Then the image data were analyzed by two experienced doctors who didn′t know the details and three degrees were made as follows: grade 0, no evidence of the tumor; gradeⅠ, asymmetry signals in the pituitary; and gradeⅡ, nodulated or sheets signals in the pituitary. The grading data were compared with statistical methods. Results In dynamic MR grading system: grade 0 was revealed in 1 patient, gradeⅠ in 29 patients and gradeⅡ in 23 patients. In conventional enhanced MR: grade 0 in 26 patients, grade Ⅰ in 17 patients and gradeⅡin 10 patients. In conventional unenhanced MR: grade 0 in 39 patients, grade Ⅰin 10 patients and grade Ⅱ in 4 patients. The diagnostic rate of dynamic MR, conventional enhanced MR, and unenhanced MR was 98.1%, 51.9%, and 26.4%, respectively. ( P