The expression and clinical significance of proprotein convertase subtilisin kexin 9 in rheumatoid arthritis / 中华内科杂志

Objective To assess the expression and significance of proprotein convertase subtilisin kexin 9 (PCSK9) in patients with rheumatoid arthritis (RA).Methods Sixty-five RA patients and forty-seven healthy controls were recruited in this study.The body mass index (BMI) and serum total cholesterol (TC),triglyceride (TG),high density lipoprotein (HDL),lipoprotein a,low density lipoprotein (LDL),very low density lipoprotein(VLDL),apolipoprotein A (ApoA),apolipoprotein B (ApoB) and the ratio of LDL-C/HDL-C were tested.Other parameters included disease activity score 28 (DAS28),rheumatoid factor (RF),anti-cyclic citrullinated peptide (CCP) antibody,erythrocyte sedimentation rate (ESR),c-reactive protein (CRP).Serum PCSK9 level was measured by ELISA and compared between RA patients and healthy controls.Results (1) The serum PCSK9 levels in RA patients were higher than those in healthy controls [(409.36 ±223.52) μg/L vs (292.19 ± 109.79) μg/L,P ＜ 0.05].(2) Compared with subgroup of moderate and low active disease and patients in remission,PCSK9 was significantly higher in patients with highly active disease (P ＜ 0.05).(3) The serum PCSK9 levels were positively correlated with RF,TC,TG,LDL,very low density lipoprotein (VLDL),ApoB,with r values as 0.303,0.490,0.320,0.451,0.319,0.463,respectively (P ＜ 0.05).(4) Multiple stepwise regression analysis showed that DAS28,RF,TC and LDL-C/HDL-C were relevant factors for PCSK9 in RA patients.Conclusions The serum PCSK9 level is elevated in RA patients,which is related to RF,disease activity,TC,TG,LDL,VLDL,ApoB.This suggests that PCSK9 is potentially linked to inflammatory reaction and lipid metabolism in rheumatoid arthritis.

Chinese expert investigation on diagnosis and disease activity evaluation in Takayasu's arteritis / 复旦学报（医学版）

Objective To investigate the current situation in Chinese rheumatologic physicians' clinical diagnosis and evaluation of Takayasu's arteritis (TA).Methods Nineteen rheumatology experts and three vascular surgery specialists in China were invited to make the nationwide investigation for the first time about the diagnosis and disease activity evaluation of TA in China,through the questionnaire survey on the internet.Weighted average was used to calculate the average scores of corresponding problems.Results Chinese experts mainly adopted 1990 American College of Rheumatology (ACR) classification criteria for clinical diagnosis of TA.In details,symptoms of age,limb claudication and amaurosis,signs including pulselessness or pulse weakening,vascular bruits,increasing bilateral pulse pressure and hypertension and acute phase reactants (APR) were critical to the clinical diagnosis of TA.Besides,noninvasive imaging examinations,such as computed tomography angiography (CTA),magnetic resonance angiography (MRA),vascular ultrasonography,and positron emission tomography (PET) were also of great importance.In the aspect of disease activity assessment,Chinese experts mainly used Kerr scoring tool.APR and noninvasive radiological examinations were considered with vital value.Some TA patients with carotid artery involvement were recommended using vascular ultrasonography,while others with pulmonary artery and thoracic/abdominal aorta trunk involvement were preferred CTA other than MRA.Conclusions APR and noninvasive imaging examinations were thought with great help to make clinical diagnosis and evaluation of TA for Chinese physicians.

The application of systemic lupus erythematosus-specific quality of life questionnaire in systemic lupus erythematosus / 中华风湿病学杂志

Objective To elucidate the relationship between quality of life (QOL) and disease activity of systemic lupus erythematosus (SLE),as well as to reveal the factors impacting disease activity and the QOL of SLE utilizing the combination of SLE-specific quality of life questionnaire (SLEQOL) and the medical outcomes survey short form 36 (SF-36).Methods SLEQOL and SF-36 health survey questionnaire were applied.Information on gender,disease duration,age,education level were collected.Serum complement (C3 and C4) level and erythrocyte sedimentation rate (ESR) were measured.Patients were divided into inactive,mild active,moderate active and severe active respectively according to SLE disease activity index (SLEDAI).Pearson's product moment correlation coefficient was used to analyze the correlation between the activity of disease and the QOL.Multiple linear regression was employed to explore the factors which could impact on SLEQOL.Results The physical function of SLEQOL was positively correlated with SLEDAI (r=0.36; P＜0.05).The association between reported health transition of SF-36 and SLEDAI was positive (r=0.19; P＜0.05).Physical functioning,role-physical,role-emotional,body pain and vitality were all negatively correlated with SLEDAI (r:-0.20,-0.19,-0.19,-0.19,-0.21 respectively; P＜0.05).The scores of patients with severe disease activity were significantly increased in the physical functioning of SLEQOL than other three groups (18±10 vs 11±5,12±6,13±7; P＜0.05).Scores on the Health transition of patients with moderate and severe disease activity were lower than those of whom with mild disease activity (23±28.14±17 vs 34±39,P＜0.05).Patients with mild or severe disease activity had lower score than those of patieuts in disease inactive (30±41,34±39 vs 44±44,P＜0.05).Multiple linear regression analyses showed that disease duration and education level might be the influencing factors of SLEQOL.Conclusion QOL of patients with SLE is related to the level of disease activity and is impacted by disease duration and education.

Analysis of optimizing countermeasure for doctor-patient relationship based on social exchange theory / 中华医学教育探索杂志

From the perspectives of social equitable exchange theory, contents and features of exchange between medical staff and patients in the doctor-patient relationship as well as their evalua-tion on social equitable exchange theory were analyzed according to basic features of doctor-patient relationship. Suggestions were proposed from government, industry, hospital and medical staff.

High resolution ultrasonographic diagnosis of psoriatic arthritis / 中华风湿病学杂志

ObjectiveIn order to confirm the value of high resolution frequency(HFUS) ultrasonography in the early diagnosis of psoriatic arthritis(PsA).MethodsTwenty-nine patients with psoriatic arthritis reporting sixty-nine finger pain and 30 patients with rheumatoid arthritis reporting seventy finger pain and 20 healthy volunteers underwent X-ray and US evaluation.The ultrasonographic characteristics and blood flows in the joints were checked with high resolution ultrasonography.Bilateraljoints were compared each other in every patient.Comparisons between groups were tested by x2 test.ResultsSonographic positive signs were found in all the involved joints in 29 PsA patients,joint effusion in 42 fingers (61％).Synovial thickening was found in 38 fingers (55％).Bone erosions were found in 28 fingers(41％),tenosynovitis were found in 40 fingers (58％),soft tissue inflammation was revealed in 29 fingers (42％).Enthesitis were foundin 30 fingers (43％).In RA patients,joint effusion was found in 52 fingers (74％) and synovial thickening in 48 fingers (69％).Bone erosions were found in 33 fingers (47％).Tenosynovitis,soft tissue inflammation and enthesitis were not found in RA patients.ConclusionHigh resolution ultrasonography is an easy,safe and effective method for the early diagnosis of pathological changes of small joints in psoriatic arthritis.

Establishment and evaluation of classification criteria for early rheumatoid arthritis / 中华风湿病学杂志

Objective To establish new classification criteria for early rheumatoid arthritis (E-RA) based on large samples of early inflammatory arthritis patients and to evaluate the value of this criteria in China.Methods Patients who had arthritic complaints with disease duration less than one year were enrolled.They were divided into RA group and non-RA group according to the clinical diagnosis by experienced rheumatologists.The clinical and laboratory parameters were analyzed and those with high sensitivity or specificity were selected as the new classification criteria.Statistical analysis was carried out by using t test,x2 test and Logistic regression.Results ① A total of 803 patients with early inflammatory arthritis were included in this study.Five hundreds and fourteen patients were diagnosed as early RA and 251 were diagnosed as other rheumatic diseases,and the diagnosis of 38 patients remained unestablished by the end of follow-up.② New E-RA classification criteria were established based on the parameters with high sensitivity and/or specificity.The sensitivity of the new E-RA criteria was 84.4％,which was higher than 1987 ACR criteria (58.0％),while the corresponding specificities were similar,which were 87.4％ and 93.6％ respectively.③ Compared with the complex scoring system of 2010 ACR/EULAR criteria,the E-RA criteria was more simple and practical.The diagnostic sensitivity and specificity of E-RA criteria were higher than those of 2010 ACR/EULAR criteria reported in the literatures.④ New classification criteria based on scoring system using Logistic regression analysis was established.The sensitivity of this criteria was 86.4％,which was higher than 1987 ACR criteria (58.0％).Conclusion The diagnostic value of the E-RA criteria developed in this study for early RA is better than 1987 ACR criteria,and is more simple than 2010 ACR/EULAR criteria.It may be used as a new classification criteria for early RA diagnosis.

Study on life quality between patients with systemic lupus erythematusus and those with coronary heart disease,diabetes and hypertension / 中华风湿病学杂志

Objective To compare the Health Related Quality of Life (HRQOL) of patients with sys temic lupus erythematosus (SLE) with other common chronic diseases (coronary heart disease,diabetes and hypertension).Methods Responses from Short Form-36 (SF-36) questionnaires from outpatients,inpatients with SLE,other common chronic diseases and healthy controls were analyzed in all domains.Results The mean age of patients with SLE was 39+13 years old,while those of patients with coronary heart disease,dia betes and hypertension were 65±16,60±13,59±14 years respectively.All SLE patients were significantly worse in all domains of SF-36 questionnaire,compared with the healthy controls.The responses of inactive patients with SLE,were not significantly worse than those with other chronic diseases in all domains (P＞0.05).On the contrary,the responses of patients with active SLE were significantly worse than those of patients with inactive SLE,as well as patients with other chronic diseases (P＜0.05).Conclusion HRQOL of patients with active SLE is significantly worse when compared to patients with other common chronic diseases.

The effect of arsenic trioxide on apoptosis and tumor necrosis factor-?,interleukin-1 in the rat model of collagen induced arthritis / 中华风湿病学杂志

Objective To observe the effect of arsenic trioxide on the apoptosis of synovium and IL-l, TNF-? in CIA rat. Methods Seventy-two rats were divided into normal control, model, and As2O3 treatment groups. The experimental models of collagen induced arthritis rats were used as the experimental moldels. The knees′ synovium, cartilage and bone tissue of the rat were taken out, then observed with light microscope and electron microscope and apoptosis were measured by TUNEL after the 15th day of treatment. Meanwhile the level of IL-1 and TNF-? were measured with ELISA kit. Results The pathological injury were improved and the apoptosis of synoviocytes were increased in the As2O3 treatment group, compared with the model group. IL-1 and TNF-? levels were decreased in the arsenic trioxide treatment groups, especially in the Ⅴ and Ⅵ groups (P

Discussion on Training of Postgraduate Students Majoring in Rheumatology / 中华医学教育探索杂志

This paper presents a description about training of post-graduate students majoring in rheumatology.The essential knowledge and theory are highly stressed,and the clinical skill,comprehensive ability are also emphasized to encouraging students to bring forth new ideas.Besides cooperation and team spirit are encouraged through group and pair work.

Relationship between the gene polymorphism of MTHFR and the cerebral thrombosis / 中华神经科杂志

Objective To investigate the association of gene polymorphism of methylenetetrahydrofolate reductase (MTHFR), and the level of homocysteine (Hcy) in patients with cerebral thrombosis in Chinese population Methods MTHFR genotype and allele frequency in 75 patients with cerebral thrombosis and 62 control subjects were measured by polymerase chain reaction and restriction fragment length polymorphism (PCR RFLP) Concentration of plasma Hcy was measured by reverse phase high performance liquid chromatography in a subgroup Results In patients and control subjects, the frequencies of T allele were 0 41 and 0 31, respectively The frequencies of CC, CT, TT genotype of cerebral thrombosis patients were 0 41, 0 35, 0 24, respectively Meanwhile those of the controls were 0 58, 0 23, 0 19 Neither the genotype ( P =0 137) nor the allele frequency ( P =0 067) was significantly different between patients and control subjects Furthermore, plasma Hcy level of the patients was (18 3?7 2) ?mol/L, which differed significantly from that of the controls, which was (13 6?5 8) ?mol/L ( P

Effects of testosterone on the fibrinolysis activity of HUVEC and its mechanism / 中国病理生理杂志

AIM: To investigate the effect of testosterone with varied concentrations on the fibr inolysis activity of HUVEC and its mechanism. METHODS: Human umbilical vein endothelial cells (HUVEC) were cul tured as recommended. After confluence, the cultures were treated with testoster one(3 ?10 -10, 3?10 -9, 3?10 -8,3?10 -6, 3?10 -5 m ol/L) , and the control confluent cells were cultured in the same medium witho ut steroid. MTT experiment was repeated for 72 hours to investigate each groups' cell proliferation. The tPA and PAI-1 antigen levels were assayed with ELISA K its. Then with HUVEC incubated in androgen receptor antagonist (flutamide) 3 hou rs previously, the experiment was repeated. RESULTS: Testosterone at physiologic or lower concentrations (3 ?10 -10 to 3?10 -8 mol/L ) stimulated the secretion of tPA by HUVEC (P