Risk factors for the flare of systemic lupus erythematosus and its influence on prognosis: a single-center retrospective analysis

Abstract Objectives: To explore the risk factors for systemic lupus erythematosus (SLE) flare and their impact on prognosis. Methods: The clinical characteristics, laboratory results, and treatment plans of 121 patients with SLE flare were retrospectively analyzed. Ninety-eight SLE outpatients with sustained remission during the same period were selected as controls. Logistic multivariate regression analysis was employed to screen for risk factors for SLE flare. Results: Infection, thrombocytopenia, arthritis, anti-nucleosome antibodies positive, anti-β2-glycoprotein I (IgG) antibodies positive, and patient's self-discontinuation of medicine maintenance therapy might be risk factors for SLE flare. Patients who discontinued medicine maintenance therapy by themselves had a significantly higher rate of severe SLE flare than patients with regular medicine maintenance therapy ( P = 0.033). The incidence of anemia associated with SLE ( P = 0.001), serositis ( P = 0.005), and pulmonary hypertension ( P = 0.003) in patients who discontinued medicine maintenance therapy were significantly higher than patients with regular medicine maintenance therapy. SLE patients with regular medicine maintenance therapy for less than 3years had a higher risk of pulmonary hypertension than those with regular medicine maintenance therapy longer than 3years ( P = 0.034). Conclusions: The accompanying thrombocytopenia, arthritis, anti-nucleosome antibodies positive and anti-β2-glycoprotein I (IgG) antibodies positive at the onset of SLE may affect the prognosis of SLE. Patient's self-discontinuation of medicine maintenance therapy is the main cause of SLE flare, which may induce severe flare in SLE patients and lead to a significantly higher incidence of pulmonary hypertension.

Xiaoyaosan Promotes Myelin Regeneration and Alleviates Depressive Symptoms in Vascular Dementia Mice with Depression via Promoting Microglia Polarization / 中国实验方剂学杂志

Objective:To investigate the effect of Xiaoyaosan on depressive behavioral phenotype in mice with vascular dementia （VaD） mice and its possible mechanism. Method:Sixty three-month-old male C57/BL6 mice were divided into the normal control group， model group， positive control group， as well as low-， medium-， and high-dose Xiaoyaosan groups. Mice in all groups except for the normal control group underwent bilateral carotid artery stenosis. Two weeks later， they were subjected to chronic restraint stress， 6 h per day， for inducing VaD complicated with depression. Mice in the low-， medium-， and high-dose Xiaoyaosan groups were treatment with intragastric administration of Xiaoyaosan decoction （5， 10， 20 g·kg^-1）， the ones in the positive control group with fluoxetine （10 mg·kg^-1）， and those in the normal control group and model group with an equal volume of normal saline for four weeks， during which the restraint stress was maintained. The depressive behavioral phenotype of mice was observed in sugar water preference test and tail suspension test. The fluorescence expression of myelin basic protein （MBP） in ventral hippocampus （vHIP） was detected by fluorescence immunoassay. The ultrastructure of myelin sheath in vHIP was observed by transmission electron microscopy. The protein expression levels of MBP， myelin oligodendrocyte glycoprotein （MOG）， myelin-associated glycoprotein （MAG）， triggering receptor expressed on myeloid cells-2 （TREM2）， inducible nitric oxide synthase （iNOS）， arginase 1 （Arg1）， interleukin-I<italic>β</italic> （IL-1<italic>β</italic>）， tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>）， interleukin-4 （IL-4）， and interleukin-10 （IL-10） were assayed by Western blot. Result:As revealed by behavioral test， compared with the normal control group， the model group exhibited prolonged immobility time and decreased percentage of sugar water preference （<italic>P</italic><0.01）. Compared with the model group， Xiaoyaosan significantly shortened the immobility time of mice （<italic>P</italic><0.05） and increased the percentage of sugar water preference （<italic>P</italic><0.01）. Western blot results showed that the protein expression levels of MBP， MOG， and MAG in vHIP of the model group were remarkably decreased as compared with those of the normal control group （<italic>P</italic><0.01）. The protein expression levels of MBP， MOG， and MAG in vHIP of the low-dose Xiaoyaosan group were increased in contrast to those in the model group （<italic>P</italic><0.05， <italic>P</italic><0.01）， while the protein expression of iNOS was decreased （<italic>P</italic><0.01）. The protein expression levels of MBP， MOG， MAG， TREM2， Arg1， IL-4， and IL-10 in the medium- and high-dose Xiaoyaosan groups were up-regulated （<italic>P</italic><0.05， <italic>P</italic><0.01）， whereas those of iNOS， IL-1<italic>β</italic>， and TNF-<italic>α</italic> were down-regulated （<italic>P</italic><0.01）. The immunofluorescence findings demonstrated that the mean fluorescence intensity of MBP in the model group declined in comparison with that in the normal control group （<italic>P</italic><0.01）， while the mean fluorescence intensities of MBP in the low-， medium-， and high-dose Xiaoyaosan groups were enhanced to different degrees （<italic>P</italic><0.01）. It was observed under the transmission electron microscope that the myelin structure of the model group was loosened and the dense layer was separated and irregularly arranged. Xiaoyaosan improved the structural integrity of myelin sheath and the looseness of lamellar structure. Conclusion:Xiaoyaosan ameliorates the depressive behavioral phenotype of VaD mice， which may be related to the up-regulation of TREM2， the induction of M2 polarization of microglia cells， the enhancement of their anti-inflammatory and phagocytic abilities， and the promotion of damaged myelin sheath regeneration.

Effect of Epstein-Barr virus infection on the inflammatory response in the acute exacerbation of chronic obstructive pulmonary disease / 中国实用内科杂志

OBJECTIVE: To study the effect of Epstein-Barr virus(EB) virus infection on acute exacerbation of chronic obstructive pulmonary disease. METHODS: 156 patients with acute exacerbation of chronic obstructive pulmonary disease were divided into two groups, 41 patients with EB virus infection and the group 115 patients without EB virus infection.which colleceted from the Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's Hospital From October 2015 to August 2017. Epstein-Barr virus(EB) DNA was detected by PCR, serum EB antibody IgG and IgM were detected by Elisa, and the expression level of PCT, CRP, IL6,IL-17 and IL-10 in serum were detected by Elisa.Sputum culture and sensitivity were used to analyze the bacteriological characteristics. The characteristics of common pathogens of pulmonary infection were also analyzed in patients with Epstein-Barr virus(EBV) infection,and the therapeutic effects and prognosis were analyzed comprehensively. RESULTS: The EBV-infected AECOPD patients had significantly higher levels of PCT, CRP and IL-6 IL-17, IL-10 in serum of patients with lung infection than those of AECOPD patients with non-EB virus infection. The etiological characteristics of EBV-infected AECOPD patients were mostly G-, The EBV-infected AECOPD patients whose the proportion of drug-resistant bacteria increased, anti-infective treatment time prolonged, complications increased, admitted to intensive care unit increased. Blood gas, the infection of Epstein-Barr virus AECOPD patients was significantly higher PaCO2, PaO2 decreased significantly, and the difference was statistically significant. However, the lung function, no significant difference between the two groups. CONCLUSION: EBV infection aggravates inflammatory response in patients with AECOPD, and promotes the progress and deterioration of the disease.

Progress on the minimally invasive surgical treatment for the acute Achilles tendon rupture / 中国骨伤

Acute Achilles tendon rupture is a common sports injury, is currently the best treatment for acute Achilles tendon rupture there are more controversial programs in the clinical, their treatment is divided into conservative treatment and surgical treatment. Conservative treatment for a long time, and then the higher Achilles tendon rupture rate, postoperative recovery slow. There are a number of complications traditional open surgery, and minimally invasive surgery in recent years developed a new technology that minimizes the exposure of the wound, reduce surgical trauma scope, shorten the operation time and reduce wound infection rate increasing importance in clinical practice, worthy of recommendation.

Strategy of prevention and management of intraoperative fractures of acetabulum during primary total hip arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To analyse the causes and resultes of intraoperative occurrence of an acetabular fracture in primary total hip arthroplasty and discuss propriate prevention and treatment of this problem.</p><p><b>METHODS</b>Between July 2004 and December 2006, 326 primary total hip arthroplasties were retrospectively reviewed and found that eleven patients (eleven hips) had sustained an intraoperative acetabular fracture involving 7 male and 4 female,aged from 37 to 71 years (mean 54 years). Analyzed the causes of fractures, the anatomic location, treatment and outcome of the fractures. Acetabular component designs were categorized and each design was analyzed for fracture risk.</p><p><b>RESULTS</b>Among 11 cases, the fractures occurrenced as setting the prosthesis in 6 cases, grinding and drilling in 3 cases, drawning hook in 2 cases. There were 5 cases of central type fracture, 3 of posterior-wall, 2 of anterior, 1 of posterior-upper. Nine of these patients (nine hips) had been followed-up for 12 to 29 months(mean 18 months). There were no heterotopic ossification, no dislocation, no deep venous embolism. All fractures were healing.</p><p><b>CONCLUSION</b>Acetabular fracture during primary total hip arthroplasty is a complication of acetabular fixation without cement, which should be think highly of. In the present series, retention of a stable cup is associated with uneventful osseous in growth and excellent early-term outcomes.</p>

Molecular cloning and expression of hypothetical proteins Rv1494 and Rv1495 of M.tuberculosis H37Rv strain / 南方医科大学学报

<p><b>OBJECTIVE</b>The mechanism by which M.tuberculosis persists and survives in host macrophage is not fully understood, however, the M. tuberculosis chromosome-encoded TA loci perform functions possibly of signaling to these processes. To explore the biological functions of M. tuberculosis chromosome-encoded TA loci, the Rv1494 and Rv1495 genes of M.tuberculosis H37Rv strain were cloned and expressed.</p><p><b>METHODS</b>The hypothetical proteins Rv1494 and Rv1495 were bioinformatically analyzed by means of Bioedit software, Dnaman software and Pfam database. The complete open-reading frame sequences of Rv1494 and Rv1495 genes were amplified by PCR using M.tuberculosis H37Rv genomic DNA as the template, and the PCR products were cloned into prokaryotic expression vector pET32a(+), respectively. After induction of expressions in E.coli host strain BL21 (DE3), the recombinant proteins were purified and detected by Western blotting.</p><p><b>RESULTS</b>According to bioinformatic analysis, the hypothetical proteins of Rv1494 and Rv1495 genes shared some homologies with mazEF family, one of E. coli chromosomal TA loci (homology at 26% and 29.5%). Sequence analysis showed that the inserted target genes and its reading frames were completely correct. The recombinant plasmids were induced with IPTG to effectively express the fusion proteins with relative molecular mass coincident with prediction. The specific positive signals were identified from the immunoblots.</p><p><b>CONCLUSION</b>For the first time, the Rv1494 and Rv1495 genes of M.tuberculosis H37Rv strain were cloned and its prokaryotic expression vectors were constructed successfully in this experiment, which may facilitate further functional study of this mazEF-like gene pair.</p>