Flare and change in disease activity among patients with stable rheumatoid arthritis following coronavirus disease 2019 vaccination: A prospective Chinese cohort study / 中华医学杂志(英文版)

BACKGROUND@#Vaccination has been shown effective in controlling the global coronavirus disease 2019 (COVID-19) pandemic and reducing severe cases. This study was to assess the flare and change in disease activity after COVID-19 vaccination in patients with stable rheumatoid arthritis (RA).@*METHODS@#A prospective cohort of RA patients in remission or with low disease activity was divided into a vaccination group and a non-vaccination group based on their COVID-19 vaccination status. Each of them was examined every 3 to 6 months. In the vaccination group, disease activity was compared before and after vaccination. The rates of flare defined as disease activity scores based on 28-joint count (DAS28) >3.2 with ΔDAS28 ≥0.6 were compared between vaccination and non-vaccination groups.@*RESULTS@#A total of 202 eligible RA patients were enrolled. Of these, 98 patients received no vaccine shot (non-vaccination group), and 104 patients received two doses of vaccine (vaccination group). The median time interval from pre-vaccination visit to the first immunization and from the second dose of vaccine to post-vaccination visit was 67 days and 83 days, respectively. The disease activity scores at pre-vaccination and post-vaccination visits in the vaccination group patients were similar. At enrollment, gender, RA disease course, seropositivity, and disease activity were comparable across the two groups. Flare was observed in five (4.8%) of the vaccination group patients and nine (9.2%) of the non-vaccination group patients at post-vaccination assessment ( P  = 0.221). In terms of safety, 29 (27.9%) patients experienced adverse events (AEs) after vaccination. No serious AEs occurred.@*CONCLUSIONS@#COVID-19 vaccinations had no significant effect on disease activity or risk of flare in RA patients in remission or with low disease activity. Patients with stable RA should be encouraged to receive the COVID-19 vaccination.

A systemic lupus erythematosus patient with sudden dyspnea and disordered consciousness / 中华风湿病学杂志

Objective:To improve the ability of identification and differential diagnosis of severe systemic lupus erythematosus (SLE).Methods:A severe SLE patient with lupus myocarditis, neuropsychiatric lupus, thrombotic microangiopathy (TMA) and other multiple system involvement was reported and discussed.Results:A young female patient developed albuminuria 5 months ago, edema of both lower limbs 3 months ago, change of consciousness 1 month ago and two convulsions attack 2 days ago. She experienced life threatening manifestations such as neuropsychiatric lupus, myocardial involvement of lupus, and TMA. During the course, her condition was generally improved after glucocorticoid pulse therapy and plasma exchange.Conclusion:Various complicated clinical manifestations related to SLE need to be recognized earlier and intervened as soon as possible.

Inhibitory Effect of Hederasaponin B on Gastric Cancer HGC-27 Cells and Its Mechanism Based on Bioinformatics / 中国实验方剂学杂志

ObjectiveTo investigate the inhibitory effect of hederasaponin B on gastric cancer HGC-27 cell and the mechanism. MethodMethyl thiazolyl tetrazolium （MTT） assay， hematoxylin-eosin （HE） staining， 4'，6-diamidino-2-phenylindote （DAPI） staining， colony formation assay， scratch assay， and flow cytometry were employed for the analysis of apoptosis and cell cycle. Thereby， the inhibitory effect of hederasaponin B on gastric cancer HGC-27 cell was investigated. Then the Pharm Mapper， UniProt， Swissdock， STRING， and Metascape were used for target screening， gene annotation， molecular docking， protein-protein interaction （PPI） network construction， Gene Ontology （GO） term and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway analysis to explore the mechanism. ResultHederasaponin B （15， 30， 60， 120 μmol·L-1） can significantly reduce the survival rate of HGC-27 cell （P<0.01） in a time-dependent and dose-dependent manner compared with the blank group. It had no significant toxicity to normal GES-1 cell at concentration below 120 μmol·L-1. Compared with the blank group， hederasaponin B （30， 60， 120 μmol·L-1） induced cytoplasmic vacuolization， and nuclear deformation and karyopyknosis， inhibited the migration of HGC-27 cell （P<0.01）， and brought about the apoptosis （P<0.05， P<0.01） and cell cycle arrest of HGC-27 cell （P<0.05， P<0.01）. Hederasaponin B （10， 20， 30 μmol·L-1） also suppressed the independent survival ability and proliferation ability of HGC-27 cell （P<0.01）. The possible action targets were kinesin-like protein KIF11， cGMP-specific 3，5 cyclic phosphodiesterase， caspase-3， serine/threonine protein kinase Chk1， proto-oncogene tyrosine protein kinase， epidermal growth factor receptor， and mitogen-activated protein kinase （MAPK） 8. The mechanism may be related to MAPK signaling pathway （pathways in cancer）， adhesion connection， focal adhesion and proteoglycans in cancer （epithelial cell signaling pathways in Helicobacter pylori infection）. ConclusionHederasaponin B exerts significant inhibitory effect on gastric cancer HGC-27 cell through multiple targets and multiple pathways.

Frequency of metabolic syndrome and correlation with metabolic syndrome in patients with psoriatic arthritis / 中华风湿病学杂志

Objective:To investigate the frequency of metabolic syndrome (MS) in patients with psoriatic arthritis (PsA) and further analyze the correlation of MS and its components with clinical features of PsA.Methods:Data including demographics, clinical manifestations, laboratory tests, MS-associated features (height, weight, waist circumference, blood pressure, serum lipid spectrum, and so on) and history of complications (hypertension, diabetes mellitus, atherosclerosis, coronary heart disease, and cerebral vascular disease) were collected from PsA patients in our hospital from Jan 2017 to Sep 2019. The frequency of MS in PsA patients was calculated and the association between PsA clinical manifestations and MS as well as its components was investigated.Results:One hundred and sixty-two PsA patients who fulfilled the Classification Criteria for Psoriatic Arthritis (CASPAR) were recruited. Hypertension was identified in 36 (22.2%) patients, diabetes mellitus in 28(17.2%) patients, coronary heart disease in 11(6.7%) patients, and cerebral vascular disease in 7 (4.3%) patients. Based on the criteria of the International Diabetes Federation (IDF), 58(35.8%) patients were diagnosed as MS. Compared with MS-free patients, patients with MS, hypertension or diabetes mellitus were older [(54±10 vs 44±13; 56±11 vs 45±12; 54±11 vs 44±13, respectively, t=5.058 , 4.450, 5.150, P<0.01 for all], with higher disease activity [DAPSA scores 16.75(11.25, 26.7) vs 8.8(4.8, 16.4), 16.3(9.6, 27.8) vs 10.0 (5.1, 18.0), 14.4 (9, 25.7) vs 9.5 (5, 17.7), Z=4.539 , 3.046, 3.063, P<0.01]. There was a positive correlation between the sum of components of MS and DAPSA score ( r=0.27 , P<0.01), but multiple linear regression showed no correlation between each component with DAPSA score ( P>0.05) except for hypertension ( P<0.01, standard coefficient=0.334) and elevated fasting blood glucose ( P=0.023, standard coefficient=0.247). PsA patients with hypertension had higher ESR [16.5 (9.5, 34.25) mm/1 h vs 10 (5, 24.5) mm/1 h, Z=2.127, P=0.012]. CRP level was higher in patients with dyslipidemia [5.6(2.1, 17.8) mg/L vs 3.7(1.5, 6.5) mg/L, Z=2.543, P<0.01]. Prevalence of inflammatory back pain was also higher in dyslipidemia patients (41.3% vs 22.4%, χ2=5.901, P=0.016). DAPSA score was higher in dyslipidemia patients (14.1 vs9.9, P=0.031). Conclusion:MS and its components are not rare comorbidities in PsA patients. PsA patients with MS tend to be older with higher disease activity, which calls for more attention.

Treatment values of precise target delineation of chest MRI for lung cancer / 实用医学杂志

Objective To investigate the treatment values of precise target delineation of chest MRI for lung cancer Methods From August 2011 to February 2015 , 45 non-small cell lung cancer patients were given chest CT scans and MRI scans before radiotherapy , and then active target tumor delineation , then related influencing factors were analyzed. Results All patients completed CT scans and MRI positioning. For patients that it was difficult to identify lung tissue lesions caused by lung cancer through CT , their MRI imaging showed high signal and the boundaries between the tumor and surrounding normal tissue became relatively clear. Meanwhile , 20 patients of borders were diagnosed by CT , while 25 by MRI; 36 patients with lymph node metastasis were diagnosed by CT while 40 by MRI. The difference was statistically significant (P<0.05). Univariate logistic regression analysis showed that pathological type and atelectasis were the influence factors for CT and MRI tumor target delineation differences (P<0.05), and multivariate logistic regression analysis showed the atelectasis was the main factor (P<0.05). Conclusion Compared with CT, breast MRI can precisely delineate target to improve the accuracy of target localization before radiotherapy. It can help determine lymph node metastasis and avoid the impact of atelectasis then ensure the accuracy of radiotherapy.